Transcripts For CSPAN3 VA Secretary Shulkin Testifies On Vet

Of time were going to go ahead and get started. Todays hearing is about the issue of suicide. As many people in the room know, this month in america is National Suicide Prevention Month across the country. Suicide is a terrible, terrible, terrible loss, and wasteful loss of life. And preventible loss of life. I think john will remember when we first came in as a committee three years ago, our first bill that we passed was the clay hunt Suicide Prevention bill. It passed this committee 990. And we asked the secretary and the other members of the v. A. Here today to give us any report they might have on the progress of the implementation in terms of clay hunt act. But its a very important act. In august of 2014, i held a hearing as a member of this committee. It was a field hearing on the issue of suicide. The reason i did was because in that year, the months leading up to august of 2014, georgia va hospital in decatur had three suicides, two on campus. Some from mishandling of available tools for suicide Like Pharmaceuticals and things of that nature. Others for a lack of awareness and many for a lack of capacity. And that was the real thing that concerned me. So we began working in the claremont hospital in atlanta to improve v. A. s response to suicide and to Mental Health issues. Suicide is a disease. And it is preventible. And there are many things we can do. And to set the example, our staff director did a great job of seeing to it that every member of the staff, majority and minority, has been through the s. A. V. E. Training for Suicide Prevention. S. A. V. E. Stands for signs are you thinking about committing suicide, which is a tough thing to address. But the key question to ask. Validate the veterans experience. And encourage treatment and expedite getting help. And i can tell you from what we learned in atlanta and have learned in the v. A. , timing is everything, as it is in health care and most things when someone is contemplating suicide, its not something you put off to an appointment on wednesday or to another day. Its something you deal with immediately and quickly and expedite the response to it. So i want to thank the staff for going through the training. And just like the heimlich maneuver has saved many a life in a restaurant when somebody was choking and somebody else knew how to apply that maneuver and they breathed their air passages. Just like cpr has helped people to who had untimely heart attacks. Just like cpr helped people who might have been drowning and they were brought back to life. Being aware of training necessary to save a life is critically important. And were going to see to it in our committee we promote this training throughout the v. A. And throughout the government to see to it that we are saving lives and helping people to recover and restore their life. I want to thank bob for his commitment to doing it on the staff and thank all the Staff Members for having done it and thank the members of the committee for their effort, as well. We have two panels today on the issue of suicide. Our first panel, mr. John day. Assistant Inspector General for health inspections. Second is craig brian. Dr. Craig brian, executive director, National Center for veterans studies, university of utah. And dr. Matthew kuntz. We appreciate all three of you being here today. Youll be allowed to give up to five minutes of testimony. We dont have a whistle that blows at the end of five minutes. But after ten, youll be in big trouble. So and you can all your statements will be printed for the record and be memorialized in the record by unanimous consent. Well start with you, dr. Day, and your testimony, and go down the list from there. Welcome. Thank you, chairman isaacson, Ranking Member tester, members of the committee. Its an honor to testify before you today on the subject of Suicide Prevention. This topic is important to mr. Missile and all of the staff at the oig. We work to ensure veterans receive the highest quality Mental Health care. We have reviewed in depth facts surrounding the death of many veterans who took their own lives. Often we find these veterans suffered the effects of chronic Mental Illness, and Substance Use disorder. In the aftermath of these deaths, we frequently hear from members of the veterans family, significant friends and v. A. Providers that they would have acted sooner or differently, only if they had known. After the Virginia Tech incident shootings, a serious review of the privacy laws that impact the disclosure of medical information was undertaken. My staff met with and talked with a number of the individuals who were involved in this review to determine if there were Lessons Learned that could be applied to v. A. Changes to law seemed too difficult to design. However, changes in practice that utilize advanced directives or similar devices may offer a way to improve communication at the critical point when a patient needs help the most. I think there is a chance to improve communication by expanding the situations under which these and similar devices are used. V. A. Has thoughtfully derived a model to predict who may suicide. The question is when would an atrisk veteran take action to harm themselves or harm others . When would intervention be most effective . Research using social media and other more timely data has shown promise in understanding the human emotional state, and therefore may assist in identifying when intervention for these atrisk individuals would be most successful. I think research and pilot studies in this has great potential. The testimony of others at this table point out that veterans, many veterans, do not obtain their care primarily from the va hospital system. And so an effort to reach those veterans who are at risk is most appropriate. And essential if we are to make a significant improvement in veterans suicide data. This concludes my oral testimony. And i would be pleased to answer your questions. Mr. Chairman, this Ranking Member and members of the committee. I appreciate the opportunity to appear here today to discuss recent advances in veteran Suicide Prevention. I will not read my written testimony in full, but will highlight a number of key points. In response to rising suicide rates, the v. A. Has adopted and implemented numerous measures intended to prevent suicide among veterans. These efforts have led to improved access to care and serves as an example of how an agency can aggressively advance the cause of Suicide Prevention. Several new studies reporting suiciderelated outcomes among military personnel and veterans have been published in just the past two years. While the most of these studies enrolled military personnel, their findings are applicable to the v. A. And veteran community as a whole. As summarized in the attachment to my testimony, all of the interventions reduce Suicidal Ideation. But only two are associated with significant reductions in suicidal behavior. Brief Cognitive Behavioral Therapy and Crisis Response planning which were found to reduce suicidal behavior by 66 . Its currently the only strategy shown to reduce behavior among those who served in the military. These treatments serve as a foundation for several studies currently under way in the v. A. , as well as in the d. O. D. These latest findings not only confirm that suicidal behavior can be prevented among military personnel and veterans, they also show us how to do it. If these studies tell us anything, its this. Some strategies work better than others. And simple things save lives. Tragically, few veterans are likely to receive these potentially lifesaving treatments for a number of reasons. Today i will focus on one particular barrier, inadequate training in Mental Health professionals. Two recurrent v. A. Studies highlight this issue. In these studies, researchers found that a key Suicide Prevention strategy used by the v. A. Was not associated with subsequent reductions in suicidal behavior, as was expected. The lack of effectiveness was attributed to poor quality implementation. Of note, v. A. Personnel often do not implement the procedure with sufficient reliability or specificity. Researchers from both studies concluded that the results pointed to insufficient training and that additional training could actually change this course. The problem of deficient training is not confined to the v. A. , though. Tragically, deficient training is endemic across our nations Mental Health professional Training System. The recent report from the American Association of suicidology highlights this issue. The Main Findings of that report are also summarized in the attachment to my testimony. As you can see, a shockingly low number of Mental Health Training Programs provide any education or training about suicide to its students. Furthermore, state licensing boards, the very bodies charged with protecting the Publics Health and safety from unqualified professionals, typically do not require any exams or demonstration of competency in suicide Risk Assessment or intervention. The implications of this report are disturbing. The vast majority of our nations Mental Health professionals are unprepared to effectively intervene with suicidal veterans. This has critical implications for all veterans, both within and outside the v. A. Weve long talked about the many barriers that stand in the way of a veteran receiving Mental Health treatment, and have invested heavily in removing those barriers. What unsettles me the most as a veteran is knowing that when a fellow veteran overcomes these barriers, he or she is unlikely to receive the treatments that are most likely to save their lives. The sobering and uncomfortable truth is that we have made it easier for veterans to obtain treatment that doesnt work, especially those veterans who receive services from nonv. A. Providers and their communities. If we want veterans to benefit from the most recent advances in Suicide Prevention research, we will need to ensure implementation is accompanied by a comprehensive and robust training program. Luckily, the past few years have also led to considerable advances in our understanding in the most effective ways of teaching these methods to others. Much of this knowledge has actually been obtained by the v. A. And their researchers. In order to reverse the trend of veteran suicide, we must therefore think boldly and must be willing to disrupt the status quo. We need to adopt the newest strategies that have garnered the most scientific support, even though they may depart from existing procedures. We need to invest more heavily in Training Clinicians to use these procedures, and create new initiatives to incentivize and support their implementation in clinical settings. These changes should not just target the v. A. And the d. O. D. , but all clinicians in all settings, as well as our universities and our Training Programs that are responsible for the readiness and preparedness of our Mental Health professionals. In conclusion, we are at a critical turning point for veteran Suicide Prevention. Answers are now clear and effective strategies have been identified. We must now take the steps needed to ensure these treatments and interventions are easily available to all veterans, both within the v. A. And in our communities. Thank you very much. We appreciate your testimony. Now from the great state of montana, the executive director of the National Alliance for Mental Illness in montana, mr. Kuntz. Mr. Kuntz . Yes, sir. Chairman isaacson, Ranking Member tester and distinguished members of the committee, on behalf of nami montana and nami, i would like to extend our gratitude to share our views and recommendations. We applaud the committees dedication in addressing the Critical Issues around veteran suicide. As someone who has personally lost a Family Member that was a veteran to ptsd, i just want to appreciate my sincere thanks. Montana has the highest suicide rate in the country with 68. 6 per 100,000. This is significantly higher than both the National Veterans suicide rate and the Western Region veteran suicide rate. As an organization thats immersed in Suicide Prevention, we think its very important that you have a framework to understand suicide. The model that we use is the die athesis stress model in which a combination of biological susceptibility and environmental factors then lead to malfunctioning neuron communications. Which develop into Suicidal Ideation behavior and other symptoms. Examples of the factors of biological susceptibility are genetics and physical trauma, examples of factors on the environmental side are emotional trauma, but on the positive, therapy and supportive family. Youll note that i will not be covering lethal means restriction, because i believe its incredibly hard to legislate that. But it is an important factor. Montana is a very rural state with an average of fewer than six persons per square mile. This creates unique challenges for our Health Care Providers, and we are deeply in need of more Mental Health providers. Ill move on to our recommendations. First, offer a Public Health intervention proven to reduce suicide during critical points of military and veteran experience. Nami montana was influential in bringing the youth aware Mental Health program to the united states, and we would like to offer it as a template of something thats proven to work in another population. It would be perfect to bring over to this one. Second recommendation, establish a clear policy goal to improve the diagnostic treatment system. The target that nami montana recommends to the committee is it asks the v. A. To work with the department of defense, the National Institute of Mental Health and private partners to identify and prepare two additional brain diagnostic measurements for clinical work in the v. A. By the fall of 2020. Our next recommendation is to develop a plan for treatmentresistant Mental Health conditions. Roughly a third of Mental Health conditions do not respond to traditional treatments. And this is a big issue, and its an issue thats not addressed in montana. The montana v. A. Has nothing in our state to address treatmentresistant depression. This is very personal to me, because i lost a dear friend that was a veteran in september 2015 to treatmentresistant depression. And to watch his options slowly slip away was one of the hardest things ive ever seen. Montana blue cross and blue shield supports tms treatment for treatmentresistant depression. I do not know why the montana v. A. Does not. Next recommendation, expand access to tele psychiatric re. And then make nonline Cognitive Behavioral Therapy available to all veterans. We also believe the v. A. Should expa expand automated suicide assessment scales. Develop a valid screening tool to determine which patients are at risk of developing side effects from cloz apeen. Develop Online Research directory for nonv. A. Resources. Create a more synergistic relationship between the v. A. And community Mental Health centers. There are over 1,300 Community Health Centers Across the country and we should be working with those to care for our veterans. Increase the v. A. s collaboration with outside researchers. And finally, establish a continuity of care pipeline for veterans directoly from the department of defense v. A. And Community Providers. Thank you again for the opportunity to testify in front of this honorable committee. Your attention to this issue means a lot to me. Our entire nami organization. And their families. Thank you. We appreciate your being here today. What im going to do is reserve my time, since we have three members that are here and different meetings take place. Im going straight to our members with questions and ill ask mine later when senator tester returns. Hes doing a presentation in another hearing and will be here in a little bit. Let me start off with john . Thank you very much, mr. Chairman. And thank you for holding such an important hearing. And, again, also to senator tester, i cant you know, think of anything thats more important to discuss. Certainly we all agree that this is a crisis. In arkansas, i think were number ten in suicide rate overall. Of that group, veterans represent about 8 of the population. But represent about 20 of the suicides. So we ar