    [Senate Hearing 119-155]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 119-155

                     BREAKING BARRIERS: IMPROVING VETERANS'
                           MENTAL HEALTH IN LOUISIANA

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

                                 FIELD HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                AUGUST 14, 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
    61-532 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

                                  ----------

                                August 14, 2025

                                                                       Page

                                    SENATOR

    The Honorable Bill Cassidy, U.S. Senator from Louisiana..........     1

                                   WITNESSES
                                    Panel I

    Fernando O. Rivera, Director, Southeast Louisiana Healthcare
      System and Network Director, VISN 16 (Interim), Veterans Health
      Administration, U.S. Department of Veterans Affairs accompanied
      by Catina McClain, MD, Chief Mental Health Officer, VISN 16,
      Veterans Health Administration; and Laurel Harlin, PhD, Chief,
      Psychology Service, Southeast Louisiana Veterans Health Care
      System, Veterans Health Administration.........................     3

    The Honorable Charlton Meginley, Secretary, Louisiana Department
      of Veterans Affairs............................................     4

                                    Panel II

    Dr. Cheryl Magee-Baker, Director, Hope Center, Inc...............    15

    Emily Meyers, LPC, Chief Executive Officer, Longbranch Recovery
      and Wellness...................................................    16

    Jackson Smith, JD, Executive Director, Bastion Community of
      Resilience.....................................................    18

    Kirk Long, Former Chief Executive Officer, Crescent City Surgical
      Centre.........................................................    20

    Paul Hermann, Executive Director, Disabled American Veterans,
      Department of Louisiana........................................    21

                                    APPENDIX
                              Prepared Statements

    Fernando O. Rivera, Director, Southeast Louisiana Healthcare
      System and Network Director, VISN 16 (Interim), Veterans Health
      Administration.................................................    37

    The Honorable Charlton Meginley, Secretary, Louisiana Department
      of Veterans Affairs............................................    45

    Dr. Cheryl Magee-Baker, Director, Hope Center, Inc...............    61

    Emily Meyers, LPC, Chief Executive Officer, Longbranch Recovery
      and Wellness...................................................    63

    Jackson Smith, JD, Executive Director, Bastion Community of
      Resilience.....................................................    66

    Kirk Long, Former Chief Executive Officer, Crescent City Surgical
      Centre.........................................................    68

    Paul Hermann, Executive Director, Disabled American Veterans,
      Department of Louisiana........................................    69

                     BREAKING BARRIERS: IMPROVING VETERANS'
                           MENTAL HEALTH IN LOUISIANA

                                   ----------

                           THURSDAY, AUGUST 14, 2025

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        This field hearing was held, pursuant to notice, on August
    14, 2025, at 9:11 a.m., in Lac Ponchartrain Room, 2nd Floor,
    Student Life Center, Delgado Community College-City Park
    Campus, New Orleans, LA, Hon. Bill Cassidy, presiding.

        Present: Senator Bill Cassidy

                OPENING STATEMENT OF HON. BILL CASSIDY,
                      U.S. SENATOR FROM LOUISIANA

        Senator Cassidy. Good morning, everybody. Thank you for
    being here. First, I have to apologize. I am dressed casually
    because I'm going on an alligator hunt----
        [Laughter.]
        Senator Cassidy [continuing]. With President Trump's
    Secretary of Labor. Now, wearing a tie on an alligator hunt is,
    shall we say, not the way to do it. So, I apologize for being
    so casual because I have multiple responsibilities today.
        But none of them is as important as this. This is actually
    a Senate Veterans' Affairs Committee hearing. This is something
    which will go into our record, and it is a chance for our
    veterans to communicate with me and with folks in the Veterans
    Administration upon issues important to us all. We're focusing
    today on mental health which we know is an issue.
        President Lincoln, in his second notable address spoke of--
    well, I won't get it quite right, but we shall, we shall bind
    up the wounds of those who have served our country on the
    battlefield. But it's also the motto for the VA. Now, some of
    those words are unseen. And some of those wounds, nonetheless,
    even though unseen, affects somebody for their whole life. That
    is what we're addressing here today. And by the way, before I
    go further, I want to thank Delgado. Madam Chancellor, thank
    you very much.
        [Applause.]
        Senator Cassidy. There's different issues. Our State is a
    rural State. We're in New Orleans. If you're in New Orleans, if
    you're Jefferson Parish, you can come to this area and you can
    get your care. But what if you're in Allen Parish? What if
    you're in Jackson Parish? What if you are in Lafourche Parish?
    How are we going to get those services there as well? That's
    number one.
        Number two, we know that according to the Department of
    Defense, half of the overdose deaths in the military are
    related to fentanyl. So, that is a problem which afflicts all
    our society, not just veterans, and not just those in the
    Department of Defense. It afflicts us all. And so how do we
    address that?
        Now, I will say, and I'm very proud of this, President
    Trump just signed into law my bill, the HALT Fentanyl Act,
    which gives law enforcement one more tool by which to go after
    fentanyl. But that is something which continues to afflict our
    communities, and we're going to hear from the VA how they may
    specifically be addressing that.
        I would also like to point out that sometimes you need
    somebody from the outside looking in to help stimulate or get
    suggestions as to the reforms that are required. One piece of
    legislation that I have promoted is called the VetPAC. The
    VetPAC would be an independent board of the VA, which looks at
    the VA operations and make suggestions to Congress and to the
    VA how they can improve service.
        I say this because this hearing should be part of an
    overall bigger effort to address these concerns. And this is
    modeled after something which is done for Medicare, it's called
    MedPAC, and for Medicaid called MACPAC, in which independent
    agencies are making suggestions to improve Medicare and
    Medicaid.
        So, I'm hopeful that this hearing, that effort is part of,
    in partnership with the VA, improving the services that are
    delivered to those who have served our country. So, well,
    that's the goal.
        Now, today, we get to hear from folks who can answer
    questions. And our first panel, Fernando Rivera, who is the
    director of the Southeast Louisiana Healthcare System. And now,
    you have VISN 16?
        Mr. Rivera. Yes, sir. In an interim role.
        Senator Cassidy. Interim. Scott McDougall has left. And so,
    he's actually over the whole VISN, which includes not just New
    Orleans, but also Shreveport, and other areas as well.
        Mr. Rivera. Yes, sir.
        Senator Cassidy. Second will be--he's accompanied by Catina
    McClain. We've decided that we're related through an ancestor
    who died in a drunken brawl----
        [Laughter.]
        Senator Cassidy [continuing]. But that's another story--who
    is the chief mental health officer in VISN 16. And Laurel
    Harlin, who is the chief of psychology services at the
    Southeast Louisiana Veterans Healthcare System.
        And also, very much appreciate Hon. Charlton Meginley, who
    is the secretary of the Louisiana Department of Veterans Care.
    And we'll hear from each of them, and then we'll open it up.

                                PANEL I

                               ----------

    STATEMENT OF FERNANDO O. RIVERA, DIRECTOR, SOUTHEAST LOUISIANA
      HEALTHCARE SYSTEM AND NETWORK DIRECTOR, VISN 16 (INTERIM),
      VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
    AFFAIRS ACCOMPANIED BY CATINA MCCLAIN, MD, CHIEF MENTAL HEALTH
     OFFICER, VISN 16, VETERANS HEALTH ADMINISTRATION; AND LAUREL
      HARLIN, PHD, CHIEF, PSYCHOLOGY SERVICE, SOUTHEAST LOUISIANA
      VETERANS HEALTH CARE SYSTEM, VETERANS HEALTH ADMINISTRATION

        Mr. Rivera. Good morning, Senator Cassidy, and
    distinguished guests. Thank you for the opportunity to discuss
    the Department of Veterans Affairs efforts to support mental
    health and well-being of veterans in Louisiana, particularly in
    rural and underserved communities.
        My name is Fernando Rivera, I serve as the interim network
    director for Veterans Integrated Service Network 16, VISN 16.
    Joining me today are Dr. Catina McClain, mental health lead for
    VISN 16, and Dr. Laurel Harlin, chief psychologist of the
    Southeast Louisiana Veterans Healthcare System.
        Veterans in rural areas face unique challenges; long
    distances to care, limited provider availability, and social
    isolation. Across VISN 16, which spans large rural populations,
    we are committed to bridging these gaps, but we know that
    Louisiana Veterans face compounded challenges beyond PTSD,
    traumatic brain injury, and chronic illness.
        Severe weather events such as hurricanes, often displaced
    veterans from their homes, jobs and support systems, and rural
    parishes, access to mental health care is limited and suicide
    risk remains high. Despite these challenges, we're proud of the
    strong integrated care we deliver statewide. VA facilities in
    Shreveport, Pineville, and New Orleans have served Louisiana
    for over 95 years.
        Across our service area, nearly 5,800 VA employees provide
    care to over 151,000 veterans annually. Access remains a key
    concern, particularly for mental health, residential
    rehabilitation and treatment programs, or mental health RRTPs.
    These programs provide essential support to veterans with
    serious mental health and substance use conditions.
        Currently, there are only seven VA mental health RRTP beds
    in Louisiana, limiting timely access to this level of care.
    Within VISN 16, we've begun implementing centralized screening
    for our RRTPs. As a result, we've seen a nearly 6 percent
    increase in veterans admitted within 72 hours of a referral.
    And this year, and the President's fiscal year 2026 budget
    proposes a $1.5 billion investment to expand our RRTP capacity
    nationwide.
        We're also expanding virtual mental health services, such
    as VA Video Connect. Since the start of this fiscal year,
    Louisiana VA facilities have delivered nearly 10,000 virtual
    mental health visits. Many rural areas still lack broadband
    infrastructure, so we're committed to technology collaborations
    that enhance access to care regardless of the ZIP Code.
        To address transportation challenges, VA's Veterans
    Transportation Service helps ensure veterans can reach the care
    they need. In VISN 16, we're expanding access to community-
    based outpatient clinics, and growing our network of more than
    1,800 mental health providers and VA's Community Care Network.
        The Veterans Community Care Program, or VCCP, enables
    eligible veterans to receive care for more than 1.4 million
    non-VA providers nationwide. This program is especially vital
    for those in rural Louisiana, providing high quality, timely
    care closer to home. We are proud of our community
    collaborations from local mental health providers and
    nonprofits, to educational institutions, and faith-based
    organizations.
        These collaborations expand our reach and build capacity.
    Initiatives such as the veteran community partnerships
    involving churches, shelters, and nonprofits help us to upgrade
    at risk veterans before crisis occurs, our collaboration with
    the Louisiana Department of Health, Louisiana Department of
    Veterans Affairs, and local providers, helps close the service
    gaps and align suicide prevention strategies essential to
    executing Secretary Collins's vision for a unified veteran care
    across the Federal, the State, and community levels.
        Senator Cassidy, thank you for the opportunity to speak
    today. Sir, we remain steadfast in our commitment to reaching
    and serving every veteran in Louisiana. And with your support,
    sir, we will continue delivering the care our veterans have
    earned.

        [The prepared statement of Mr. Rivera appears on page 37 of
    the Appendix.]

        Senator Cassidy. Thank you. Secretary Meginley.

       STATEMENT OF HON. CHARLTON MEGINLEY, SECRETARY, LOUISIANA
                     DEPARTMENT OF VETERANS AFFAIRS

        Mr. Meginley. Senator Cassidy, I want to thank you,
    Chairman Moran, the Ranking Member, for holding this hearing
    today. On behalf of Governor Landry and Louisiana Department of
    Veterans Affairs, I'm very proud to affirm our state's
    unwavering commitment to serving our Louisiana veterans. I
    think as most people know, we are very passionate about doing
    this and veterans first. This is our job.
        During my 19 months in this position, I'll tell you there's
    two numbers that have weigh very heavily on my mind. The number
    17.5 and 150,000. 17.5 represents the estimated number of
    veterans who die by suicide each day, and the 150,000, is the
    estimated number of veterans who have died by suicide since
    2001. And that's an estimate. I think the number actually just
    sit a bit higher.
        Senator Cassidy, given the billions of taxpayer dollars
    that have been spent on veteran mental healthcare for the last
    few years, these numbers are not just unacceptable, they're
    unfathomable. The mental health of our veterans should not be
    simply a top priority, it must be the priority.
        Nationwide, about 25 percent of veterans struggle with
    mental health issues, but Louisiana, that figure may be as high
    as 50 percent. The demands for services is increasing with 40
    percent of all VA appointments now addressing mental health. We
    must act now to close any gaps in care and ensure that our
    veterans receive the support they have earned.
        As you'll see from our written testimony, the LDVA operates
    within two key environments, which we may encounter veterans
    with mental health issues, those veterans who are in our homes,
    and of course the veterans within the community. Our veteran
    homes face a critical and pervasive challenge with mental
    health disorders affecting a staggering 78 percent of our
    residents.
        With 493 out of 632 individuals diagnosed with at least one
    condition, more than half of these residents grapple with
    multiple mental health disorders and diagnosis, compounding the
    complexity of their care. Furthermore, 435 residents, about 69
    percent, rely on antipsychotic or psychotropic medications to
    manage their conditions.
        Unfortunately, on too many occasions, we've had to deny
    admission to veterans with certain mental or behavioral health
    issues because we simply don't have the means to adequately
    take care of them or manage their needs. Over the last 2 years,
    72 percent of our admission denials were due to mental and
    behavioral health issues.
        These findings highlight wider challenges in the VA system.
    Some of the frequent comments that we receive from veterans
    around the State regarding VA services include; insufficient
    training in hospitals and clinics, community care coordination
    failures, long wait times, especially for psychiatric
    appointments. And most concerning that we hear that's often is
    the over-reliance on mental health-related medications without
    sufficient follow-up.
        Senator Cassidy, with this said, I firmly believe that if
    you want to address the mental health needs of our veterans,
    you have to address the root causes. Why are so many veterans
    distressed? Underlying factors include exposure to combat
    trauma, PTSD and TBI, the stress of separation from family and
    support systems, difficulties transitioning to civilian life
    such as adjusting to new roles and isolation, legal issues, and
    co-occurring issues like substance use disorders, anxiety, and
    depression, exasperated by military demands. And of course, the
    experiences that some may have had with sexual assault or
    training accidents.
        These causes are compounded in Louisiana by geographic
    isolation, rural poverty, and limited access to services. With
    respect to our 263,000-veteran community as a whole, we know
    that our Federal VA partners can't prevent suicide and address
    the mental health issues that veterans face by themselves.
        Fortunately, they don't have to. There are an estimated
    45,000 non-profit organizations nationwide that have stepped up
    to help veterans. In our written testimony, we've written we've
    highlighted just a few of these organizations that have made
    life and death differences in the lives of veterans.
        There is one partner that I want to specifically
    acknowledge, and that is the University of Louisiana at
    Lafayette. An R1 institution, ULL is in the process of
    preparing a report that will undoubtedly shed some light on the
    extent of Louisiana's mental health crisis within its veteran
    community.
        Preliminary findings from the survey are deeply concerning.
    While the national average for PTSD amongst veterans is 11 to
    20 percent, our survey preliminarily is showing that that rate
    could be around 45 percent for Louisiana's veterans. Similarly,
    depression and anxiety rates are more than doubled than the
    national average according to, again, the preliminary results
    of the survey.
        Factors include; geographic isolation, with 42 percent
    living more than an hour away from a VA clinic, transportation
    gaps, rural poverty, food insecurity, nation and neighborhood
    safety concerns. Many are Vietnam-era veterans with complex
    medical and mental health needs. Others are younger veterans
    dealing with combat trauma, TBI, and challenges transitioning
    to civilian life.
        We plan to work with our ULL partners to conduct post-
    survey-focused discussion groups across the State to better
    understand the findings. I have probably a little bit more to
    go, but if you need me to stop, I will.

        [The prepared statement of Mr. Meginley appears on page 45
    of the Appendix.]

        Senator Cassidy. I see the time expired over there. And so,
    we'll allow you to develop some of that and go through the
    discussion.
        Mr. Meginley. Fair enough, sir.
        Senator Cassidy. Okay. Thank you. Thank y'all for that.
    Fernando, if I'm asking some of the folks out there, they're
    going to say you got a lot of turnover in your healthcare
    staff, and particularly in mental health. When I see the stats,
    I'll see in Washington, they'll tell us, oh, we've hired this
    many people, which it's a lot of people, but that tells me as
    well that you're filling a lot of positions and there's a
    little bit of a flow through.
        So, I think one of the concerns would be why so much
    turnover and what can be done to limit the turnover as a
    physician. I know the therapeutic relationship is something
    which has to be developed, and if it's changing on a regular
    basis, that's difficult. What can you inform people?
        Mr. Rivera. Well, thank you for that question, Senator
    Cassidy, as usual, extremely insightful, and open for quite a
    bit of discussion. We've always balanced, in the VA, the
    opportunity of serving and providing healthcare services to
    veterans. And then also, preparing and educating the future
    providers of those healthcare services.
        At the VA here in New Orleans, we have a huge education
    mission. We're privileged to be one of only 15 VA hospitals
    across the country that's co-located with more than one medical
    school, and as a result, we're able to draw specialty care
    providers. We're able to associate Louisiana future providers
    who are enrolled in this freshman class at your alma mater, and
    encourage them to stay to learn about veterans.
        70 percent of the doctors that graduate from a United
    States medical school rotate through a VA hospital for some of
    their training. This year, over 2,300 trainees in associated
    health programs and programs related to nursing, dental care,
    pharmaceutical care, and the like, psychologists of course. And
    in that sense, we we're finding that roughly about 50 percent
    of the staff of the students tend to stay in the State. They
    tend to go back to the communities that they serve.
        Senator Cassidy. I get that. But I think that the issue is
    that people feel like the doctor that they're seeing, the
    psychologists whom they are seeing, the nurse, et cetera, is
    different on a--there's a turnover there. And I accept that
    some of them may be resident physicians, and that's true. But
    there also seems to be a turnover in terms of the psychiatrist,
    for example.
        Is there a root cause of that, and is there something that
    can be done to change that? Because as we spoke, you have a
    therapeutic relationship, and all of a sudden, somebody is
    gone.
        Mr. Rivera. Yes, sir. There's a shortage. We can't get
    around the fact that the predictions are roughly 100,000
    physicians nationwide, 200,000 registered nurses nationwide in
    our State. We don't have an overabundance of mental health
    providers.
        Senator Cassidy. Now, let me ask you, because one thing
    that's been done for optometrists, for example, is that if
    there is a sudden opening, an optometrist scheduled, there is a
    program that will take somebody who needs an eye examination
    and they will do it by internet. And they may be talking to
    someone in Wisconsin, even though they live in Jackson Parish.
    And it fills in that gap.
        So, knowing that some cities have an overabundance of
    psychiatric support and others not so much, and the rural
    areas, not at all. Is the VA, or is our VA, embarking on any
    sort of virtual scheduling and other visits that will allow
    their sudden opening to be filled with somebody who needs acute
    care here?
        Mr. Rivera. Absolutely. And our telehealth program
    continues to grow in the mental health division. It has grown
    more than probably in other areas. We experience using
    telehealth to stay connected and maintain continuity of care.
        Almost every year with hurricane seasons, our mental health
    providers will work from home. We will work with other mental
    health providers at other sites. I'm going to ask Dr. McClain
    to talk a little bit about our clinical contact centers because
    that is one of the real opportunities that we have not only to
    support VA hospitals that may be serving rural communities, but
    to support them through periods where they may have had staff
    turnover where we may have only had one or two psychiatrists
    and one has taken ill, another one has relocated because their
    spouse now works somewhere else. So, Dr. McClain.
        Dr. McClain. Thank you, Mr. Rivera. And thank you, Senator,
    for the question. We are very fortunate in VISN 16 that we do
    have a clinical contact center where veterans can call and make
    same day linkages with mental health providers. May not be
    their provider, though.
        And so, we also have a clinical resource hub. If a provider
    is ill, a provider retires, leaves VA for whatever reason,
    we're able to assign one of our virtual psychiatrists to pick
    up the care of that veteran and fill that gap until another
    permanent psychiatrist can be hired by the local facility.
        Other steps that we've taken to try to reduce turnover
    include the establishment of a virtual on-call telepsychiatry
    program within the VISN. We were hearing anecdotes from some of
    our departing psychiatrists that they were taking positions in
    where the on-call burden was less than in VA. And so, while
    we've not eliminated on-call responsibilities, we have been
    able to alleviate some of the burden of that for our psychiatry
    staff.
        Also, VA has taken steps to adjust the physician pay
    scales. For example, VA has done special salary surveys for our
    psychologists. So, lots of things underway to try to reduce
    that turnover.
        Senator Cassidy. So, there could be a systems issue, but
    y'all attempting to address it?
        Mr. Rivera. Yes, sir. And there is an opportunity to
    incentivize future providers to stay in Louisiana and return to
    the communities where they serve.
        Senator Cassidy. And you also mentioned, and I would be
    interested, I'm not sure everybody kind of caught this, but I
    think I got it. The mental health residential and
    rehabilitation treatment program, did you say there's 7 or 17
    beds?
        Mr. Rivera. Seven.
        Senator Cassidy. Seven. And describe for people like what
    that actually means, because when Charlton is saying he's got a
    limited ability to take care of people with severe psychosis,
    and I'm presuming that veteran might get a referral to you and
    this sounds like a wraparound service. Describe what these beds
    are please.
        Dr. McClain. So, residential rehabilitation beds are
    established where we can give evidence-based therapies in a
    more concentrated manner that can be achieved on an outpatient
    basis. The RRTP beds are in layman's terms, I suppose, sort of
    the in between outpatient, full outpatient care and acute
    inpatient care.
        Services include: substance use treatment, general homeless
    domiciliary programs, PTSD, residential care. Veterans in these
    programs receive intensive services, evidence-based therapies,
    state-of-the-art psychopharmacology, if indicated. And then, it
    helps them to transition to that more stable condition where
    they're able to manage successfully on an outpatient basis.
        Senator Cassidy. So, wraparound services that restore
    somebody to wholeness, but it's a more intense environment than
    just the outpatient. So, there's only seven beds. What is the
    waiting list for entry into these drugs?
        Dr. McClain. The number of veterans, I don't have the exact
    number of veterans. One of the things that we have done across
    the VISN is to try to leverage our RRTP resources to serve
    Louisiana veterans. Given the low number of RRTP beds
    available, we have established single screening so that if a
    veteran is screened in Louisiana, that is good enough for
    Mississippi or Arkansas, for example, to accept that veteran
    into a residential program there.
        We're also leveraging our community partners. We've
    outsourced a number of veterans this year, about 313 referrals,
    to our community partners for residential care. Our wait time
    has improved. We are shifting that curve to the left so that
    more of our veterans are getting into our RRTP care within 72
    hours of the referral, about a 6 percent improvement over
    fiscal year 2024 for that group. Another 6 percent improvement
    in the number getting in within four to seven days. So, we've
    had about a 12 percent increase in the number of veterans
    accessing that level of care within a week of referral.
        Senator Cassidy. That's great. So, I'm very happy about
    that. By the way, I'm not blaming you if there's a shortage.
    It's up to Congress to kind of, I'm learning from you, redirect
    resources to expand those number of beds.
        Dr. McClain. Yes.
        Senator Cassidy. So, Charlton, your testimony didn't go
    there, but we know that mental health is oftentimes tied to
    transition to the community, is tied to getting a good job that
    makes you feel good about yourself. I once heard a testimonial
    from a Marine who had been in Fallujah. He came back, and he
    tried to commit suicide. And he said over there I was part of a
    unit, and I was a Marine. And here, I was, you know, whatever
    it was, wasn't fulfilling to him.
        And so, there was that transition of all the things that
    are implied in that. What can your agency do, and how do you
    manage that? And how do you work with the VA Federal?
        Mr. Meginley. Well, that's a great question, Senator
    Cassidy. I've only been retired from the military for a little
    over two and a half years, so I think a lot of folks even still
    consider me to be a transitioning vet. And so, the first thing
    that comes to my mind when I was thinking about when I hit the
    retirement button was, ``What am I going to do with myself?''
    You know, ``Where am I going to work?''
        Well, in Louisiana, we have two incredible partners that
    actually get to the core root of what you're talking about
    right now. One of them is a program called The Boot, and one of
    them is Next Op. And their entire mission, both of them, is to
    put the transitioning service member to work. So, they have
    forged relationships with various companies and entities.
        They've gone in the house, said, ``We've got a ready-made
    employee ready for you. They're trained, they're disciplined,
    and they may not have the skills that you're looking for, but
    we know that you can train them because they've already been
    trained.'' And they help kind of ease that transition to get to
    that point where that individual is put to work, getting a good
    paying job, and can kind of start moving away from their
    military time back to transition into the civilian world.
        And so, both The Boot and the NextOp, again, they've been
    incredible partners, and this is their sole mission. This has
    been a focus of ours since we came in; is what do we do for
    that young 22-year-old soldier who wants to say, ``I really
    like it here in Louisiana, but there's no jobs.'' We're telling
    them, ``No, there actually are plenty of jobs here. We're going
    to help you find one.''
        Senator Cassidy. And implicit in that, is that if you can
    get them plugged into a job, they're more likely to find
    community and they're more likely to be mentally whole----
        Mr. Meginley. That's correct.
        Senator Cassidy [continuing]. Because you don't have the
    vacuum left from that camaraderie, from being in the service.
        Mr. Meginley. That's right. And those of us who were in for
    extended periods of time will tell you, when you're in the
    military, there is a certain process. There is a certain code
    of discipline, essentially. There is a certain way of acting.
    And when you get into civilian world, it's not like that.
        Oftentimes, the discipline and the structure that you had
    oftentimes does not exist. And so, you expect more of your
    civilian counterparts. Oftentimes, that doesn't come. And so,
    these programs help kind of ease our service members back into
    what real life is.
        Senator Cassidy. Now, there's lots of folks here from
    veterans service organizations, and thank y'all for being here.
    Now, as it turns out, we know a lot of veterans will never
    knock on your door, on his door, on my door, but they will show
    up and play pool with somebody in a VSO.
        Can you tell us how you can work with those organizations?
    So, if someone sees a buddy who's having a problem, he can say,
    or she can say, listen, ``We know where to direct you.'' How do
    you disseminate your information to them? You see where I'm
    going with that?
        Mr. Meginley. So, I'll tell you the State gave us a car,
    and we've put over 30,000 miles on it in the last 11 months.
    All we do is travel. We go into the VFWs, we go into the
    Legions, we go into DAV, and we're talking to the veterans who
    feel like no one's listening to them. You can't live behind a
    desk in Baton Rouge. And I think myself and my deputy, you
    know, at least once or twice a week, we're out there talking to
    the veterans and trying to understand what their issues are.
        But I'll tell you something else. There's a really
    important component to this, and that is the gentleman sitting
    down here at the end, and then Mr. Crockett's in here, Mr.
    Dante's in here, the VAMC directors, anytime I call them with a
    veteran issue, they respond. And sometimes it's just a matter
    of making the phone call to them because the veteran doesn't
    know how to get to them.
        You know, one of the complaints that I get about the VA is
    phones. If someone would just answer the phone, most of the
    time the issue gets resolved. Okay? I will leave that up to the
    VA to determine and how to figure that out. But once that
    veteran calls me, and I get them to the right person, most of
    the time the issue is taken care of.
        So, the VSOs, it's important for everyone to know this. I
    can't do my job without the VSOs. I don't have a State budget
    for mental health. But for me to get the VSOs to trust me and
    to trust our team, we have to go to them. And that's what we've
    been doing. And it's not just the Legion, it's not just the
    DAV, it's also the other partners, the 501(c)(3) partners that
    we have, the folks who are dealing with homelessness, the other
    ones who are dealing with mental health care. And it's forging
    those bonds, those partnerships, that allow them to kind of
    pick up where the VA may not understand or be able to capture
    those issues.
        I'll give you one example. There's an organization called
    Objective Zero. They have an app that deals strictly with
    mental health for veterans, and the veteran has a live person
    to talk to. They may not want to go to the VA, but they have a
    resource right then and there that they need to talk to someone
    and chat with someone. It's there.
        Supporting those types of partnerships and those types of
    entities who are getting in the mix, really at the grassroots
    level, is really important for the VA and Congress to start to
    understand and to fund, in my opinion.
        Senator Cassidy. So, the audience is here. They are
    motivated. They are here because they care about veterans'
    issues. So, ask first, you, then Fernando, or your staff. If
    somebody is needing services from the VA because of
    homelessness, or because of job transition, or because of
    mental health issues, fill in the blank. And one of the folks
    in this room can finally tell me how that would work. Just lay
    it out for--give a do this, do this, do this, for if the person
    lives in an urban area, like say Jefferson Parish or a suburban
    area like St. Tammany, or if they live in a rural area. So,
    chop, chop, chop, tell them what they should do.
        Mr. Meginley. From the DVA point of view, we have 74
    counselors spread out throughout the entire State. So, if
    there's a veteran who's having an issue, they've got a parish
    counselor right then and there. Oftentimes that phone call is
    made----
        Senator Cassidy. How do they reach that? Is it on the
    internet? How do they know where to find that person?
        Mr. Meginley. So, our website is brand new. We just
    completely renovated it. It's updated. All you got to go to the
    website. Phone numbers are there for every VAC office.
        Senator Cassidy. Give them the website.
        Mr. Meginley. vetaffairs.la.gov
        Senator Cassidy. Veterans?
        Mr. Meginley. vetaffairs.la.gov
        Senator Cassidy. La.Gov?
        Mr. Meginley. Yes, sir. And so, you go to the website, it
    has the phone number and it has the contact information for
    that local veteran affairs office. And so if that individual,
    that veteran calls one of our guys and lets us know, we can get
    them to the proper local authorities if we need to or get them
    to the big VA if that's necessary.
        Senator Cassidy. I'm in Cameron Parish. I can go to
    vetaffairs.la.gov, I'll find the local person in Cameron Parish
    who I can call. Maybe they come visit, and they can intervene,
    and they can be a navigator for this person to reach your
    services through you or through Federal VA?
        Mr. Meginley. That's correct. And then at the campuses, we
    have 32 college campus navigators. So, if there's a college
    student who's having some sort of distress, a veteran college
    student, we have campus directors, campus navigators who are
    there to help our college students as well.
        Senator Cassidy. So, Fernando, how would you build upon
    that?
        Mr. Rivera. The average piece, sir is very much about
    seeing the fabric, the veteran family, across the Louisiana
    Department of Veterans Affairs, the Federal Veterans Affairs,
    the veteran service organizations, spiritual leaders in our
    communities. So, our outreach programs are designed to connect
    at all of those levels, to not only be partners in outreach
    activities, but to have our own outreach activities.
        Our facilities and clinics so far this year have conducted
    nearly 3,000 outreach visits. Whether those outreach visits are
    being conducted on a daily basis by a team of homeless veteran
    outreach providers, social workers primarily who are going out
    every day to shelters, verifying whether there are any veterans
    there, making sure those veterans are connected to a program.
        Senator Cassidy. So the VA sends people to shelters on a
    daily basis looking for veterans who are homeless?
        Mr. Rivera. That's correct, and we are in that level of
    communication. We work closely with the student veteran
    associations at the universities as well. We stay connected.
        My personal practice for 20 years now is to give every
    veteran that I have the privilege to serve my cell phone
    number, my email address. And often, I get phone calls. Every
    one of these individuals who know me have my cell phone number.
    They know how to find me. We view this concept of expanding our
    outreach program and developing it even further as critical.
        When we're talking specifically about high-risk mental
    health patients being able to make that connection, whether
    it's because we have inclement weather coming and we need to
    know where our patients who are at risk for suicide are, and
    how we can stay connected with them so that there is continuity
    of care, whether we're talking about a veteran who is homeless,
    who is also having mental health illness. How do we connect
    them to those services?
        This piece is very much a community piece. We all have skin
    in this game. We all have to know and be better at recognizing
    veterans in distress, understanding how to help that veteran,
    whether that veteran is sitting next to you in church, or he's
    in front of you at the Walmart, or he is next to you in a
    clinic.
        Senator Cassidy. Okay. So, hang on. I was not aware of
    this. Do y'all actively go out to pastors, priests, to rabbis,
    to Imans, you name it, and say, listen, here's our phone
    number, sir.
        Mr. Rivera. Yes, sir. We hold mental health stand downs. We
    invite spiritual leaders and other key stakeholders.
        Senator Cassidy. Now, what is the participation. To what
    degree does everybody who attends such an organization--I'm in
    the church. Do I need to knock on the door of my pastor and
    say, ``Pastor Kevin, are you aware of this? And if so, are you
    making a referral?'' So, how much uptake do you have from the
    faith-based community to be your liaison?
        Mr. Rivera. The short answer, sir, is not enough. When
    we're talking specifically about suicide, statistics are
    showing that 60 percent of that 17 are not enrolled in the VA.
    And they may be very well entitled to receive mental health
    care in the VA. So, reaching to that 60 percent that isn't even
    connected to the VA healthcare system is critical.
        Senator Cassidy. So, one thing everybody in this room can
    do, if they're based in any sort of civic organization, whether
    it's faith-based, Rotary, is the leadership of that node. If
    there is in our community someone who needs help, what number
    would they call? I mean, what is the specific point of entry
    into the services required?
        Mr. Rivera. The 24/7 service is the Veterans Crisis Line,
    which I, myself, called on behalf of a veteran two nights ago.
    And VA was able to provide care for that veteran. And then
    there's the medical center number. There are the community-
    based, our clinic numbers that can be reached.
        Senator Cassidy. So, the Veterans Crisis Line?
        Senator Cassidy. Yes, sir.
        Senator Cassidy. What is that phone number?
        Senator Cassidy. 988
        Senator Cassidy. 988. Okay. And that seems like something
    which like--well, let me ask you, Charlton, after speaking of
    that, people download, what's the name of that app?
        Mr. Meginley. Objective Zero.
        Senator Cassidy. Objective Zero.
        Mr. Meginley. The objective being no suicides
        Senator Cassidy. And I presume it could also link there.
    Correct?
        Mr. Meginley. They do have contact information for the
    Veterans Crisis Line.
        Senator Cassidy. By the way, going back to the job
    transition programs and the job training programs, do y'all
    also connect veterans with those programs?
        Mr. Rivera. We do, and we work with NextOp in our outreach.
    When we do outreach out of our facilities, it's usually a
    multi-professional team. We will have mental health providers
    on that team, but we'll also have human resources staff who can
    teach veterans about employment, how to seek employment, not
    just within the VA or the Federal Government, but other
    opportunities.
        Senator Cassidy. Now, again, if somebody wants to access
    those services, because a good job is good for somebody's
    mental health. And if you can look at the so-called deaths from
    despair, they're concentrated among men, principally men, but
    also women, who feel like the economy has left them behind.
        And by the way, I asked one of the previous VA secretaries
    if some of the suicide in the VA was just representative of
    this broader societal phenomenon. He said he thinks so. And so,
    it's an influence back and forth.
        So, if somebody wants those job training resources, and
    we're all listening, and people who are watching by other means
    are listening, so I'm asking to speak to them as well. I'm
    trying to transition out, I want a better job. I think their
    job training programs out there, and I don't think to call the
    State, I want to call the VA, what number would they use? How
    do they reach?
        Mr. Rivera. They would call the medical center's number,
    sir, and each medical center has its own number, and request
    assistance.
        Senator Cassidy. And so I can call and say, I would like
    information on job training. I'm a veteran. I'm eligible for
    benefits. Where do I call next?
        Mr. Rivera. They would be able to refer to either our human
    resources department that would be able to refer to our
    veterans' experience officers and all of them would be able to
    make that connection.
        Mr. Meginley. I think it's important though, for veterans
    to know the VA's website as well. The website has tremendous
    amounts of information.
        Senator Cassidy. Va.Gov?
        Mr. Meginley. Yes, sir. And when I was in my process of
    getting out, I spent almost a day just going through the VA's
    website seeing, ``Okay, what may I qualify? How am I going to
    start preparing for my exit out?'' And I learned so many things
    the VA was doing I had no clue.
        And so just sitting there and going through everything, as
    I would've expected, especially with training and education
    opportunities once I was done and how to use my GI bill, the
    best way possible for my kids.
        So, that's my biggest encouragement for any veteran. Go
    spend some time on the VA website. You will learn a tremendous
    amount about the veteran benefits. There's a benefit not too
    long ago that I learned, I didn't even know about. One of my
    counselors said, ``oh, did you know about this?'' I'm like,
    ``no.'' And it was just like, ``yes, here it is.'' I'm like,
    ``wow, that's amazing.''
        Senator Cassidy. Yes. By the way, I was once explained,
    again, in fairness to the VA and the DoD, I asked if they
    walked through the process of somebody leaving from Fort Polk
    and how would they transition out? And they said, we have a
    whole day in which we tell them everything. I'm thinking, yes,
    but you're 26 years old, you're super excited. You want to
    move. And you're sitting there thinking----
        Mr. Meginley. You might strike a nerve on this one. For
    those of us who have walked out in recent times, I had a TAP,
    it was 5 days. The one thing that I was told, if you listen to
    nothing else, Friday, 9 o'clock, VA briefing was the most
    important thing. And I was lucky enough, I did pay attention,
    it helped me out a lot.
        But TAP is shotgunned at you and you're just sitting there
    saying, ``I don't understand a lot of what you're talking
    about.'' And you're getting it within 6 months of walking out
    of the service. You're just worried about getting a job. That's
    what I want to know. How are you going to put me to work when
    I'm walking out, right? If I have medical benefits, how am I
    going to access those when I walk out?
        And so, to me, the TAP program does need to have some
    reformation done to it. Not just the shotgun approach, ``Hey,
    here's some tools, good luck,'' because that's what I think a
    lot of service members, and now veterans, will tell you that's
    what they got out of the program. Was, ``Here's some stuff.
    Thanks for serving. Good luck.''
        Senator Cassidy. So, I just got a note. I'm supposed to
    wrap up this panel and go to the next, thank y'all very much.
        Mr. Meginley. Yes, sir.
        [Applause.]
        Senator Cassidy. Okay. Thank y'all for being here. In the
    second panel, we're going to have veterans and leaders of the
    community that have been doing outstanding work regarding
    mental health on behalf of our veterans such as community care
    provider, providing state-of-the-art clinical care for
    veterans, faith-based homelessness center.
        And I'll just let them introduce themselves. And so again,
    I thank you for being here, and thank you for contributing to
    this dialogue. Ms. Magee-Baker, please introduce yourself, and
    please make your remarks.

                                PANEL II

                              ----------

             STATEMENT OF DR. CHERYL MAGEE-BAKER, DIRECTOR,
                           HOPE CENTER, INC.

        Dr. Magee-Baker. Good morning. I am Dr. Cheryl Magee-Baker,
    the director of the Hope Center, Incorporated. So, good
    morning, Senator, and Members of the Committee. And since this
    is a testimony, I cannot let it pass without being honored to
    say I'm thankful to God for the grace He has given us in my
    Lord and Savior Jesus Christ.
        I'm honored to represent Hope Center, which is a faith-
    based organization headquartered in Gretna, Louisiana, of
    Jefferson Parish. It is an outreach ministry of the Hope of
    Glory Church under the extraordinary leadership of Dr. W. Ron
    Walker, President. I'm here today to speak about the lifesaving
    work we've done under the Staff Sergeant Gordon Parker Fox
    Suicide Prevention Grant Program, and the Supportive Services
    for Veteran Families Program. This is about our unwavering
    commitment to the veterans and military families who call
    Louisiana home.
        Let me begin with a truth we all know too well. Suicide
    among veterans is a public health crisis, and for far too long,
    too many have slipped through the cracks. But I'm proud to say
    that in our corner of the country, we're doing something about
    it. The work of suicide prevention and ending homelessness is
    our opportunity to reach veterans and their families with help
    and hope.
        At Hope Center, we touch the lives of 123 veterans and
    service members through the SSG Fox Grant Program. And not one,
    not a single one, has been lost to death by suicide. This is
    the impact of timely outreach, culturally competent care, deep
    rooted community trust. And on the homelessness side, in the
    past 13 years, Hope Center has served over 5,425 veteran
    households.
        The work is not easy. We must address mental health
    concerns and move from trauma-informed care to healing center
    engagement if we want the best outcomes. Over the past year,
    Hope Center has conducted outreach across six parishes in
    Southeast Louisiana in libraries, churches, barbershops, and
    coastal communities where veterans live in isolation.
        Through these grassroots efforts, we've engaged over 530
    veterans and service members, many of them for the first time.
    We've connected 26 individuals to the VA who had never accessed
    their benefits, and I can imagine there are more. And then
    there was another 42 who are on the rolls at the VA, but not
    accessing VA benefits or services or VA healthcare.
        These are men and women who served our country with honor,
    but carried their battles home in silence. And silence,
    Senator, can be deadly. The stigma of admitting suicidal
    thoughts keeps many from speaking openly even when they come to
    us asking for help. We've seen veterans on suicide watch unable
    to check a box on a form. What they really need is someone to
    sit down, look them in the eye and say, ``You matter. We are
    not going anywhere. We are here with you.'' That's the heart of
    what we do.
        Our peer support specialists, veterans themselves, offer
    more than services. They offer hope. They hold healing circles.
    They walk into someone's living room at 6 p.m. on a Friday.
    They host the Still Standing Podcast where listeners hear real
    stories from real people who walked through darkness and made
    it out on the other side.
        We build partnerships with the VA Suicide Prevention team
    meeting weekly to coordinate care Veteran. And Hope Center is
    working to inform and educate the community by training faith-
    based organizations to open up veteran welcome centers in their
    houses of worship.
        Senator Cassidy. Dr. Magee, can you wrap up?
        Dr. Magee-Baker. Yes, sir. So, we urge the Committee to
    continue to expand the SSG Fox and SSVF Programs, including re-
    engaging veterans who are on the rolls but not using VA
    services.

        [The prepared statement of Dr. Magee-Baker appears on page
    61 of the Appendix.]

        Senator Cassidy. Thank you. Ms. Meyers.

       STATEMENT OF EMILY MEYERS, LPC, CHIEF EXECUTIVE OFFICER,
                    LONGBRANCH RECOVERY AND WELLNESS

        Ms. Meyers. Hi, my name is Emily Myers, and I'm a licensed
    professional counselor in the State of Louisiana. I have
    dedicated my career developing programs to support individuals
    and their families recover from the mental health and substance
    use disorders.
        Today, I proudly serve as the Chief Executive Officer of
    Longbranch Recovery and Wellness. We are a part of the
    Community Care Network, and it's both an honor and a profound
    responsibility to be here today to speak on behalf of an issue
    that's deeply personal to me; showing timely, effective, and
    equitable access for behavioral healthcare for veterans.
        I want to begin my testimony by expressing my respect and
    admiration for the Veterans Health Administration and its
    dedicated employees. We work very closely with them. In my
    experience, the VA staff care dear equally for the veterans.
    They serve and work tirelessly within their constraints of
    policy to deliver the best care possible.
        At Longbranch, we view ourselves not as critics of the VA,
    but as partners standing alongside the VHA and its mission to
    ensure every veteran receives the highest quality care. Since
    the inception of the MISSION Act, and more recently, the
    COMPACT Act, our organization has worked hand in hand with the
    VA responding whenever a veteran calls us directly or is
    referred to us by the VA staff.
        We understand mistakes. Veterans struggling with substance
    abuse and mental health issues face an elevated risk of
    suicide, medical crises, and premature death. When they reach
    out for help, the window to act is short and the urgency is
    real.
        Longbranch was founded in 2018 and provides evidence-based
    holistic treatment for substance use and co-occurring
    disorders. Our company is clinician-led, trauma-informed, and
    tailored to the unique needs of each individual, recognizing
    the distinct experience of veterans. We worked with the
    feedback of the local VA staff to develop both a separate male
    and female extended care program for veterans. These programs
    address the veterans' clinical issues coupled with the
    developing life skills and recovery for progressive autonomy.
        As Longbranch's CEO and COO positions are filled by
    clinicians, it is one of our guiding ethical principles to
    invest in the excellence of our clinical team to be trained and
    competent working with this population. For example, all of our
    clinicians are trained in interventions such as prolonged
    exposure therapy and cognitive processing therapy for PTSD, or
    post-traumatic stress disorder, that is a very common co-
    occurring diagnosis for our veterans.
        We also have collaborated with the research within the VA
    on improving approaches such as yoga therapy for veterans with
    substance use disorders and chronic pain. These results have
    shown very promising outcomes for a significant reduction in a
    variety of symptoms that we survey across the treatment
    process.
        Longbranch offers a full spectrum of care from
    detoxification, to residential to extended care, intensive
    outpatient long-term monitoring medications, assisted
    treatment, and aftercare. We are one of the few programs that
    offer services to families for our patients through workshops,
    counseling services, and aftercare support groups because
    family involvement could substantially improve patient
    outcomes.
        We take pride in exceeding not only VA, but our third-party
    administrator Optum standards, and also, the requirements of
    the State licensing bodies, and national accreditation
    agencies.
        Lastly, Longbranch employ many veterans who are in
    recovery, which is something that our leadership team is
    extremely proud of. While the MISSION Act and the COMPACT Act
    were landmark steps toward improving access, implementation for
    veterans with substance use disorders has been inconsistent and
    those inconsistencies can be deadly for this population.
        Different VA Medical Centers or VAMCs interpret the same
    policy in vast different ways. In some locations, veterans are
    offered a choice of community providers and the opportunity for
    those providers to educate the VAMC staff on available services
    or resources and others that choice is restricted or absent.
    Some VAMCs maintain strong ongoing communication with the
    community partners. Others do not.
        These variations result in delays, confusion, and sometimes
    in cases, the loss of the short willingness window when a
    veteran is ready to enter treatment. I'll give you an example
    of what might a veteran have to navigate under the current
    status quo. This is cited from Veterans report, VA staff, VA
    policy, and VA literature.
        The veteran must schedule an appointment to see their
    provider to discuss their substance use issues and that might
    have a wait time. Then, they're provided a referral to a
    substance use disorders clinic or staff to assess them for
    treatment needs. If their current provider believes they need
    treatment at the time of the original appointment, that
    doctor's referral must be reviewed by another provider and
    approved.
        Once the substance use disorder assessment is completed or
    referral to treatment is approved, the staff first look for a
    VAMC residential treatment bed. If the VA residential treatment
    bed is not available, the veteran may be referred to community
    care, but only if the wait time is expected to be 20 to 30
    days. This process from the first phone call to actual
    placement commonly can exceed 30 days as the clock times does
    not start until they come in for the original appointment.
        There are numerous phone calls and back and forth for
    appointments to get care. And as you might be able to tell,
    this process can be confusing to navigate for anyone,
    especially someone with an active substance use disorder. This
    process can also vary from VA Medical Center to VA Medical
    Center based on resources and staffing, so veterans giving
    veterans the accurate information for the VAMC they're
    connected to of how to get help when they reach out to us, can
    be unclear.
        For veterans with substance use disorders, 20 to 30 days is
    not simply a wait, it can be a fatal gap. During that time,
    they face heightened risks of medical emergencies, accidents,
    incarceration, suicide, or overdose, particularly given the
    dangers of today's fentanyl-laced drug supply.
        The result is that the VA staff who are doing their best
    are forced to follow a process that works against the urgency
    of substance use disorders treatment. It's not a matter of the
    individual performance, but a policy that does not count for
    the acute risks of substance use disorders. And unless the
    veteran is actively suicidal, they're lost in the gap between
    the MISSION Act standards and the COMPACT Act standards.

        [The prepared statement of Ms. Meyers appears on page 63 of
    the Appendix.]

        Senator Cassidy. Mr. Jackson.

      STATEMENT OF JACKSON SMITH, JD, EXECUTIVE DIRECTOR, BASTION
                        COMMUNITY OF RESILIENCE

        Mr. Smith. Thank you, Senator Cassidy, for the privilege of
    testifying here today. And I also want to start by saying thank
    you to the representatives of the 15,000 strong veteran
    population of this city who fill this room. I'm acutely
    conscientious that I testify up here, not on my own behalf, but
    on behalf of you.
        My name is Jackson Smith. I'm the Executive Director of the
    Bastion Veterans Community here in New Orleans, and a Marine
    combat veteran. My experience with the most pressing issues
    facing our veteran population began in 2010 in Helmand
    Province, Afghanistan. I spent eight months there in high-
    intensity frontline combat with the 78 Marines and Sailors of
    Third Platoon, India Company, 3/6.
        And over those eight months, I watched virtually every one
    of those Marines experience multiple, in some cases, dozens of
    brain-injuring events like landmine explosions and firefights.
    And in the years since then, I have seen how few resources
    there are out there for the hundreds of thousands of veterans
    with experiences.
        Just like the Marines of Third Platoon, suicide, PTSD,
    traumatic brain injury, overdoses, deaths of despair, these
    problems are growing worse for our veterans, not better. In the
    last two years of available data, we have seen the veteran
    suicide rate here in our State of Louisiana increased by nearly
    35 percent, while the civilian rate has stayed relatively flat.
        The Wounded Warrior Project's 2025 Community Survey, some
    of the most detailed data that we have available on post-9/11
    disabled veterans, shows that homelessness among this
    population has doubled between the last two surveys. We've
    heard today about continuing to lose nearly 18 veterans per day
    to suicide. But that number grows to 44 when we account for
    overdoses and other self-induced deaths. That means during the
    course of this hearing alone, we will lose as many as four more
    veterans. Four right now as we speak.
        But the news is not all bad. Initiatives like the Staff
    Sergeant Fox Grant are an important first step toward
    delivering the innovation and care that our veterans so
    desperately need. But it is only that a first step. I have
    heard witnesses before this Committee in previous hearings
    testify that the primary purpose of the Fox Grant is outreach,
    connecting with those veterans who are otherwise slipping
    through the cracks.
        And I agree, but outreach requires presence, boots on the
    ground in the communities where these veterans live and in
    their lives. And at less than two Fox grantees per State today,
    and seven states with no grantees at all, we are not cutting
    it. The Fox Grant program should be expanded significantly,
    including the availability of significantly more grants for
    first-time applicants.
        In the last cycle, more than 80 out of 93 Fox Grants went
    to existing grantees making the pool of available funds for new
    initiatives vanishingly small. Thus, for small community
    organizations like Bastion, it is difficult to justify the
    significant effort required to even assemble a Federal grant
    application. And that really matters because it's organizations
    like ours on the ground that are often best to deliver that
    follow-through, that in-person care, eyeball to eyeball that
    can make the difference.
        Organizations like Bastion are already working furiously to
    innovate and fill gaps in the continuum of care. Bastion's
    Headway program, funded since its inception by the Wounded
    Warrior Project, is a perfect example. One of the first long-
    term no cost community-based rehabilitation programs for
    veterans dealing with traumatic brain injuries.
        An expanded Fox Grant, particularly one that specifically
    incentivizes programming for brain injury affected veterans,
    could help to deliver programs like headway at the scale that
    is required.
        I also urge this Committee to consider renewing or
    replacing the Assisted Living-TBI Pilot Program. That program
    was terminated in 2017 without replacement for a variety of
    reasons, including that it was deemed prohibitively expensive.
    But I would submit to this Committee, respectfully speaking,
    that given that there is no alternate or replacement program in
    place, expensive compared to what? I believe that we owe it to
    these veterans to deliver the care that they need regardless of
    cost, just as they raised their hand and swore to defend this
    Nation and their Constitution, regardless of cost, even that of
    their lives.
        I would also submit to this Committee that in terminating
    that program without replacement, we have merely passed on the
    cost to our veterans and their families with stark
    consequences. Today, the suicide rate for long-term caregivers
    of non-seniors is as high as 20 percent. We can do better, and
    we must.
        I will leave this Committee with the words said to me just
    last week by one of our head of veterans, ``This program saved
    my life.'' To hear those words from a fellow veteran is a gift
    that I lack the words to properly describe other than to say to
    my friend, if he's listening, ``I'm proud of you.''
        But when I hear those words, I cannot help but to think of
    how many more veterans we have not yet reached. How many of my
    brothers and sisters we have already lost because we could not
    reach them in time. How many more will we lose if we wait
    another year? How many more will we lose today? Too many.
    Organizations like Bastion can make the difference in the lives
    of these veterans. We prove it every day, but we need your help
    and your resources to turn the tide. Thank you.
        [Applause.]

        [The prepared statement of Mr. Smith appears on page 66 of
    the Appendix.]

        Senator Cassidy. And next is Kirk Long. Kirk Long is the
    one who said to me, ``Hey, when you go out on that boat today,
    don't fall off.''
        [Laughter.]
        Mr. Long. Don't fall out the boat, Doc.

        STATEMENT OF KIRK LONG, FORMER CHIEF EXECUTIVE OFFICER,
                     CRESCENT CITY SURGICAL CENTRE

        Mr. Long. Good morning. My name is Kirk Long, and I
    appreciate Senator Cassidy's invitation to speak with you
    today. I'm also a United States Marine Corps veteran, and the
    proud father of an active-duty Marine, currently serving in
    Camp Pendleton, California.
        I have been a hospital developer and operator for over 30
    years. With the last 15 years being spent as a Chief Executive
    Officer of Crescent City Surgical, located in Metairie
    Louisiana. Crescent City Surgical is a licensed general acute
    care hospital focusing on a broad array of specialized care to
    include neurosurgery, orthopedics, surgical oncology, pain
    management, and mental awareness. Our provider network is large
    and is augmented by a partnership with LCMC Health, the largest
    hospital system in the New Orleans region.
        Initially, I was asked to speak on the barriers to entry
    with the Community Care Network. Put simply, unless you know
    someone in Congress, you'll not receive a return phone call.
    Then, when and if you do, you will be presented with a
    boilerplate contract with lower than market payment rates.
    There's no room for negotiation. All of this combined with the
    immense difficulties of dealing with the VA in general, present
    little to no incentive for private network providers to engage.
        However, these challenges encouraged our team to propose
    the creation of a pilot program that would augment the current
    VA system. Specifically, our intent was to address the
    egregious wait times many veterans encounter, especially if
    they need specialized care. We learned that the NOLA VA Medical
    Center was faced with many staffing shortages, especially in
    the surgical specialties.
        Since our network does have access to these specialists, we
    are confident that we will be able to successfully reduce these
    wait times and treat the veterans in a timely manner. We have
    presented this project to Members of Congress and have been
    encouraged by the response, and we look forward to seeing it to
    fruition.
        Additionally, we are encouraged by the ACCESS Act
    legislation currently making its way through Congress. It is
    apparent that the Members of Congress, such as you, Senator
    Cassidy, as well as other Members of the United States House
    and Senate VA committees, have heard about the many challenges
    of working with the community care networks and are working
    hard to address them. We applaud this.
        We are also encouraged by the renewed focus within the new
    ACCESS Act legislation to address the dire mental health issues
    currently faced by our veteran community. I would like to take
    this opportunity to announce the creation of a new mental
    health facility in New Orleans, the Crescent City Behavioral
    Health Center. The comprehensive care provided at this new
    center will include both inpatient, outpatient, and partial
    hospitalization mental health services in a safe and
    comfortable environment.
        The center will also be committed to the treatment of
    chronic pain, including the myriad of organic and degenerative
    diseases contributing to the mental illness. We will also
    recognize the need for additional substance abuse disorder
    services and intend to include this in our services.
        I'll be happy to discuss any of the further details or
    answer any questions at your convenience. Thank you.

        [The prepared statement of Mr. Long appears on page 68 of
    the Appendix.]

        Senator Cassidy. And then, Paul, please.

        STATEMENT OF PAUL HERMANN, EXECUTIVE DIRECTOR, DISABLED
               AMERICAN VETERANS, DEPARTMENT OF LOUISIANA

        Mr. Hermann. Yes, good morning. My name is Paul Hermann.
    Senator Cassidy, Members of the Committee, thank you for the
    opportunity to appear before you today as we discuss how we can
    improve mental health care for veterans in Louisiana across the
    country.
        On behalf of the Disabled American Veterans, Department of
    Louisiana, I'm honored to offer testimony in support of one of
    our organization's top legislative priorities for the 119th
    Congress; eliminating persistent gaps in veterans' mental
    health care and suicide prevention, particularly for service-
    disabled veterans in rural, remote, and underserved
    communities.
        Now, I want to be clear, VA has done a lot over the years
    to improve mental health services. They built strong programs
    for PTSD, depression, anxiety, substance abuse, and military
    sexual trauma. But even with all that, too many veterans are
    still falling through the cracks. And that's especially true
    for veterans who historically have been overlooked, like women
    veterans, rural veterans, and those dealing with MST and
    intimate partner violence.
        Here's one example. VA has a suicide prevention model that
    helps identify veterans at crisis. It's a smart tool and it's
    saving lives, but originally it did not include MST or intimate
    partner violence despite evidence that both are major
    contributors to veteran suicide. We are very pleased that VA
    has addressed the issues and recently rolled out REACH VET 2.0,
    which includes MST and IPV. Same goes for the community care.
        VA trains its own staff in things like suicide prevention,
    lethal means safety, trauma-informed care. But once you send a
    veteran to a proper provider in the community, those
    requirements disappear. That's just not good enough. If we're
    going to trust the community providers with veterans' mental
    health care, they need to understand where veterans are coming
    from and be trained accordingly. We need to make sure that all
    providers, VA or not, are prepared to meet the veterans where
    they are with understanding with the right training and with
    consistency.
        The last part, consistency is a huge issue. Veterans often
    finally build up the courage to open up to a therapist or a
    psychiatrist only to find out that that person has left and
    moved on. Then, they've got to start over again with someone
    new. Trust doesn't come easy when you've been through trauma.
    Losing a trusted provider can set someone back months and
    sometimes years.
        Another thing we've got to address is how we deliver care
    in the rural areas. Look, not every veteran can or wants to do
    therapy over video. Some veterans live in areas where there is
    no reliable internet. Others just don't feel comfortable
    talking about trauma on a screen. They want to see someone face
    to face, not feel like they're just another face on the
    monitor.
        After Hurricane Katrina, the VA sent out mobile clinics to
    serve veterans where they are. Why not do the same for mental
    health? Let's bring psychiatrists care to rural veterans, even
    if it's just a few days a quarter. The mobile units could run
    out of the VA medical centers in New Orleans, Alexandria, and
    Shreveport, and rotate throughout the rural parishes. That kind
    of regular in-person contact could make a real difference,
    especially for veterans who are isolated and don't have
    transportation.
        Now, when we talk about MST, we have to understand it's a
    different kind of trauma than combat.
        Senator Cassidy. Just for a second, MST is military sexual
    trauma.
        Mr. Hermann. Yes, sir.
        Senator Cassidy. Yes, so everybody knows what you're
    talking about.
        Mr. Hermann. I'm sorry. MST survivors shouldn't be placed
    in group therapy with combat veterans. They need tailored
    support, and that goes for any mental health issue. We have to
    meet veterans as individuals, not try to treat everyone the
    same way.
        Finally, I want to emphasize something simple but
    important. Veterans need to know they matter. They're not just
    a number. They need to be heard, believed, and treated with
    dignity. When veterans feel like they're being passed around,
    rushed through appointments, or pushed to the side, it can feed
    into the hopelessness that we are trying to prevent. One
    suicide is too many. We have to do better.
        So, here's what we're asking; continue to update the
    suicide risk tools to reflect real veterans' experiences, make
    suicide prevention and trauma-informed care training mandatory
    for all providers who see veterans, and invest in face-to-face
    rural outreach, especially for mental health. If we can do
    that, we can start closing the gaps, and truly show veterans
    that their lives and their well-being are worth fighting for.
        On behalf of DAV, Department of Louisiana, and the veterans
    we serve, thank you for your leadership and continued
    commitment to this mission. I'm happy to answer any questions
    you may ask.

        [The prepared statement of Mr. Hermann appears on page 69
    of the Appendix.]

        Senator Cassidy. Thanks, Paul. Again, thank you all and
    I'll just kind of go down some lines, some questions I came up
    with. Doctor----
        Dr. Magee-Baker. Yes.
        Senator Cassidy. Fernando really emphasized coordinating
    with faith-based institutions, and obviously you're one of
    them.
        Dr. Magee-Baker. Yes.
        Senator Cassidy. What can we do to improve the
    understanding of, you name it, mosque, church, synagogue, that
    this resource is here, you do it within a faith-based setting,
    but the VA? You see where I'm going with that? How can we
    improve that? Because I'm not sure my--I have to ask my pastor,
    but Fernando suggested that it's not as wide a place as it
    should be, because he says it's not as much as it should be.
    How do we improve that?
        Dr. Magee-Baker. Well, we've improved our relationships
    with connecting with houses of worship and faith-based
    organizations. And let me just tell you, Director Rivera has
    been very open-hearted on, but I think inviting those
    institutions of faith into the VA and welcome them in, I think
    sometimes what happens is because of, you know, the religious
    pact and different things like that in the separation of church
    and State that sometimes is operated under, that leads houses
    of worship to think that they're not wanted in government.
        So, one part is inviting them in to see the facility, to
    explore the needs. And part of our work is working with those
    other faith-based organizations and houses of worship to
    recognize because some of them don't even know that they have
    those who served in the military veterans or who are the
    military families within their local congregations. So, as we
    reach out to them, they become more aware.
        Senator Cassidy. Sean, are you still here? Sean is one of
    my staff here in Baton Rouge, and he interfaces with a lot of
    the VSOs. They have a very active program to help veterans.
    Sean is available 24/7. He's a bachelor. You can call him day
    or night.
        [Laughter.]
        Senator Cassidy. If you wake him up, who cares?
        [Laughter.]
        Senator Cassidy. But, Sean, on our website, we need to put
    information for veterans. Somehow, we need to begin
    communicating to these faith-based organizations that the VA
    wants to work with. And so just think about that.
        I want my office to pick up the same challenge I've given
    to everybody. How do we help Fernando better connect with those
    faith-based organizations? Because they're oftentimes the
    person who knows the need.
        Emily, you used the word navigation. It almost seems like
    there needs to be a navigator to take somebody through this
    process. Any thoughts on that?
        Ms. Meyers. Thank you for question, Dr. Cassidy. I
    appreciate it. Yes, I know there are patient experience
    officers within the VA. So, we try as a community care partner,
    when a veteran reaches out to us in crisis or their family, to
    get connected. We try to direct them to the Veterans Experience
    Office----
        Senator Cassidy. But you were speaking really fast.
        Ms. Meyers. Yes.
        Senator Cassidy. And even speaking really fast, it takes a
    really long time for someone to potentially work through the
    process. And I'm a doctor who used to work with patients with
    liver disease, and some patients with liver disease have a
    history of addiction. On the other hand, everybody in here
    knows somebody who's had a history of addiction. And the
    willingness window, we know that exists. We know that
    willingness, and you can catch them then, and if not, they are
    back on.
        So, how do we shorten that process to get to see a
    community provider if the VA's not there for someone in that
    willingness window?
        Ms. Meyers. Yes, I know that there is that current
    legislation that was referenced earlier, the ACCESS Act.
    They're talking about that for substance abuse, because again,
    navigating that process for a mental health or substance abuse
    crisis can be very challenging for them. And so, what I had
    proposed kind of--I didn't get to, even though I talk fast--was
    looking at prioritizing a rapid placement for veterans with
    substance use disorder, and especially with detox needs, and
    finding a way that maybe we could supplement the VA while
    they're waiting for an RRTP bed.
        And I know there is a VA up in North Dakota that's done
    that, where they work with a community partner for rapid
    placement, and then they coordinate the long-term step down to
    a residential bed within the VA system. So, that could
    potentially be a solution long-term to assist those veterans in
    crisis that don't meet acute inpatient criteria.
        Senator Cassidy. Now, why do we need legislation if North
    Dakota's already doing it?
        Ms. Meyers. I think it's that kind of gap between the
    Federal legislation and sometimes like the specific VA has
    ability to negotiate contracts. So, I think there's that
    confusion between the community care process now that exists
    and then the specific VA negotiating a contract because there's
    a gap in services in their area.
        I know North Coast is pretty rural, so that could be part
    of the reason they're doing that as well. But I think New York
    also has a similar program.
        Senator Cassidy. Paul, you mentioned specifically the rural
    areas. Thank you for emphasizing that, sir. And it does seem
    like somebody in a rural area by definition lives far away from
    another person.
        Mr. Hermann. Yes, sir.
        Senator Cassidy. And so what do we do for outreach that
    those people know that they can access the VA, or va.gov is a
    nice place to be. But as you point out, sometimes there's not
    even good broadband there for the services. By the way, in my
    legislation I've worked in the bipartisan infrastructure bill,
    I'm hoping it's soon implemented, there'll be access to high
    speed, affordable internet for everybody in Louisiana, no
    matter where they live. So, we're trying to confront that.
        But that said, how do we connect those people, anyone who
    might have that need, when they're in a rural area for that
    initial visit?
        Mr. Hermann. I think a lot comes from family or friends
    checking on them, other veterans checking on them. The VA has a
    program that they're supposed to check on them so many times
    when they first get out. But I believe that if we brought the--
    like I was talking about the buses, we did it in Katrina, bring
    them out to a local area and these people can----
        Senator Cassidy. So, let me ask you, because I've been told
    that there's a stigma, and that some people in rural areas do
    not want to go to a mental health clinic because small towns
    talk.
        Mr. Hermann. Correct. Some of them don't even want to admit
    they have the problem.
        Senator Cassidy. Now, but they have more likely to admit
    because you stressed you need to have an appropriate setting
    for the appropriate issue.
        Mr. Hermann. Correct.
        Senator Cassidy. So, if you bring the kind of VA mental
    health clinic to small town, does that push people away? You
    follow? I'm saying mental health clinics.
        Mr. Hermann. I follow you, but I don't--I honestly believe
    if we started this program, that veterans would come to it
    because now they can see somebody face to face and talk to
    somebody face to face. And even if even if the bus came and
    they had groups working with PTSD clients or MST clients,
    because again, they're PTSD, but it's not the same. Combat and
    sexual trauma are two different things.
        So, it's just the only way to--we've got to figure out a
    way to reach them. And I believe that that could possibly be a
    way to do that or find someone in the local community for them
    to get together, you know, at a barber shop, whatever it is,
    and have someone there that's trained in these types of traumas
    so that they're talking to somebody.
        One of the biggest things veterans don't want to do is talk
    to somebody that doesn't have a clue what they're going
    through. I mean, that's the bottom line, too. Iraqi veterans
    don't want to necessarily talk to Vietnam veterans because they
    don't think it was the same type of war, but it's still war.
    So, we've got to get people to talk to other people that are in
    their age group or they suffered the same type of trauma.
        And like I said, to me it's find a local area that we can
    send someone to. The VA sends people out locally to help with
    claims. So, why not do the same thing with mental health?
        [Applause.]
        Senator Cassidy. Chronic pain. Chronic pain, brother, that
    drags you down. Once I had a neck pain for about three months,
    I had a pinched nerve, and I mean, all my emotional energy went
    to managing that pain and eventually the nerve died and that--
    so, I hear what you're saying. So, is the chief barrier the
    ability to contract with the VA in order to provide those
    services?
        Mr. Long. So, one of the main barriers, Senator Cassidy, is
    the community care networks are statutorily limited in how the
    VA is allowed to pay the private providers if a veteran is able
    to utilize a community care network. And that was one of the
    frustrating things that we ran up against was that even though
    the community care networks are administered by Optum, Optum is
    owned by UnitedHealthcare. We as a provider had a contract with
    UnitedHealthcare, but Optum was not allowed to offer us the
    basic same rates.
        Senator Cassidy. And these are just fair market rates. And
    so, I was actually talking to Fernando before we came up here,
    and one of the suggestions that we had was add some language in
    some of this legislation that would allow the negotiation for
    fair market payment rates through the Community Care Network.
        So, if you're a veteran and you need to go see a
    neurosurgeon, and a local VA does not have a neurosurgeon
    available within two or three months, you're able to go outside
    the VA system. You go see a neurosurgeon. Well, as we all know,
    a lot of times, we've discussed it here today, the veterans are
    usually a fairly complicated case.
        They don't just go because they've got back pain. They go
    because they have back pain. They also have five other
    comorbidities. They have COPD, they might have cancer, they
    might have addiction issues, they might have some sort of
    mental health issue, but they might have intractable pain that
    causes them mental anguish.
        And so, these cases require a lot more time, and effort,
    and resources by the private provider. All we would ask to just
    be paid fairly for that. Not anything more or less, just a fair
    market negotiation. And I think that would really open up the
    success and provide for many more positive outcomes via the
    Community Care Network, which is a great idea.
        It's just there's some communications issues with it. There
    are continuity of care issues with it. And I think the ACCESS
    Act addresses several of those from the version I saw. And we
    applaud that. And I think that with the addition of some sort
    of fair market payment negotiation, that availability would
    really go along way.
        Emily, in the initial stages of the fentanyl epidemic,
    people spoke about how someone would come in with pain and be
    given oxycodone, and that would--they would maybe have a
    genetic predisposition or whatever--but they would transition
    from taking one oxycodone every three days to escalating doses.
        Of those who are addicted that you see, how many of them
    begin with a chronic pain kind of precursor and it leads to
    that? Of course, not all, believe me, I don't want to put a
    stigma on anybody with chronic pain. Period. Don't do that.
    Just like we don't want a stigma on veterans regarding mental
    health, but for those who have that issue, we want to
    acknowledge it. So, how many of those.
        Ms. Meyers. Well, thank you, Dr. Cassidy, for that
    question. So, a lot of people, I don't have the exact number on
    top. I can get that for you in the post hearing. But most of
    our veterans come in with two diagnoses for addiction, is going
    to be substance--or sorry, alcohol use disorder is the primary
    or opioid use disorder is the primary. So, those are usually
    our two diagnoses.
        Now, what I will say is that every single person, we pretty
    much drug test any illicit drug they're taking now. Anything
    they get off the street which is a common thing for chronic
    pain. When they start with prescriptions and then they navigate
    to street drugs, everyone is testing positive for fentanyl.
        So, it's every single patient pretty much we drug test that
    uses illicit drugs. But yes, many of our veterans especially
    have chronic pain issues. And we try to address that
    holistically with yoga therapy, coupled with medication-
    assisted therapies, as well as helping them work through those
    issues with other models.
        Senator Cassidy. Jackson, my staff confirmed the original
    bill, the original legislation that you're describing for the
    TBI was my legislation. The Veterans Traumatic Brain Injury
    Care Improvement Act passed when I was announced
    representative. And as you're speaking of it and the
    effectiveness of it. Of course, I like that if you sponsor
    something, do we have longitudinal data?
        As a doctor and then as a Senator, if I'm going to make the
    case that this needs to be reinstituted, you want to have the
    outcomes that shows, wow, it did improve lives and by improving
    lives, you may think it was expensive up front, but it saved a
    lot of money on the back end. Do we have that data for this
    program?
        Mr. Smith. Sir, I don't believe that we have that data to
    show effectiveness at the outset. What we have instead is a
    quickly growing body of evidence as to the negative outcomes
    that we're heading toward absent intervention. And as I've
    stated in my testimony, my overriding concern is that there is
    no replacement in place for that permit.
        Senator Cassidy. I'm with you on that. But let me ask, it's
    a lot easier to make the case, and you're kind of making it,
    it's the absence of it. Now we're seeing the untoward effects.
        Mr. Smith. Yes, sir.
        Senator Cassidy. But it would be good to catalog what those
    might be. For example, this VetPAC that I'm proposing, Senator
    Hirono from Hawaii is proposing as well, an outside evaluator.
    They could look at this program which has been terminated, and
    then see the results, and then they give advice back to the
    Congress and to the VA that this program should be reinstated.
    You with me?
        Mr. Smith. Yes, sir.
        Senator Cassidy. So, if you're telling me that the folks
    who formally were in the program who are now not in the program
    are having this and all of that bad, then that's also helpful.
    So, I'm going to ask you, if you can, working with others,
    however you can do it, and we'll provide resources if you can
    document that, because it's easier for me to make a case.
        You notice I explored with Emily the relationship with
    someone beginning on opioids because of chronic pain, but it's
    easier for me to make a case for her position if we establish
    that some of what she's catching is related to the absence of
    effective therapy. Are you with me?
        Mr. Smith. Yes, sir.
        Senator Cassidy. That's not a big stretch.
        Mr. Smith. No, no, not at all. What I can say right now
    that we already know, we've talked a lot about veteran suicide
    today. For individuals with moderate to severe TBIs, they are
    experiencing suicide and excess mortality across all causes at
    11 times the rate of their non-injured counterparts. Numbers
    that are that stark combined with the caregiver statistics that
    I mentioned. That, to me, is a flashing red fire alarm. And it
    tells me that we have to put intervention and resources into
    this now.
        And given how early we are in this process, we've done this
    pilot, that's true. Our understanding of the nature of brain
    injury and brain health has advanced considerably even since
    2017 when that program was terminated, especially in terms of
    understanding how many more veterans there are out there with
    these kinds of conditions.
        Things like blast exposure and training. I was talking with
    my fellow Marine over here about shooting mortars. Every one of
    those has a brain injury in the back. Marines fire hundreds
    over the course of training alone. So, frankly, we are way
    behind the power curve here.
        My overriding concern is that we start to pour resources to
    see what works. Because right now we're really not even at that
    stage yet. Programs like Headway at Bastion have demonstrated
    efficacy. We have almost five years of data now on individual
    participants in that program, and ``knock on wood,'' we have
    yet to lose one of those veterans to suicide.
        But across the population, nationally, we are drastically
    behind. And when we look at the things that are coming out of
    conflicts like Ukraine and Gaza right now, the next war is
    going to be horrific in its effect on the brain health of our
    service members.
        Senator Cassidy. I'm going to ask each of you, Fernando was
    so gracious, he is there and I'm here. So, both Congress and
    the VA. If you had to each give like one piece of advice that
    you would want us to hear on behalf of the veterans, I'm going
    to just go to start with you, Paul, and it may be reason
    something you've already said, but just emphasize that one
    thing, then let us hear it and let us take it back.
        Mr. Hermann. The one thing I would say is competent
    psychiatrist and psychologist to deal with the issues that
    veterans are dealing with. Don't stick somebody that has
    depression with a combat veteran, or an MST patient, or an IPV
    patient. It is totally different. You need to train those
    doctors and psychologists in those fields.
        Senator Cassidy. So, MST versus combat and have competent
    physicians, psychologists trained for those.
        Mr. Hermann. Trained for combat MST and IPV, the
    interpersonal violence to be able to help the veterans deal
    with that. And it's not just women veterans. Remember, military
    sexual trauma does include men veterans.
        Senator Cassidy. That's one thing I've heard that believe
    me, there's more of a stigma associated with that and the men
    are less likely to come forward.
        Mr. Hermann. Yes, sir.
        Senator Cassidy. But when you do it, you find it.
        Mr. Hermann. Yes, sir.
        Senator Cassidy. If I had to say one thing, I would say
    let's make it easier for the VA to utilize the private sector
    and the private providers that are currently out there that
    currently have the capacity, the bandwidth, and the runway to
    take care of these veterans. It wouldn't be difficult. It will
    be a small jump. I'm going to ask you to be offline later.
    Communicate that directly because Emily spoke about how there's
    this kind of folding over of combat admission and somehow
    sometimes things free fall between. And so, later you have my
    contact. Send me something specific in regards this is what you
    would do. There's been a great deal of discussion and testimony
    today around outreach. Outreach requires presence. It requires
    presence in person and on the ground.
        Mr. Smith. There are no remote jobs in the military. There
    are no one person jobs in the military. We have talked about
    that veteran living rurally or struggling at home alone with
    mental health issues. All of the new things that we're rolling
    out; telehealth apps, those are important steps toward access.
    But I have been that lonely veteran, and I have gotten on the
    app, and I was as lonely when I got off as when I got on. I
    might have gotten some good advice. I might have gotten some
    counseling to help me with some of the other things that I'm
    dealing with. But if I am alone and isolated to be at the
    beginning of that call, I'm isolated at the end.
        Community organizations, like the ones filling this room,
    are already doing the work. We talk about faith groups. When
    Bastion's new facility opens, the first thing that we are doing
    is going to every one of our local churches because we know,
    they know where the veterans are and where the struggling
    veterans are.
        You give $1,000 to the DAV, you'll get $1,000 worth of
    outreach and serving veterans. I guarantee, same thing for the
    VFW. Same thing for all of our community organizations who are
    face to face with these problems every day. And right now,
    resources are not getting down to those ground level
    organizations from the pots of truly life changing, game
    changing resources like the Federal Government, the VA.
        Organizations like ours are not built to compete for a Fox
    grant as it is currently configured at 11 grants available per
    year nationwide in the last cycle. I just can't justify. I have
    no shot competing against organizations that can hire an entire
    outside company just to assemble that grant. Organizations like
    our VSOs, our DAVs, our American Legions, it's the same thing.
    We don't have time to do that because we are face to face with
    that veteran.
        So, we need avenues of funding that are more accessible.
    And that can mean in smaller amounts, a $750,000 Fox rate is a
    big deal, especially if you're counting on it renewing next
    year. It doesn't have to be that it could be a $50,000 grant,
    it could be a $25,000 grant. But with an application process
    that is navigable for these community-based organizations, we
    need the resourcing to further the work that we are already
    showing we are capable of doing.
        Ms. Meyers. So, what I would say is the biggest issue and
    what I would ask for help with is basically when a veteran
    reaches out for help that phone call is really challenging for
    most people with substance abuse issues and veterans especially
    asking for help is really challenging. And so, we want to help
    them urgently navigate the process. So, developing consistent
    guidelines of implementation for getting them into.
        Senator Cassidy. Did you mention that VA's have different
    processes, so what you're saying there needs to be one which is
    common for all VAs?
        Ms. Meyers. And kind of what they mentioned with VISN 16,
    developing an outreach center. You know, I didn't know they had
    fully had that yet, and online. So, that's great for me to know
    so I can direct them to the right place. Because sometimes them
    making a second phone call or a third phone call, they get lost
    through the cracks and that's what we, none of us in this room
    want. So, finding a way to maybe let us help them urgently and
    in crisis and then help them get back to you as a healthier, a
    little bit more stable so that we can, we can continue long-
    term wraparound care. Veterans with substance abuse issues and
    co-occurring mental health disorders are very complex cases.
    They usually have a lot of medical comorbidities. They have a
    lot of mental health comorbidities.
        There is, as we talked about, MST, PTSD sorts of very
    challenging mental health diagnoses and they deserve care and
    really quality communication between us and them. And I know
    most of the community partners that I know in the substance
    abuse world and addiction world are willing to coordinate and
    talk and work together to get them back to you guys. Get them
    back to utilize services more effectively. Help set up
    aftercare appointments with, with the VA and also give records
    and coordinate. So, developing that consistent implementation
    across VAs would be really helpful.
        And second on that same note, is how do we engage with the
    VA can vary from place to place. So, is it a weekly staffing
    meeting? Is it an email? Is it a fax? Is it a you know, just
    how do we engage? Can we discuss resources that are available
    for the community care office? So, what they get a veteran that
    doesn't know where they want to go or what they want to do. You
    guys know where to send them. Not every veteran's right for us,
    right? There's other places that are better or might be a
    better fit for that patient.
        So, we want to make sure they get to the right place, they
    get the right care at the right time and the right level of
    care.
        Senator Cassidy. Doctor?
        Dr. Magee-Baker. And just to piggyback, many of the things
    that we hear from our veterans is about navigation. Where to
    begin in the VA you know, telling them a call and waiting on
    hold. Not being able to really explain or know what they need
    or what department they need to get to is important. So, what
    we would recommend is stronger navigation and VSOs and
    community-based organizations can be that resource when funding
    to help veterans walk them step by step in navigating how to
    access VA resources, how to access veteran benefits as well.
        Senator Cassidy. Thank you. You all join me in thanking our
    panelists.
        [Applause.)
        Senator Cassidy. This has been very helpful to me. I'm sure
    it's been helpful to you, Fernando. I thank you all for being
    here. And truly me, Sean will make himself available. If
    there's something that you think that you've got a personal
    story that's going to help us serve others better, we would ask
    that you would reach out to my office. And we're also on the
    internet, of course. And with that, I conclude the hearing.
    Thank you.
        [Whereupon, at 10:56 a.m., the hearing was adjourned.]

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