[inaudible conversations] committee will come to order. Good morning, everybody. Thank you for being with the committee for todays oversight hearing entitled combating the crisis evaluating efforts to prevent veteran suicide. As the hearing title suggests, we are here this morning to discuss the ongoing veteran suicide crisis that, according to the latest Data Available from the department of Veterans Affairs, finds 22 veterans a day dying at their own hands. Im disappointed that the v. A. Was not able to release updated veteran suicide statistics at this time for this hearing. I understand that the center for Disease Control finally provided National Data to v. A. In the middle of march. Considering the critical interest in updated veteran suicide data, i cant emphasize enough the need for v. A. To pursue their analysis with a sense of urgency. Its my fervent hope that the new data will show a reduction in the rate of veteran suicides as a result of the investments we have made in v. A. Mental health care and Suicide Prevention. Regardless, im hopeful that v. A. s Witnesses Today will be able to provide some more recent insights into the numbers of veteran suicides and to shed some light on whether the efforts dedicated to this crisis are, indeed, making any impact. I recognize the challenges that v. A. And, indeed, the American Health care system as a whole faces in preventing suicides. The rates of suicides have risen significantly over the past 15 years for almost every single demographic. Except for veterans. And i think that is due in large part to the hard work that v. A. Health care providers do every day to extend helping hands to those most in need. But that is not to imply that the current rate is in any way acceptable. I continue to be concerned that, again, according to the latest data from v. A. That is admittedly dated, the number of veterans dying by suicide has not fallen despite significant increases in budget, in staff and programming for v. A. Mental health care and a number of targeted veteran Suicide Prevention initiatives. Its not enough for veteran suicide rates to remain stable. Our work will not be over until veteran suicide rates are eliminated. There are many reasons a person may choose to take their own life, and there are many opportunities along the way for someone with to for someone to step in and intervene. V. A. Should certainly be proud that veteran suicide rates have not risen along with rates in the general population, but theres clearly a deadly disconnect between the Many Services and supports that v. A. Offers and the veterans that most need our help. Care, particularly for someone that is contemplating suicide, is not one size fits all. And while suicide undoubtedly is a Mental Health issue, it is also much more than that. Eliminating veteran suicide altogether will take a comprehensive approach to insure that those most at risk have not only the care they need, but also a job, a purpose and a system of support in place to help carry them through their struggles. Therefore, v. A. Must adopt a Suicide Prevention strategying that recognizes the need for Wraparound Services that treats patientses as individuals and em bases patients as individuals and embraces complementary and alternative approaches to care where appropriate. Furthermore, v. A. Needs to better integrate a veteran and family perspective that incorporates the Lessons Learned from those who have been on the front lines of the fight against suicide and offer a personal perspective and a message of hope to those that are still struggling today. Last year the clay hunt Suicide Prevention for American Veterans, or s. A. V. E. Act, was signed into law. This law was named after a brave 28yearold marine, clay hunt, who returned from battle against our enemies in iraq and afghanistan but who, in 2011, lost his personal battle to the demons he brought home with him from those conflicts. The law included a number of provisions that i believe will help connect veterans in crisis with the care that they both need both in v. A. And in their communities, that will provide valuable information about what programs are working for veterans in crisis and assist v. A. In recruiting high quality Mental Health professionals to treat veteran patients. Fully implementing the clay hunt s. A. V. E. Act should be v. A. s highest priority. I look forward to discussing the departments progress to date and hearing about how the implementation of that important legislation is helping v. A. s efforts to prevent suicide among our nations veterans. In clays memory and in the memory of the countless other veterans who have lost their lives to suicide, we have to do better. With that, i yield to the Ranking Member, ms. Brown, for an Opening Statement that she may have. Thank you, mr. Chairman, for calling this hearing today. Strong oversight of the department Suicide PreventionProgram Remains a priority of this committee. We are all aware of the oftencited statistics of 22 veterans a day committing suicide. We also know that v. A. Reports in 2014 that there is a decreased rate of suicide among users of the veterans Health Care System with Mental Health conditions. The question becomes how can we insure ready access to safe, quality Mental Health services for veterans in need of care. I hope that the v. A. Witness here today will be able to update us on those numbers as much of the country was not included in previous estimates. The last subject that concerns me relates to the new my v. A. 12 breakthrough priorities. I understand that addressing the suicide problem is not one of those. Increased iss to Health Care Access to health care, improving comprehensive exams, continuing to reduce homelessness and transforming the supply chains are all on the list. But specifically reducing suicide is not included. Given that suicide nationally is considered by some to be a Public Health problem, i believe v. A. Should include Suicide Prevention as number one my v. A. Priorities. I look forward to v. A. Testimony on this and where Suicide Prevention fits into the 12 priorities. I still believe that Suicide Prevention should be one priority of their own. Top priority. Mr. Chairman, this hearing also examine and implement the clay hunt Suicide Prevention for American Veterans act passed in the early days of 114th congress. This law focused the nation on this terrible epidemic affecting veterans. This law requires that the secretary of Veterans Affairs and the secretary of defense to arrange for an outside evaluation of their Mental Health care and Suicide Prevention. It also requires any Service Member being discharged to have their case reviewed for any evidence of posttraumatic stress disorder or trauma, brain injury or military sexual trauma. We have been at war for over 14 years. There are many veterans out there who do not engage the v. A. Care system for purposes of Mental Health treatment. Todays discussion should include how v. A. Is going to reach out to these veterans, and i definitely want to say that one of the major problems and i thank the v. A. For having the conference on Suicide Prevention that i was able to attend but one of the points that was pointed out that many of the veterans even though we have 22 a day, only three of them are involved in the system. And many of them are are getting on veterans who when they returned home wasnt received properly. So we immediate to figure out how we need to figure out how were going to reach out to these veterans and include them in the system and, with that, mr. Chairman, i yield back the balance of my time. Thank you very much, ms. Brown. With us this morning is ms. Jackie maffucci, joy ilen, thomas berger, the executive director of the Veterans Health council for the Vietnam Veterans of america and kim ruocco, the chief external Relations Officer for Suicide Prevention and postprevention for the Tragedy Assistance Program for survivors. And were also joined by dr. Maureen mccarthy, v. A. s assistant deputy undersecretary for health, for Patient Care Services who is accompanied by dr. Harold kudler, v. A. s chief consultant for Mental Health services, and dr. Caitlin thompson, v. A. s National Director for Suicide Prevention. Thank you all for being here today to testify before our committee. Dr. Maffucci, you are recognized for five minutes. Thank you. Chairman miller, Ranking Member brown and Committee Members, on behalf of iava, thank you for the opportunity to share our views on this critical issue. In 2014 iava launched the campaign to combat suicide, a result of our members continually identifying Mental Health and suicide as the number one issue facing post9 11 vets. This campaign centers around the principle that timely access to high quality Mental Health care is critical in the fight to combat suicide. The signing of the clay hunt s. A. R. S. A. V. E. Act was an important first step. We thank congress for passing legislation and the v. A. For their commitment to fully implement the law. We knew it would take time, and were pleased that weve been included in the process. Were committed to working with the v. A. , congress and our vso partners to progress both the s. A. V. E. Act and i new initiatives that are certain to follow. Personally, ive been working on this issue for about eight years, and never in that time have i seen a movement around this issue so strong or a collective will so unified than in this last year. The conversations are moving to action, and its our responsibility to make sure that this continues. So today id like to focus on four specific areas critical to progress; access to care, interdisciplinary approach to care, supporting those most at risk and the importance of research. In iavas annual member survey, over 80 of members reported seeking care. This is an increase from our last survey. They continue to emphasize the role of the family and friends with over 75 who reported having a loved one suggest they seek help and, as a result, getting that help. For those in care, three of four of our members are using the v. A. This year we saw over 75 of those using v. A. Mental Health Services report little to no scheduling challenges, which is up 10 from last year and comparable with those using a nonv. A. Clinician. The same number were also satisfied with that care. But with more Health Seekers comes more demand, and its critical to insure that the v. A. Is properly resourced to provide high quality care. Efforts are underway with the administration to bolster the v. A. Work force, recruiting medical students and improving curricula, but thats not enough. Beyond the challenge of a clinician shortage is the difficult task of hiring and retaining talent in the v. A. The federal hiring process is confusing and lengthy, at times deterring or rejecting qualified candidates. It must be made easier. The v. A. Needs to fully understand why staff are leaving. They need to know how best to attract and retain talent and to use updated staffing models and Realtime Data to establish where the need is. Climate surveys are showing that, in large part, v. A. s losing staff because of noncompetitive salaries and low morale. We all play a role at the v. A. We often forget to praise the dedicated staff who support v. A. s mission, some of whom are iava members. Our members have shared stories of the great work and dedication of these staff, relaying how these individualings saved their lives or cared for them in some of their hardest moments. We all must do our part to help celebrate what makes the v. A. Good while also focusing on how to make it better. Finally, we need to insure that high quality care exists outside v. A. Just under 40 of the veteran population actually seeks care at v. A. , which means the Current Community care work force needs to be equipped to help veterans and their families. Its not even common practice to ask a military person their history. This has got to change. But beyond asking about military histories, Community Care doctors need to know how best to provide treatment once they have the answer, and the v. A. And its academic partners are best equipped to lead this effort. Its not just about Mental Health care, in february we called upon the secretary to elevate the v. A. Suicide Prevention Office and were pleased that that call was answered. While Mental Health is a major aspect of Suicide Prevention, its not the only aspect. There are social factors that impact this as well. For the v. A. Suicide Prevention Office to truly take a Public Health approach to decreasing suicide, it must have impact wherever veterans and their dependents go. Within the v. A. , this has to include vba. So we ask congress to insure that the office, the Suicide Prevention office, is fully resourced through a line item on the budget so that it can be certain to carry out its critical mission. Weve also been focused on veterans with bad paper. This is a community thats been identified at high risk for suicide and homelessness. We can do something about this. Iava urges passage of the fairness for veterans act as part of the solution, but we also know that we, together, need to come up with a comprehensive solution with congress, dod and v. A. We simply dont know enough yet, and this is where the Research Piece comes in. We know that suicide impacts seniors disproportionately, but we dont know why. We know that women vets have a high rate of suicide but dont understand how best to intervene. This is why iava supports the female veteran Suicide Prevention act. We know that the post9 11 generation is showing an increased risk but are just starting to understand the risk factors to impact interventions. More research and evaluation is critical to developing these interventions. We simply cannot solve what we dont understand. The v. A. Has a wealth of research and a wealth of data, and they need to call upon academics to partner with them. And so were asking the v. A. To open up their data and invite academics to help be their army to look at this data and help us find the solutions. All veterans deserve the very best our nation can offer. We look forward to working with congress and the administration to address these very real challenges with informed solutions. Thank you. Thank you very much, doctor. Ms. Ilem, youre recognized for five minutes. Thank you, mr. Chairman. We appreciate the opportunity to testify as well on this important issue. Over the past decade, v. A. Has enhanced and promoted a comprehensive set of Mental HealthServices Including integration of Mental Health into primary care and a goal of improving access, minimizing barriers and reducing stigma. Research shows Early Intervention and timely access to Mental Health care are key to improving quality of life, promoting recovery, obviating longterm Health Consequences and minimizing the disabling effects of Mental Illness and the risk of suicide. In recent years v. A. s Mental Health programs and Suicide Prevention efforts have been both praised and criticized. Outside sources have described the scope, depth and breadth hofstras multivariant Mental Health approaches as superior to care in the private sector. Data shows v. A. Users have a lower rate than veterans not using the v. A. Health care system, as youve noted. However, there have been documented issues with access in the past over prescribing of medications and serious failures for some veterans. Along with a call to action to do more to prevent suicide in this population. In our opinion, v. A. Has two major challenges. One, to insure it meets the diverse needs of an increasing number of veterans, enrolled veterans who ne