Transcripts For CSPAN2 Senate Veterans Affairs Committee Hearing On Suicide Prevention 20240712

Organizations on legislation recently passed in the senate which is expected to be taken up in the house. This is 90 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] good afternoon, everyone. The committee will come to order. I am pleased to have this opportunity today to hear directly from organizations that work with, represent or support millions of veterans every day. This committee has gatheredli today to hear from these organizations their firsthand perspective and reasons they support our comprehensive Suicide Prevention legislation, s. 785, the commander John Scott Hannon Veterans Mental Health care improvement act. This is a legislation that is been before this committee and before the senate, and i wanted to give the opportunity to those Veterans Service organizations and others the ability to tell us any thoughts that in regard to this legislation as we negotiate with the house in its passage and its ability to be sent to the president. Additionally, tomorrow, september 10th, is worldwide Suicide Prevention day, and this hearing is our opportunity to call attention to the tragedy of suicide impacting so Many Americans and urge for swift passage of our legislation that will provide lifesaving measures for veterans who are at risk. Just yesterday i was notified of yet another veteran who died by suicide while on va property. Despite years of increased investment in Mental Health care at va, there is a need for a new approach that places the veteran at the center of the system, and focuses on new connections and forms of outreach. This bill achieves those goals in many ways includingil bolstering outreach to veterans not yet identified through organizations already serving them, directing cuttingedge research and greater data sharing, exploring alternative Suicide Prevention programs, and making certain there is no wrong door to accessing Mental Health care and Suicide Prevention services for our nations veterans. As we know from va data, 14 out of the 20 veterans who die by suicide each day are not enrolled in the va system. This bill will enable the va to better work with and amplify the efforts of organizations already serving veterans across the country who are filling gaps, especially in rural and medically underserved areas. In our committees first markup after i became chairman in january, we reported this bill favorably with a 170 vote. I was pleased to work with Ranking Member tester and our colleagues to pass this legislation out of the Senate Unanimously last month. Senator tester has been a a ler in this legislation from the very beginning. While our country has faced unprecedented and unexpected challenges this year, we cannot lose focus on the needs of our nations veterans. I look forward to the testimony from everyone who will be taking part in todays hearing about your organizations reasons for supporting the commander John Scott Hannon Veterans Mental Health care improvement act becoming law, and how this billl will make a meaningful impact on the lives of veterans. Let me now yield to the Ranking Member, senator tester. Continue highlight the significance of the commander john scott hannan veterans Health Care Improvement act that was introduced as the chairman said by the chairman and myself a little more than a year ago. This bill is named for a former navy seal who served our nation honorably for 23 years. Would expand and improve the Services Available for veterans struggle with the invisible wounds of war. After serving in combat, scott return to helena, montana, and he was open about his journey to recovery, getting involved in the montana chapter of the National Alliance and Mental Illness and animal therapy programs in montana wild. Unfortunately, he died by suicide on february 25, 2018. 2018. This bill honors his legacy by supporting the types of programs that improve commander qualityoflife, and helping understand our understanding of Mental Health conditions which made diagnosing his conditions easier. A lot of importantmp provisionsn this bill represents compromise at the time when compromise hard to come by. This at least one Suicide Prevention corded. Bolsters Research Efforts particularly and identifying and validating bring in the till health biomarkers and studying the effects of High Altitude on Mental Health and the risk of suicide. It provides the tools for effective v. A. Suicide prevention and Mental Health outreach. It helps expand role veterans access to v. A. Telehealth care. Requires v. A. To take a hard look at its Mental Health professional staffing levels. To establish a Scholarship Program for students studying a psychological social workers, marriage and Family Therapy or Mental Health counseling. Though students will enter into an agreement to work fulltime at a veteran Center Following completion of the program of study. It would allow the v. A. To reward grants to commute or physicians to provide to families, veterans and families. And as part of this grant veterans will be able to receive mrs. Emergency care when they are in crisis. And if they need ongoing care they can get that care from the v. A. I encourage myy colleagues in te house to support the commander John Scott Hannon Veterans Mental Health care improvement act so we can move this bill forward. A message and has indicated we are ready and eager to work with her house counterparts prevent additional legislation that could improve Health Outcomes for veterans. I work can set a a very importt message that on the veterans but to the American Public that we can come together during potentially Turbulent Times to do whats right, in this case provide critical supportrt to those who sacrificed so much on our behalf and to connect more of them to lifesaving Mental Health care they need. In particular i want to thank the hand and family to continue being a part in his family to improve service for veterans who need help in improving their Mental Health and like to recognize the wind is for montana matt coates who remains close to the hannan family and help make this possible. I want tocy thank you, mr. Chairman. Is been a pleasure working with you and imr appreciate your dedication to getting things done. With that i yield. Senator tester, thank you for your opening remarks. You and i been involved in many piece of legislation, many of them related to the care and wellbeing of our nations veterans. None should be considered more important than effort twitter about today and i thank you for the wayn weve been able to come together, Work Together and hopefully achieve an outcome that is individually beneficial to those who served our nation. Let me know introduced our witnesses, ms. Katie purswell is Deputy Director of Health Policy at the American Legion. Mr. Jeremy butler is chief executive officer of iraq and afghanistan veterans of america. Mr. Jim loraine is president and ceo of americas Warrior Partnership. Mr. Matthew kuntz is executive director ofec nami, the National Alliance for Mental Health. Thank you all for being with us in some form or another today, will now begin hearing from our witnesses. Ms. Purswell, you are recognized for five minutes to deliver your testimony. Heartbreaking truth of veteranas suicide is that nearly every veteran has been touched by it in some form or fashion. Many of the so some who died by suicide, tented attended suicir thoughts of suicide. It never felt it, its hard to comprehend what could be so painful that ending a life would seem like the only solution. Good or bad, the things weve done and seen are now a part of us. From complications with assimilation into civilian life to reliving past traumatic experiences we struggle at times to find a way to cope. Its crucial veterans understand the multitude of Resources Available to them, even more important these resources must be thoughtful and accessible. S. 785 the commander John Scott Hannon act of 2019 addresses these multifaceted issues focusing on Research Initiatives come healthcare modernization, oversight and adaptive Suicide Prevention programs. Chairman moran, Ranking Member tester and distinguish members of the committee on behalf of National Commander james oxford and our nearly 2 million members, take you for inviting the American Legion to testify on this critical piece of competence of legislation. Through transition assistance, prevention, Research Awareness and appropriate Mental Health Care Services we feel this whole health cycle approach would be effective in reducing veteran suicide. As a legion member and a bedroom has been touched by this tragedy i am proud to say the American Legion supports this bill in its entirety. Foren generations veterans have struggled to reintegrate back into civilian life. Through strengthening the transition assistance program, reviewing Lessons Learned and expanding v. A. Services to ellisville veterans, s. 785 ensures safety net is a place during this critical first year. Through our own research we have found many servicemembers have s difficulty entering the emotional strain with psychotherapies. As such we support the use of complementary and integrated Health Services endorsed by this bill. S. 785 creates and expand access to diverse Treatment Options including animal therapy in sports and recreation therapy. We can all agree the success of this program is in on proper staffing. We have found staffing and retention are often the culprit of delays in accessing Mental Health care. These findings are lined with the v. A. Office of Inspector General report which determine Mental Health providers are among the most critical in need. As recruitment and retention have long been a major focus to the American Legion we are pleased to see legislation that addresses this issue. Asas reflected in the system wee seeing an annual report, staffing issues while we understand the gap analysis and report on women better utilization of healthcare sections have been moved back, we are proud to say we support both bills and the focus on improving care for all eligible veterans and in a in a more ine benefit the American Legion feels inclusivity and both minority and world veterans who have remained undisturbed for far too long. S. 785 785 expansion of teleheh services in conjunction with the American Legion at this Pilot Program will bring servicesl to these underserved populations in need of a comprehensive healthcare. And to include Mental Health care access. Ourar organization understands Mental Health care does not have a onesizefitsall solution in preventing suicide. It is a complex problem that needs to be treated at an individual level as each veteran situation is new. Commander handed unique battle with with with w ptsd, severe depression and bipolar disorder. He was decorated navy seal and while battling his own invisible wounds he spoke it a bit about his Health Journeys and advocate of Mental Health treatment and alternative therapies. It is h in his honor this legislation was introduced. While in the end we lost commander handed to suicide we can learn from his story and from others to further the conversation in awareness and prevention through action, action like the passing of this bill. While we supports s. 785 as written we appreciate the House Veterans Affairs committee researchbased edition surrounding Mental Health at open to exploring those recommendations in the. Future. We strongly urge the committees in both chambers of Congress Move expeditiously to reconcile their versions of s. 785 to ensure this important legislation is passed before the end of the 116th congress. Thank you, chairman moran, Ranking Member , Ranking Member tester, and distinguished members of the committee for your commitment to this difficult subject at the continually keeping veterans at the core of your mission. My privilege to represent the American Legion before this committee and i look forward to answering any questions you have. Ms. Purswell, thank you for your testimony faq to the American Legion. I now recognize mr. Butler. Chairman moran, Ranking Member tester, distinguished names of the committee, about iraq and afghanistan veterans of america and are more than 400 with 5000 members i would like to thank you for the opportunity to testify here today. For nearlyfo a decade the veters committee has called for immediate action by our nations leaders topo a properly respondo the crisis of over 20 military and veterans dying everyday by suicide. Military family members and or allies theres been progress but the tragedy continues. According to the data post9 11 veterans aged 1834 continue to have the highest rate of suicide. Suicide. While not always an indicator of suicide vigil Health Injuries continue to disproportional impact the post 9 11 generation. In our latest Member Survey 65 of members reported serviceconnected ptsd and well over half report anxiety or depression. Over 60 no post 9 11 but attempted suicide or who died by suicide. And along 22 increase rise since 2014. Everyday we are losingr more off her brothers and sister to suicide. Iava will continue make up the ship and fighting to bring these numbers down. In march a test lead before joint hearing of the senate and House Veterans Affairs committee on our big six players were 2020. Thee number one issue was and remains our campaign to combat suicide and the centerpiece of the campaign is just a short talk about today, the commander John Scott Hannon Veterans Mental Health care improvement act. We are proud to work with both chairman moran and Ranking Member tester on this landmark legislation and we thank them for the important leadership on this critical issue. In march i applaud this committee on passage of s. 785, urged your house colleagues to follow and for the the presideo signed into law. I hear today to reiterate our strong support for this legislation and to think the committee again for your action which let unanimous passage out of the senate a month ago. The primary message today is to reemphasize myes belief it would be completely irresponsible if the 116th congress ended legislative work this december without having at least pass the commander hannon accurate theres been talk but not enough action to address the worsening crisis of veteran military suicide and we are literally at a crossroads. 2020 can be the year will be joined together to pass muchneededak legislation to tae the next big step to combat this crisis. However, we are deeply concerned for the current path forward. While we appreciate the house te committees wellintentioned efforts to add new provisions, we have strongf concerns they give it a limited number of legislative days at the Upcoming Elections there will likely not be enough time to negotiate and pass this legislation might be into view. We believe the best and most responsible way forward for our nations better disavows to take up s. 785 as past by the senate. Following enactment we encourage the committee to consider additional provisions in in a w package of legislation. While passive to go along way in improving the delivery of Mental Health care, we know our job will still not be done. Thank you again for the opportunity to share our views and express imports of passing the commander John Scott Hannon Veterans Mental Health care improvement act this year. I look forward to at you questions and continue to work with committees. Thank you very much for your clear testimony. I now recognize mr. Lorraine for his testimony for five minutes. Chairman moran, Ranking Member tester and members of the committee, thank thank you fore invitation to testify today. I would like to ask that my written testimony and our joint letter from august 18, 2020 be added for the record. Since the 116th congress convened on january third, 2019, the president , the department of Veterans Affairs and both the senate and house v. A. Committees committed to addressing of veteran suicide epidemic. In the 615 615 days, approximay 12,300 veterans died by suicide, and despite increasing the veteran Suicide Prevention budget, to stem of veteran suicides, the number continues to rise. In the last 18 months, the president signed an executive orderr to prevent veteran suicide. The v. A. Established the veterans to prevent task force and the Senate Passed one of the most impactful veteran Suicide Prevention bills of the last ten years. Yet we continue to lack the comprehensive integrated law that could be implemented by the v. A. To in the veteran suicide. In early august American Warrior partnership and 30 of our partners provided this committee and the house v. A. Committee a letter strongly supporting senate bill 785, also known as the commander John Scott Hannon Veterans Mental Health care improvement act of 2019. Senate bill 785 is essential in both breadth and depth. Getting upstream of veteran suicide, innovative in the integration of Community Grants to proactively connect veterans come with veterans before the crisis of suicide. Combine with the Community Enabler such as Research Studies correlating opioid related deaths, programs providing better access to complementary and integrated Health Services through animal therapy, address therapy, sports, posttraumatic growth and recreation therapy, research on Mental Health biomarkers and increasing the capacity of v. A. And that center counselors. Solving the veteran suicide crisis requires a holistic solution. Veterans, their families and e nation are losing hope that the government will act, especially during these unknown times. You have done your job, and i hope the house of representatives will pass senate bill 785 immediately. The need is now and the need is great. Americas Warrior Partnership is leading a nationwide veteran Suicide Prevention study called operation deep dive. In partnership witham universe alabama, this study is showing us some of the states undercount veteran suicide by much as 25 . Honorably discharged veterans. Veterans younger than 64 due of all causes of die of all causes of death at a rate four times greater than nonvet a iran are ares. Anded [inaudible] i would like to public lu thank karen and her Suicide Prevention team at the department of defense for partnering with us as we peel back another layer of the onion. Wi if we peel back another layer sof suicide, findings would not be possible. Theyre currently working c with data we welcome inc. Community members in the future. M operation deep dive seeks to provide commission to help prevent veterans suicide. Increase the quality of life for veterans and their families. Reducing homelessness, increasing access to Reliable Transportation and maximizing Educational Opportunities working in s sustainable employment, increasing opportunities and having access to 20 seconds, physical and Mental Health care. Achieving investments looking to the future of hope. Again, time is not our friend. Our nations veterans and families providing our mission protocol. When we have over 6000 veterans and their families, we learn 95 do not believe the country is doing enough for the Mental Health of our veterans. 77 do not believe dishonorably discharged members should receive be a health care. 86 feel the va must partner with nongovernment organizations to prevent suicide. In summary, the time to act is now. This bill is the right bill right now. I joined the leaders of ourhe countrys largest veteran collaborative to help adopt 785 immediately. Im hopeful for our military, our veterans and hopeful for our success in ending veterans suicide. You for the opportunity to present this bill. Thank you. I appreciate your passion on the issue. You have five minutes. Distinguished members of the committee, id like to extend our gratitude for the opportunity to testify on the commander john scott, Veterans Mental Health improvement act. Grassroots Mental Health organization dedicated to building better lives for the millions of americans affected. Dedication addressing the issues around veterans suicide. In the fall 2013, retiring with his service from the navy seals to live on his familys homestead outside of montana. Mama and friends call him by the name of scott, i will use that name throughout this testimony. Scott and i met because we thought we might strike up a friendship. Neither of us were especially social and struggled to find something to talk about. Thankfully, we realize we bothth love designing custom Outdoor Adventure gear. That mutual obsession formed the basis of what would become strong friendship in the following years. Scott served in the seals 1991 2012. More than his fair share of hidden wounds in his familys hardware. His journey toward recovery was courageous and took years of persistent work. Hes able to turn the tide against his posttraumatic stress injuries and alcohol addiction. Amazing therapist and brought traditional treatmentha team in and outside the va providing for his care. He benefited from the experience helping heal the injuries of the rehabilitation center. He teamed up with the va to incorporate this experience into the inpatient dual Diagnosis Program and worked to help document the outcomes of this important effort. I can imagine while looking at section 203 in his legislation, it provides a pathway for Research Proven complementary treatments. Scott was adamant the system for veterans needed to improve. He volunteered in our efforts to support, educate and advocate. Mental illness and their families. Scott talked f about how the program helped his family better understand his condition and support his journey toward recovery. He worked to regain his w healt, he is able to have his recovery where he rebuilt the emotional bond with his daughter. I can still remember when he described how amazing it was to spend weeks in 2017 with her. Wonderful weeks were the best weeks of scotts life is recovery after years of struggling, his clinicians were found able to diagnose and treat bipolar disorder hiding behind the posttraumatic stress and alcohol. Unfortunately, his symptoms reemerged hotter in the fall of 2017, his family and support system helped him overcome the mania with deep depression that followed and we lost him. Pride and and i have laughter together remembering him. One conversation remains with me and is essential to understanding the Medicine Initiative in section 305 of this bill. His sister said i just wish we had known about theo bipolar disorder earlier, scott overcame everything else, he just needed more time to work on that one. I couldnt agree more. Scott spent more than half a decade in intensive Mental Health and substance abusetm treatment both in the va and department of defense, different with his trajectory, scott and his loved one in care team exactly which Mental Health conditions he had in the beginning of his treatment and what types of care they would respond to. Instead, the care in his recovery for years with treatments not targeted in his key condition. I believe section 305 in the legislation, for veterans receive the right care at the right time. Helping to ensure the wounds of war will not take them away from their life and the people who love them, a powerful and appropriate legacy to a dear friend who served this country honorably. Thank you again for the opportunity to testify in front of this committee. Your attention means a lot to this issue, meeting the family and the organization we look forward to working with you to save the lives of americas injured heroes and ia look forward. To questions. Thank you. I want to thank everybody, i am stepping in fornt chairman moran as hes voting right now. I do think him and drinking members for convening the hearing today. Iri think everyone knows Suicide Prevention week, september 12, national Suicide Prevention awarenesshe, the month of september. The great state of alaska, we have more veterans in the country but we also have very high suicide rates, particularly among our veterans and its been a priority of mine in the senate to advancee legislation that brings greater awareness and services to the devastation to many of our finest all suede two. As a marine, it is a personal issue to me, ive seen it unfortunately, up close and personal with some of my units and certainly one of the first bills i focused on as a new senator was Suicide Prevention act which was focused on these issues but we still have much more work to do. I want to thank the witnesses today. I know this isnt an easy topic. The good news is, as 785, commander scott Mental Health improvement act of 2019, which i have cosponsored, actually over half the u. S. Senate has cosponsored going to help us make progress, it includes a bill i introduce, veterans medication Suicide Prevention act but this bill, the broader bill is very strong support in the u. S. Senate bipartisan support because members recognize we must not relent in our fight against the scourge of suicide among our military veterans and veterans populati population, it builds on the Suicide Prevention act was i believe the first built by cosponsored. I think a l lot of us on both sides of the aisle you this is must pass legislation, i hope the house leadership takes it up as soon as possible and i urge all my colleagues who have connections, we all do in the house, to make sure house colleagues move on it and we can senate to the president s desk where it needs to be signed into law. Let me begin with some questions questions. Share with the committee the data you referenced in your testimony in regards to operation deep dive Research Progress and how do you believe it can assist you in your efforts. Thank you for all you do in alaska. The data we have, the state of minnesota and florida lights all the death data for the last five years. In our partnership, we send all names and Social Security numbers and provide it as fact with the confirmation of who served in the military and history of the service experience, characteristics of discharge and dates of session and discharge. What we have been able to do with that data, is to get to not in aggregate data, aggregate records provided by the state but individual records so we know when they died, how they died and their cause. Around suicide but we also correlated to military service. Im able to say in the state of minnesota, the last five years, theyve only had three veterans with dishonorable discharges who passedho away and none were from suicide. In florida, there were five and one was suicide. We are fortunate to go through this, we got the f next data ses we looking at our massachusetts and alabama and north carolina, wisconsin, wyoming and montana and tennessee. I think your section, which is section 102 about opioids, what we see is because we can see all that, we can see not only those classified as suicide, we can see those classified as overdoses with the Opioid Impact is that accounted as was i. Opioid deaths from overdose are categorized this way, its important for us to get the, its important for us to get to the impact of suicide shortly after transition from the military. One of the data points we are looking at right now is 18 to 34 yearolds who died within the last five years of discharge, 25 by suicide. One of the sections you talked about is critical today. I appreciate that and that is the kind of data we need. This committee has been veryho focused on but those are sobering statistics you just highlighted that we all need to be aware of the we can continue to focus our efforts in the senate and the congress on this issuell that unites members her. I will now turn the questioning over to senator. Thank you. I have about 15 minutes so i will produce questions. Thank you. Senator brown. Thank you for your important work, all of you in this committee. Over this work, helped improve access to Mental Health services the Senate Passed the Mental Health bill, its a step in the right direction, we should continue to push forward until the bill becomes law. I wanted to ask the witnesses about Veterans Health and Mental Health, especially during covid19. My first question is, Deputy Director, thank you for your testimony. In my state of ohio, its been pushed out of our county, we have Veterans Services an Organization Offices in every county. As they attempt to access va care and benefits, as the va asked you or others in the Community Involved with this project Better Connect them to other organizations like this . Your volume is not on. Sorry. Thank you. Va has been very forthcoming with contacting us and trying to help us in any way we can, trying to identify locations that would best serve the veteran population. Weve mostly been looking into the most underservedul areas we know our veterans struggle to find care. Or difficulty getting to those locations that are far away. So yes, va has been in touch with us, we are continuing conversation weekly we also speaking with phillips and the Alice Program providers that are helping us identify what our needs are, what our infrastructure needs are, how we set up theio locations and tryig to get the Pilot Program underway as quickly as we possibly can so we can blow this up and help as many veterans as we possibly can. Thank you. Thank you for your work. You have one of the most best advocates in the u. S. Senate you should be part of that. Drink the pandemic, we know veterans have based even more challenges for thats because of restrictions being delayed, i talked to a woman in dayton, for 15 years, shes on her ba prescriptions on the day she expected, given the tracing number in the va because of the change in the postal service, it seems to be disrupted. Shes not getting what shes needed so for some of the neighbors t, each of those issus can be an additional Mental Health stressor for a veteran, what advice would you give veterans facing additional Mental Health stresses during the pandemic for veterans who have these challenges at this time . Thank you so much for your question and for highlighting her work, weve worked together for years. Im really grateful for that. When we talk to people really struggling rightht now, and thee are so many, we just say, dont give up. The main thing is, we will get through this and there are places that will help. It is really important with no wrong door, you go to the va, the senate, go to the world health center, find a place to go, Emergency Department, find something to engage in. There are online apps, this is a tremendous struggle but there are options and we tell people, try to engage, try to keep going and the reality is, sometimes they cant but i do theres a lot of work to do. Thank you. Want to thank you again for yielding time. And to close by saying i hope we can join together as monomers of this committee and responding and discussed by the comments by the president last week. Tell whether its senator manson or chester or moran, theres always been a deep reverence for Service Members who made the ultimate sacrifice and thats what makes the president s comments to securely outrageous what these americans have laid down their lives because they love what this country stands for and they understand something the president ever has, the idea of service in giving your all is something greater than yourself their moms and dads and sons and daughters and aunts and uncles and colleagues in some of us our veterans deserve better than those comments from the president so i yield back my time, thank you. Thank you very much. Thank you. Your experience with Community Collaborative programs, how helpful with grants be to Community Organizations when it comes to outreach to Service Members, veterans and their families, how have some of your Community Organizations used the grants successfully in the program to address veterans homelessness and do you believe the Grant Program in 785 can replicate the programs success to prevent veteran suicide . Thankor you so much for the question, its great. We started, we were based out of georgia but when we started, one of our key successes was this grant. And ill only provided us with the funding on the va for our manpower to outreach and engagement, when we started, there were 157 almost veterans but really what the grant provided was the authority to work in collaboration with the va so the funding was important but the authority was key because now our teams and staff can work in conduction hand in hand with the va. Within two years, wee had the homeless number in georgia down to seven. We almost down to seven in 24 months. It was because of the as sbs grant, the funding provided but more importantly, the authority it gave us as a nonprofit to work with the Government Agency in the va. That is remarkable. We had a similar situation in arkansas, it shows the importance. Your operation deep dive, getting the data you mentioned, example 25 of newly transitioned veterans who die within fivei years, died by suicide. Can you explain your work and how you capture the data and provide the Committee Recommendations and how we may be able to w work better with te dod and ba in the future regarding the challenges as transitioning Service Members. Thank you. I have to think florida and minnesota, they provided the full data set and all deaths in the last five years. With that, they will confirm actually served and who didnt. They are more interested our goal with veterans but what we looked at was and what Service Members died in those states in those five years and then we drill and from there. Dod is key, weve never been able to do this from what weve seen, it has not been done before. Without them, we couldnt have done it the next piece is the va so one of the things we are seeking to work with the va on a data sharing, confirm the Service Members who died, how many were enrolled in them or both so we can come back and say weve been talking about in the va, we just want to be more exact in the work we do and i think this helps us get there. Its got to be one of the big successes weve seen, the fact that we are sharing data securely, through research to get to a better understanding of veteran suicide. That is so important and congratulations and thank you for the great work youre doing in that regard to solve a problem, you have to have the information as to what the extent of the problem is to begin with so that is very helpful. I want too thank the rest of the panel for the great work they are doing and thank you, mr. Chairman and sanders for getting this great group together, it is such an important subject. Thank you for your leadersh leadership, we look forward to continuing to find the right results for those who served our country in this arena and othe others. I am going to yield and go after the next republican testimony. Our leader, that is for sure. I appreciate it very much. This is too everyone on the panel, on average, one dies by suicide every 24 hours. Theou cdc, experienced a 37 increase in suicide deaths since 1999 and theres no group more impacted in our military veterans. The department of Veterans Affairs is more than 17 veteran suicide every singleci day acros the u. S. Twenty a day if you include military members that means suicide rate among veterans is nearly twice in the general population and for some crews like 18 to 34yearold increasing rapidly. It is ay national tragedy, i think we all agree on that. They raised their lives for our nation. Nothing less in the very last week offer, i am proud to be a sponsor of the 785. Would you think why do you think the vass efforts today have not reduced these suicide . I know weve all seen it and acknowledged it but i think has worked, can you give me any reason . Was not accomplished we could do better. If you dont mind me stepping in p please. I think the key is knowing who the veteran is, building a relationship. I think Suicide Prevention is holistic, it is relationship based. In the most recent f study, of e 20 were not enrolled in the va, closer veterans outside the va system, not seeking assistance or asking for help and it takes getting into the unity getting to k know who the veterans are ohio, the county is key, county bsos are. I think all of us working together to get to know the veterans, build a relationship connect to the services they need and help them move forward in their life. Me say one more thing and anybody can jump in also. One of the first lines of defense is the Veterans Crisis line and national Suicide Prevention lifeline. That is 182738255. How many veterans and family members or caregivers to think about that number memorized . How many do think they have that in a time of crisis . I hate to say i dont think any do, which is why i advocate with my colleagues for three digit dialing code for a hotline fcc followed our calls to approve 988. 9883 digit dialing code for the Veterans Crisis line and national Suicide Prevention lifeline. That number will be 988. It will go into effect july 16 in 2022. What does this line need to do to prepare . Might be the first, it is something we desperately need. I would like to add to that, i completely agree and look forward to that lifeline. I think one of the things we find is m many parents, especiay veterans, familyer members dont know who to reach out to in a time of crisis, more often than not, we get people who realize family, members, a friend, maye the veterans themselves is in a time of crisis they dont know where to turn to or how to. We have a Quick Reaction force since the foundation in 2012, one of the top reasons why veterans and family members reach out is for help connecting to tele Mental Health, Mental Health options they can turn to. Sometimes it is because they dont want to use the va, maybe theyve had a bad experience so we support the grant option because it can get Community Port services were local people can realize where they can turn to get veterans helps in a quick and timely manner. I think all you panelists for what you do we are so patriotic and our state and every state, americans are patriotic theres some are close to 30,000 nonprofits who work for veterans in some way, shape or form. Id say, what have we found, whether to program or intervention, treatment, therapy etc. Thats proven to prevent veteran suicide, what do we know that works . What evidencebased research is out there that shows peace between intervention and veteran suicide . Anybody with anybody comments on that. Thank you for being so kind. I want to hear on anything we can do. Forty nonprofits are concerned about this. One thing that i think is exciting about this bill and Emergency Department measure, Research Proven program thats been worked on for ten years has now become one of the top two clinical priorities for the va, that is a place where we can connect with veterans in need of suicide theres no question why they are there deliver that intervention, cant be delivered through telehealth. This is we are here to support that. To be a has a goal of expanding the 94 Emergency Rooms i believe that needs to be in every emergency room in the country because its a proven intervention with what we can do with telehealth right now, theres no reason it shouldnt be right there and accessible anytime a man or woman walks into the er in crisis. Thank you all so much. Appreciate your service. Thank you. Thank you. Thank you, mr. Chairman. Most of all, i want to say thank you to everybody on this panel, this is a very important issue. I think you for bringing it to attention and to try to promote the passage of this in the house of representatives before the end of the year. My first question, first of all, i thank you for your service in the u. S. Army and for being here to represent the american legi legion. In your written testimony remarks, he talked about the importance of product alice this is where the lesion is partnering with the va to install technology in rural areas to make sure veterans have access telehealth. Based on your expertise, if it does not get past the house and sent to the president s desk, what kind of impact will have on access to Mental Health care for rural veterans . Thank you for your question. If this bill does not go forward, id like to say we will probably pursuit every method we can to make sure alice and our service would be a is continued and expanded as much as we can. However, without this bill will help up grant money dedicated to expanding that program, it will slow. We will not be able to get the infrastructure in, we will not be able to get n allet of the ts we need to get in whether its the compliance needs, broadband structure, staffing, all of lthose things take support. The American Legion was happy to get our own grant to get this location up and running. We do not have the ability to continuens to do that for other locations so it is vital that this bill is passed so we can have funds allocated to make sure our Service Members can get the care they need, whether to Mental Health care or any other company has of medical care they need. We are really pulling for it. Thank you. I couldnt agree with you more, this is really important. Telehealth is not only accepted, it is now becoming the norm in many cases so this would be very beneficial to grow communities and the great plains region. My second question, mr. Butler, thank you for your 20 plus years serviceav in the navy and naval reserve. You called attention to a sobering fact that veterans 18 to 34 have the highest rate of suicide, that struck me because in south dakota, we have over 11000 veterans under the age of 40 so id like to know, what are a couple provisions you find most helpful to preventing suicide among the younger veterans . Fo thank you for the question. One of the biggest provisions we support his grants going to community and local providers, i think that is one of the biggest ways in which we can bring this number down providing resources in local communities veterans and family members and friends will know about then, when a veteran to a time of crisis, they will have to figure out where to get help. By the number is so high for younger veterans in the provision would help that is the work to connect and research the possible connection between tbi, ptsd and Mental Health problems. As we know, tbi is our signature wound war from the last 20 years and i think understanding better understanding of the connection to Mental Health programs would really go a long way to helping us solve this problem. Thank you. It is very important we draw attention to tbi and theen possible connections with Mental Health challenges we have and attemptednd suicides suicides wh the Younger Generation were thank you for your service and the insight you bring to the committee today. See if you want to be gracious one more time. No, i am sorry but i do want to say thank you, mr. Chairman and i listened to the folks who give testimony, veterans are very lucky to have you giving testimony today on their side. I cannot find better advocates the folks who testified in front of the committee today. Want to thank you all very much for not only a testimony but what you do every day to solve problems for veterans, in thisor case, a very important, maybe the most important problem we are facing right now amongst our veterans. Ive known for a good long time now, somebody i think the people in this Committee People need to know, every time there it with i this, he turned into a positive. I seen it time and time again, the suicide, hes got a hand in this and its another example in his work trying to make the best out of a really bad situation. I want to start with some questions for you, matt. I know we need to continue to make improvements to quality and Mental Health provided by the va and i do believe this bill, through your good work, it is at mark. I want to thank you for urging the house to seize this opportunity to get this bill passed. Scott, a, friend of yours, youe already shed a lot of light on it but i want you to talk a bit about scotts involvement in Health Organizations and how this legislation would further the efforts of Mental Health organizations. Okay. Thank you. Ik scotts work with us, we were exactly the kind of nonprofit these kinds of funds would go to. Our relationship really went beyond professional pretty quick. He really did engage with his local group, there is a lot of different folks there for him. Even the nontraditional support is his involvement to search and rescue team two weeks before he died, he saved the life of a Young College kid who jumped in the plunge wearing a banana su suit. [laughter] one of those things even in his worst times, he is able to help others and communityho organizations allow our veterans to do that. Thank you. I have a question that goes back to the conversation you had senator sullivan and i dont know you ever heard before but i think the answers to his questions would indicate and the testimony would indicate the number of suicides, this may be pretty significant. In my reading what you said wrong . Would you believe suicide rates are much higher than we are counting . Great question. I think based on q the data we look at to date, i think based on the data we have collected to date, indicates the suicide rate is higher than we think it is. What we are doing is as we are aggregating more states togeth together, you get a bigger enumerator balances out so you can say yes to the country but the Third Largest state for veterans was 20 undercount minnesota, one of the most states, 25 over count. Alabama looks like its going to be in undercount also, in the 20 margin. So yes, i think it is higher than we think it is. I think we dont know as much about veteran suicide as we think we do and i think we need to dive deeper into understanding the Community Factors and how it relates to the outcome a Great Community wrapped around, was the last year of his life, how could we have intervened in that . That is another part of it that is we need to get the bill and move on quickly. The more tools we have out there in peoples hands and can utilize them and i think if nothing else has happened today, it shows wee have no time to wat here. I want to say thank you, there are people who want to ask questions but i want to thank you all. Thank you. Thank you very much. Thank you, mr. Chair. I think the panel for being here. If i had time, i was going to ask this question but it touches on what senator finished on. I understand we will have a markup in the house thursday, i believe. I also understand the chairman of the House Committee is going to introduce or allow the introduction of 735 amendments and id like to note to the extent you have all done the research. If there are limits you think are particularly helpful or harmful to get into the president s desk, serve mr. Butler. Thank you. Ill say quickly and bluntly, to give the others time, we are not against what the house is trying to do. Our concern is that we arewe running out of time. Weve been working on so long. You know that, we appreciate what the senate has done. Thats the reason for my question, very few things to go to this committee to have an objection, i am worried about runway at the end of congress and also whether or not the amendments can be viewed as being additive to the core of what we are trying to do the senate bill. Are there other ideas, i wouldnt want to attach it as a vehicle for getting something done at the extent of getting nothing done and anyone else have any comments . The American Legion, we are really passionate about research and we strive to identify the gaps in care to be able to confidently legislation like this. We did extensive reviews the additional sections pullout and we are very much in support of the efforts they put in for research and we want to be able to partner with them in the future to be able to get past. However, we do feel the need that this billl gets passed in congress but again, we do appreciate the work they put into the additional pieces of legislation and we hope we stick with it for the next congress so we can revisit those. Just to answer your question, we asked 600,000 veterans and their families and 77 dont believe dishonorably discharged should have va healthcare. Dont know if everyone understands what dishonorable discharge entails in terms of punitive action and the extent of murder, rape, etc. But they are serious crimes and when he opened up, that is one of the bills the house is proposing. We also look at 785 allowing communities to identify the best way they should approach communitybased care, the house companion piece working in some areas but not in rural areas so if there are two things we focus on, it be those, my fellow panelists have said, 785 is a fully packaged integrated bill, i like that it is built on each other. I dont see that on the other side and i think most American People arent sure what is going to happen in washington d. C. In the next month to two months. What they are interested in is get a bill passed before, while we know where we stand before we get into postelection or maybe a boat may be delayed and get past to congress and then we have to from scratch again. This is the right bill for right now and thats why we supported. Thank you, any other comments on the Virtual Panel . I used all my time on the one question but when you have thousands of veterans dying every year, losing their life to suicide, i believe there are a lot of great ideas should work on but just exactly what jim said toward the end, this is an integrative bill, if are amendments that make it better focus on the core objectives of the bill, i think they be welcome, they probably make it through conference fairly quickly but if this is a vehicle for other matters that are very important, you can take a very impressive list who support this bill and have fragmented. Thousands more lives may be lost because we are not getting this bill through so i encourage my house colleagues and bsos to go in and think about how does this make this Foundation Better and lets work on all the other things. You will never fully repay, i think this would be a major installment if we could move it through quickly in congress. Thank you. Thank you very much and more important, thank you for keeping up witnesses and comments they have made in response to your question, the comments were very helpful and he did. T perhaps this is where i should say we have ongoing conversations with the House Veterans Affairs committee, absence from time to time is an attempt to visit with chairman today but on a staff level, weve reached an understanding the house will take up this bill september 20 the 21st or second and pass it presumably with the attempts to pass without any amendment. Thats exactly what we are looking for while senator mentioned the concept of a Conference Committee about the delay that could occur as a result of any amendment to the bill in thehe short time we hav, we are at a stage in which is our understanding this is a bill signed by the president so would become law. It would delay getting us to that position because the potential loss of life. We want our bsos and Community Organizations, Research Efforts to have the tools this bill provides so it is my understanding in return for the expeditious effort by chairman and Ranking Member, congressman rowe we will then make every effort to passed by unanimous consent, a number of bills that are priorities related to this topic. Meaning there are those that can unanimous consent and we will work on ones less capable of being passed by unanimous consent to be put in a package and considered by the senate, all with the goal of passage, not just the goal of consideration. I dont know that chairman would be listening to this conversation but i would convey to him my commitment to see if theres a victory, not the senate Veterans Affairs committee for the house but a victory for those who served our country, our veterans and the organizations attempting to save their lives and provide Mental Health care and treatment and to accomplish a goal both house and senate have in mind. Theres no reason whatever appreciation that comes from the passage of this legislation cannot be shared by those served on the Veterans Committee the house and i will work to accommodate the priorities our staff have talked about in today, this weeks conversations of legislation the chairman of the House Committee is most interested in and do what i can do and working with senator mcconnell, who held and democrats committee to see theres a success in the items that success can achieve and avoid any delays we might be able to do in the senate. I dont know what the Senate Schedule will be a continuing resolution is in the works and elections are pending. Nothing up to send in our way and protecting the lives of those who served our country. I reiterate, michael is not a victory for the Senate Committee and passage of a bill we passed the utilize the opportunity where bill that passes that has really happened. Nineteen this committee and unanimous consent of the u. S. Senate to use that momentum to get us to where whats long been awaited. There are developments that appear to be concluded including today and i chairman his willing to work with us in accomplishing a goal are witnesses and many other Veterans Service organizations find desirable. Thank you for your question and thank you for the responses testimony of the witnesses here others inmany Veterans Service organizations around the country advocating for this opportunity to see this to the finalal conclusion. I recognize senator bhumibol. Thank you. I appreciate those remarks and if i can encapsulate them five senses are less, we are going to get the jobob done. Whatever steps necessary to do it. Counting on your leadership, which has been admirable on this bill and i appreciate it both on your part and Ranking Members. We are going to get it done and hopefully we will have the good faith and efforts by the house on a moments necessary in accordance with the purposes of the. I appreciate that statement and it eliminates a number of the questions i was going to ask. [laughter] weve worked together so well that you know read my mind. I allowed [laughter] anyway, i do appreciate your leadership. Let me just say this exchange the conversations weve been having with the witnesses, i think it demonstrates very strong bipartisan tradition committee, our approach to these issues which is to hold our veterans as heroes in the highest regard. Unfortunately, there have been statements by the president that belied that spirit. My recounting is unnecessary, im sure you are aware and im sure you never would have called Fallen Heroes and cemeteries losers or suckers, he never would have precluded, amputees for marching and any of our parades and you never would have called john mccain a loser. Nor am i, and anyway, doubtful you would have given the highest regard to john scott hannan whose name is on this bill and he, among all members of our literary driven by invisible wounds, posttraumatic stress or traumatic brain injury or, as he did, suffer from bipolar disorder b to take their own lives. Still 20 veterans a day do so. I offered veterans protection measure with john mccain, passed by this committee a number of years ago. With john mccain at obamas side as he signed the bill. I stood next to both of them think about that for a moment, to president ial opponents side by side, obama elected president sender mccain, a loser in that race but stature of his spirit, john mccain spirit, i think was so powerful that day and it is the spirit that should bring us together here. Unfortunately, it hasnt with the president so i want to say the senate proud of this measure, we should be proud we Work Together on the bipartisan basis and every member of the senate deserves it. I want to ask the witnesses a question about the postal service, which i understand my colleague, senator brown asked as well, whether you have heard there are delays in due for delivery in veterans prescriptions, 80 of all veterans scriptures are delivered by mail. Are you aware of them being delayed in the mail that may have occurred and go down the line. Ill quickly respond, we did an informant informal survey. We heard from veterans who said prescriptions were delayed in many also said they have no trouble. My take away is in many respects, i think it is regional the results you are finding. Thank you. A partnership on the Network Connected to 302 communities throughout the u. S. , weve heard nothing from the communities north veterans about a delay in medicine. Thank you. This is katie from the American Legion. I want to say we have not had any reports at the local level stating members have been having delays and services on medications. I can speak personally my husband and i have been receiving our medications on time. In fact, one that was supposed to be delayed in developing shipped, i believe ups which we were not expecting and arrived earlier than we expected so for any issues that may be occurring, i do believe they are trying to find ways around any delays. Why would they shipped by ups . Im not sure, it was something he needed and they didnt tell us why, they just said there would be a delay, they didnt have it in stock at the local va pharmacies but we did receive it. Thank you. Have not personally worked with any veterans that have had delays. I have certainly seen it in some of our facebook conversations as well but its not something i can personally vouch for. Thank you. Thank you, senator blumenthal. Senator tester, anything further from you . Let me ask my usual question then. Do any of our witnesses have anything they would like to add or augment what they said, crack what they said, tell us something we failed to ask them in anything you like to make sure we hear before i conclude this hearing . I will very quickly say thank you, sir, it would be incredible if we could come to that bipartisan result that you discussed, especially in this corners. Not only passing the act but if theres additional things that can be done as i said in my testimony we know the commander act wont solve the problem of veteran suicide but make great progress in getting us there but if we could do more this congressional cycle everything that would be incredible. Thank you for your work. Thank you mr. Butler. Anyone else . Mr. Chairman, i wanted to thank you for the opportunity to speak and wanted to thank you all for working with the house to hopefully reach a solid conclusion to pass this bill immediately. I think you know, all of us working together im a big collaboration person but alsoo working together, American Legion, our communities and everyone else out there who wants to serve veterans is critically important. I think the addition in the bill posttraumatic growth of equine therapy, Recreational Therapy and the importance in recognizing that we do a survey every year in the top three things is veterans are seeking is sports and recreational activities, connections to other veterans and volunteer opportunities. If this bill can help us get there which it will that will go a long way. Thank you, sir. Senator telus. Mr. Chairman, i appreciate the work youre doing with posture and you can count me in to support these other measures that have merit but could slow down senate bill 785 and i also wanted to thank the minority staff. I hear we are making great progress on the team act which is something that i look forward to having the same outcome with 30 veteran Service Organizations also behind that. I want to thank the staff are working together over the recess and bring that before the committee. Thank you. Senator telus, thank you for your consistent dedication to that issue and all of these Veterans Affairs issues. Any of our other witnesses yes, sir this is matt and i would like to say one last thank you to everyone involved to help name this bill after scott. I know it means a lot to his family but especially to his daughter, evita. I also want to say the majority or minority staff has been remarkable to work with on this bill. I cant say how just professional and indepth it went in on every single section. Its an honor to work with them. Thank you, sir. I thank you for saying both of those things great thank you very much. I met commander hanans family when this bill was introduced with senator tester and every suicide has a story and every suicide involves a human being and their moms and dads and brothers and sisters and sons and daughters and all are worthy of our recognition and i am honored to utilize this bill to recognize john, commander john hannon and i appreciate the opportunity i had to get acquainted with his loved ones. Let me do just a couple more things but first of all, in regard to the efforts to resolve the opportunity to pass the bill in the house, to our witnesses and other Veterans Service organizations, Community Organizations and our ability to do that has been helped immensely by your efforts and your work with the house chairman and Ranking Member. I thank you for that. I would also indicate to my colleagues that first of all, to the house may be that we need the senate bill 785 to pass as is and i will work hard to get or excuse me, i will get a list of those house bills that have been discussed as ones that could move by initially by unanimous consent and others grooved to be packaged together for consideration by the senate and i will work to get that list to colleagues on this committee so that you can understand the direction we are going. My assurances have been that these bills that we have agreed to move are ones that we have support of all four corners, senator tester and i, as well as the house chairman and Ranking Member, mr. Rowe. And then finally let me take a moment and i am a house member. Or i was a house member and i remember it my smile a moment ago because our member thinking that when i was a member of the house Veterans Committee we sent bills to the senate where they died and im not interested in that and im interested in results and it is especially a remembrance for me today and may be senator boozman will member this but the passing occurred this week of john bradley who was a vietnam veteran and advocate for veterans in a tireless way and he when i chaired the House Veterans Affairs help subcommittee was my staff director and he has battled cancer for a long time and when he returns from vietnam he went to work for the apartment of Veterans Affairs and work for the senate Veterans Affairs committee and was House Veterans Affairs Committee Staff director as well. I would use this moment to express my gratitude for this veteran who served other veterans. There are, there is no one i hold in higher regard than those who service in uniform, perhaps other than those who served in uniform and then served other veterans as well and john bradley did that innumerable ways and in a consistent manner until his health prevented him from doing so and so i use this moment to probably, unlikely, that there will be another opportunity to express my gratitude to him for his service to our nation for his service to other veterans and to pay my respects to him and to honor his family now at the time of his death. Mr. Chairman, could i just say that i second that and having served with you on the House Veterans Affairs committee and again getting to know him very, very well you know, its just a very sad thing but we do appreciate his service in so many different ways and seen his finger in so many different bills throughout the years, he had a profound impact for our nations veterans. Its a big deal. I appreciate you recognizing that, senator boozman. I think the organizations who delivered their comments today in regard to senate bill 785. I appreciate the important work you do each and every day in your partnership in serving those who served our nation and i would ask unanimous consent of the members be given five days to revise and extend their remarks, including extraneous material and with that our hearing is now concluded. Adjourned. Thank you. [silences] [silence] the Senate Returns today at 3 00 oclock eastern time to continue work on judicial nominations with a vote at 5 30 p. M. Eastern to advance in many or federal claims court. This week all makers will also work on executive nominations, including three positions of the equal implement Opportunity Commission which enforces laws against workplace determination. Watch the senate live here on cspan2 beginning at 3 00 p. M. Eastern. Next, the American Bar Association hold a discussion on the justice departments recently proposed changes to the Communications Decency act written in 1996. Lauren willard serves as counselor to attorney general william barr and she outlined the changes to section 230 of the act which provides protections for Internet Service providers against lawsuits for content posted on their sites. This runs one hour. My name is richard, im a partner [inaudible] of my prior lives as