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

Sufficient significant discussion about veteran suicides today, let me start by sharing the Veterans Crisis line. If you were a veteran you know are struggling, please contact the Veterans Crisis line 24 hours a day, seven days a week at 182738255 and select option number one or text 838255. I want to thank everybody joining us today. Weve made Suicide Prevention or top priority and today 25 to 31 bills we will discuss or related to improving access and reducing suicide in the veteran population. The issues surrounding Mental Health care are broad and complex. Let me address some of the remarks made by the Senate Counterparts at the hearing yesterday. The committee has been trying to work with the senate for six month is a end after promising staff conversations we are pleased to hear they are committed to moving forward with meaningful improvements to help reduce veteran suicide and help prevent veterans from falling into crisis. I look forward to speaking with chairman mao ran directly since we havent had the opportunity yet and to discuss further his commitment to pass the houses bipartisan addition to as we will here today. There are muchneeded improvements to strengthen and fully meet the needs of our veterans. They deserve the best we can offer and i look forward to working with the senate on passing provisions included in house companion. A discussing every possible solution is key to finally making a Significant Impact in reducing suicide and improving the overall Mental Health of our veterans community. I am extremely disappointed in the va for opting not to participate this morning. Equally disappointed in the fact that secretary Opinion Pieces and press releases allow for the legislative priority is but neither he or his deputy acting deputy secretary and executive in charge of Principal Deputy undersecretary for health and the executive director, director of Suicide Prevention or his Deputy Director of Suicide Prevention didnt find the time to testify today. The secretary and i both agree that addressing veteran suicide is our top priority and get only one of us is here today. Leadership is more than doing what is convenient or making a comfort based decision. As the former va secretary bob mcdonald wrote encouraging the passage of a comic book, truly comprehensive and bipartisan Suicide Prevention package yesterday, leadership is making its way. Being sent over by the senate however i prefer to take the harder more substantive approach. The members of the staff i of te committee have spent this entire Congress Working on this approach and after six months of working with Mental Health experts and key stakeholders, we have 25 truly comprehensive veteran Suicide Prevention bills that will make a meaningful difference for veterans and crisis and prevent veterans from going into crisis. The vast majority of these initiatives have bipartisan support and many are cosponsored by our own minority members. In addition, these bills have the support of more than 24 stakeholders and Mental Health professionals and represent the culmination of hundreds of hours of staff level engagement and coordination. Though the hearing is about setting those policy ideas and bringing them into a competitive package, we need to do more to authorize more reports, more studies. Never before has the committee seen its policy without first fully understanding what impact it could have on veterans lives and what the cost will be to american taxpayers. On the agenda today are those that fill the gaps that previous pieces of legislation dont address. To truly succeed in reducing risk factors associated with suicide, we must refine our focus on those risk factors that affect the subpopulations. It would be wrong to congratulate ourselves on passing a Suicide Prevention bill without including a specific provision that address the particular needs of women veterans. The astronomically high rate of suicide among native American Veterans and the need for acute crisis care when veterans are at imminent risk of self harm. We should not have t ask veteran suicide legislation without ensuring Community Providers that arent competent. We should pass legislation without expanding the vas own lethal means Safety Training developed by the va, the foundation and the foundation for Suicide Prevention. The White House Task force recommended both Community Provider training and lethal means Safety Training be implemented and expanded and we agree. Last, the cdc taught us that smooth transition from militaryy service to the va are critical to maintaining health care and lowered the risk of suicide and that is why one of the bills today will make enrollment into the va automatic with an opt out provision. This will reduce the bureaucracy that lets veterans fall through the cracks. Most of the Mental Health care legislation before us today is bipartisan. So i want to thank the members of the committee for always trying to find a way to Work Together to advance policies. We know that none of the reporters but these are sufficient enough to swiftly reduce veteran suicide. Instead, Congress Must pass legislation that includes forceful provisions to mitigate known suicide risks and meaningfully reduce suicide deaths among veteran. Recent actions to advance Suicide Prevention offers a promising start, but it is the peoples houspeoples house that complete the work necessary to tackle the crisis of the veteran suicide. We need sweeping what is the faction backed by researchers, stakeholders, Mental Health experts, political psychologists and medical professionals. We need the support of a Bipartisan Group of lawmakers committed to taking on this challenge and leaders with a willingness to work with the white house and make permanent the measures recommended by the White House Task force. Weve already begun the work and together we can make progress towards reducing veteran suicide. I would like to speak to each of the bills on todays agenda but in deference to everyones time i will stop here and with that i nonow recognize doctor wrote for his opening remarks. Thank you, mr. Chairman. Its been nine months since the committee considered the wellbeing bipartisan bills to prevent veteran suicide. Since then, thousands of veterans have died from suicide. Thousands more struggle with the thoughts of self harm and im glad we are finally meeting again to consider legislation to get them to help they desperately need. It is unquestionably a National Tragedy every day, 36 365 daisy gear for three years counting an average of 20 servicemembers and veterans die by suicide. That has been true for so long that i fear we have forgotten its significance. That is an unacceptable loss of life, friends, churches. No one is immune. Last month the Senate Passed senate bill 785 in the veterans mentalhealth care improvement act. 785 as a bipartisan bill sponsored by chairman moran and supported by every single sitting senator from across the ideological spectrum from harris to Bernie Sanders to tom coughlin and others. Also supported by the veteran Service Organizations many of whom sent us letters of support over the last several weeks urging a quick house passage of the bill. I stand in full agreement with the call to action and task but the letters its a new record for todays hearing. Without objection, so ordered. Thank you mr. Chairman. To be clear it will not eliminate. No bill could do that. Passing is our single best chance of supporting veterans at risk suicide for the 116 congress is over. After all, only if theres 25 legislative days remaining this year. Fall before the election and 13 during. The provisions of 785 i strongly support them. There are also many other bills on the agenda, some of which i support and some of which i dont. The concern of veteran Suicide Prevention. I understand the chairman would like to see them included in the senate bill 785. But the fact is we have all considered them in the bipartisan bicameral negotiations and we failed to do so when the clock has mostly run out. The committethe kennedys spent g about how to eliminate the veteran suicide, and i know that it is a priority but now is the time to prove that. To that end, im encouraged by the announcement made yesterday they reached a deal with chairman mcconnell that includes the house passage of s. 785 this month. As Americas Partnership will testify today the need is now integrate. We cannot let the perfect be the enemy of the good bond with so many lives on the line and though i am disappointed that the da didnt provide a witness for todays hearing, yet the department viewed on the proposals. I look forward to a productive conversation this morning on the probably this afternoon, and hopefully the house consideration of 785 can return next week. Before yielding i do want to notice that there are several bills on the agenda this morning concerning other important issues for veterans and the literary families including protecting the Second Amendment rights of the nations veterans, securing the safety of children and va childcare programs and bringing veterans eligibility care into the va Healthcare System into the 21st century. Ive been advocating for the kennedy for a long time and the entire congress in some cases that i appreciate the chairman putting those on the docket today. I wish we could have done this so much earlier in the Congress Rather than the Fourth Quarter but im glad we are finally discussing them today and this is the lengthiest agenda that i have seen in my 12 years on the committee with 31 doubles. I know some of them come and ive read through all of them and your bill, for instance, would really have been good to have an entire legislative hearing. He deserved that, and im afraid with so many bills on the agenda today we are not going to give them the details that they need. Perhaps maybe next month or the month following we can do just aboujustthat but what about mr. N thank you and i will yield back. Thank you, Ranking Member. Today we have a total of 31 doubles to be discussed. Committee members will be recognized in order of the bills posted. Members will have five minutes to discuss their bill. On Committee Members will have their statements for the record outlining the bills. Many members will be recognized in the order of busines those lr us. You are recognized for five minutes to discuss your bills. Please remember to pause for a couple of seconds before beginning your statement. Thank you mr. Chairman and Ranking Member. I appreciate you including two of my bills. We all know one bette veteran dy suicide a day is too much and our goal must be to bring it to zero. Thats why im proud to introduce hr 7541, the zero suicide demonstration act with my colleague. I also like to thank the paralyzed veterans of america, the American Legion and the vfw, disabled american vets, minority veterans of america for showing their support for this bill. Of the 20 veterans a day that take their lives by suicide only six in the va. We focused much of our Suicide Prevention. The zero Suicide Initiative focuses on is a this initiative is based on the Henry Ford Behavioral Health model that i am here and can actualized zero suicide to develop the care pathways to access and modify the risk. This approach is towards a new culture based on the premise that no suicide is faded. I would like to clear up a couple of claims they stated regarding the bill. First of all, this bill does not implement a Suicide Prevention Program Education curriculum of one specified nonprofit organization. Its rather based on the proven medical approach that is a published in many multiple medical journals and second it doesnt mandate that all Healthcare Systems must use this approach. In fact, pilot programs like this are quite the opposite. This bill has run the program to see if this approach is better than what is currently implemented. It also offers an opportunity for the va to bridge its systemic gaps in care for those that are at risk of suicide. To come up with best practices if they can strengthen the current program, why wouldnt we run this pilot program. Our nations veterans deserve our full support from the spell with the support of both parties chose our veterans that they are not alone. The second bill being discussed today is hr 7879, the tele Health Extension act which i was honored as the chairwoman of the subcommittee to introduce with my colleague. This bill seeks to close the gap and provide access by allowing the va to provide grants to outside partners creating Technology Access points. Quality Tele Health Services are vital to veterans to access quality healthcare during the pandemic especially for those in the medically underserved communities. We cannot let this compromise Healthcare Services for the veterans and Service Members. Its increased by over 1000 between march and june of this year. In my home state of nevada, the Southern Nevada home care system uses the video connect which delivers care to veterans in their homes over computer, tablet or smart phone. On the week they started responding to the pandemic of the encounters were 128. Fast forward to the week of july the 19th and they were providing 2,221 to veterans. Even though theyve expanded their tele health capacity, many veterans still have limited access to service. This is no time for excuses and its our responsibility to adapt to changes thrown our way. Our bipartisan bill will make sure that local va facilities have the capacity and technology to provide Tele Health Services and that veterans in all the communities have access to quality Health Services that they have earned, so thank you mr. Chairman and i will yield back the balance of my time. Thank you, ms. Lee. Congressman roy, you are recognized. Please remember to pause for a couple of seconds before beginning your remarks. Thank you, mr. Chairman for holding this important hearing on an issue that is obviously important in a bipartisan basis and i want to start by saying hello to my friend. You all know that i am a proud graduate from the university of texas but i also recognize [inaudible] i want to say hello from texas. Mr. Chairman, i appreciate you putting this hearing to get just the other day were about a month ago i was made aware of a tureen who committed suicide in had served 12 tours of duty. I think one of the things we ought to be talking about which isnt germane to this committee, we are going to address a lot of the sting is today talking about suicide and what the va ca witho but we do need to have a conversation about a 20 year old authorization force. We have men and women in uniform and listing today who were not alive when we passed the authorization under which they are operating. I read and oped in january, three democrats and three republicans and an end and. We wrote a piece saying Congress Needs to vote, have a conversation about the use of the authorization of force and make sure that we are all standing behind our men and women in uniform when asking them to serve seven, eight, nine, 12 tours of duty so i throw that out there as something that i hope this body will take up and debate, but this is an open hearing on 31 bills you could forward and we will discuss a lot of these important issues of the veteran suicide. I appreciate you for including hr 3450 of here for discussion. Some people will say that it isnt wholly related because they think its specific and focused on the Second Amendment but i do believe it is related. I talked to a number of veterans who have concerns and fears about whether they can get services at the va. They fear that if they do that they might end up in a position of having their Second Amendment rights taken away, and i think we all recognize how many of our veterans believe that that is a fundamental right for them. So im glad were having this on the hearing. No veteran should be deterred from seeking Mental Health care or benefits the va because they fear of losing a constitutional right. This legislation builds on the Ranking Members bil bill hr 386 different Second Amendment protection act and hr 3450 clarifies simply because the veteran received a disability rating for Mental Illness does not mean that they should have their Second Amendment rights infringed. It would simply codify the Current Practice of not transmitting the names of the veterans connected to disability compensation to the fbi system with a little background check system solely on the basis of that adjudication. Unfortunately compensation for ptsd or other Mental Health disabilities are at risk of losing their constitutional right to bear arms if her example hr 1121 were enacted. Some on the committee have raised maybe this issue isnt right but i would suggest that because that isnt the law, i would suggest because we passed legislation out of the house, it was actually raised this issue and because we want to make sure that theres no confusion for our veterans the ought to preemptively work to codify that which is currently the rule to ensure that our veteran dont have any concerns. Hr 112 we could have that debate. There will be disagreement about that and as a result individuals who cannot possess a firearm expanded to include those that preceded with a Mental Health illness. Veterans havent been found by the Judicial Authority to pose a danger to themselves or others shouldnt be told while they are capable of bearing arms to fight for our freedom, they are not capable o as a civilian simply because they are receiving disability benefits. Im grateful that the veterans brought this issue to the judiciary. Hr 112 was being debated on the house floor in february i introduced hr 3450 to propose a solution that i believe is in the best interest of americas veterans. The bill would protect veterans 112 that would cause them to lose one of the freedoms they fought for and it would give them the assurance they can go for Mental Health without losing their right to own a firearm. I appreciate the comments during the American Legion hearing in 2019 and the people on his side of the aisle are interested in protecting Second Amendment rights. I concur protecting that is a bipartisan issue and i hope the chairman can advance hr 3452 the next markup so we can get the bill to the president s desk as soon as possible and with that i will yield back. You are recognized for five minutes, please remember to pause a couple of seconds before beginning remarks. Thank you, mr. Chairman and Ranking Member. I am grateful for the inclusion of my legislation, hr 3788 javier Child Protection act in todays legislative hearing agenda which i introduced in july of last year along with ten of my colleagues on this committee. I want to thank the chairman and Ranking Member for holding this hearing and once again highlighting and underscoring a critically important issue of veteran suicide and the need for us to come together in a bicameral bipartisan way to reduce the tragedy of 20 servicemembers and veterans fighting thy suicide every single day. September is Suicide Prevention awareness month, so all these bills and everything we can do to reduce the barriers to our servicemembers and veterans to access Mental Health services, Healthcare Services to prevent suicide is a very worthwhile cause. I would submit one of the barriers to accessing those services is child care. My bill would prohibit the va from or the lack of childcare i should say. My bill would prohibit from paying a Child Care Provider if they employ an individual who depend charged with a sex offense involving a child victim, violent crime, drug felony or another offense but the va determines appropriate unless the Childcare Provider had suspended the individual from having any contact with children while on the job until the case has been resolved. The recent pandemic has recently highlighted the critical bold childcare place in our everyday lives and as the National Conversation over childcare access continues, my legislation works to ensure that those taking care of our kids are vetted and safe and a parent including veteran parents who need to access Healthcare Services and the way to do that is to get them child care that there is no deterrent from them accessing the childcare. In my home state of kentucky i am grateful to have the support of prevent child abuse kentucky regarding this legislation and know that this type of legislation makes for taking the needed extra steps to ensure the safety of children at the va facilities. Many on this Video Conference and kennedy are parents and the question is simple. Would any of us want one of our children to be cared for by someone whos been charged with a serious crime like a Sexual Assault against a minor before they have been fully cleared. I will repeat the question what any of us wants one of our children to be cared for by someone who has been charged with a crime against children before they had been fully cleared of the charge, of course we wouldnt come and we wouldnt want that for our veterans children either. But has not yet his or her when this issue came to my attention just several members of this committee and while there were concerns from the other side to see this legislation considered. The safety of our veterans children should be a top priority for this committee i would like to make clear that this legislation does not presuppose anyone that is charged with any of these crimes. It does not deny anyone due process but it does impose an obligation to ensure the safety and wellbeing of children cared for under the program to recognize that some cries one crimes carry repercussion while they seek resolution what has she closed consistent contact relying on us to protect them that they should not be allowed to work in close contact with children until they are cleared. And with this common sense legislation children of veterans those who have served in uniform first. And hoping that this would be noncontroversial but i appreciate the opportunity to once again and. Before we go on thank you to the members and you and others to know we are holding your state of them fair because of the terrible wildfires you are undergoing in california. Its just awful and i cannot imagine what you are going through. Im proud to sponsor while it is next to impossible the primary focus for todays hearing with karen benefits and services they address that issue to have a critical barrier for care and the other by creating a pathway to the Healthcare System tailored to the current and future generations of veterans. I have traveled extensively to travel those v. A. Facilities literally from long island to los angeles and all points in between and during that travel veterans across the country have told me they avoid seeking out the care and the benefits they have earned because they feared doing so one of the factors is the huge consequences for fiduciary and with the fbi National Criminal check and just like that they are no longer allowed to possess a firearm. With the constitutionally protected rights that doesnt occur unless a very high bar has been met and criminals must be convicted in a court of law. And with those bureaucrats not judicial authorities. There is zero evidence those that need meets the fiduciary are a danger to themselves or society. During last november legislative hearing of the improve act several groups had a statement for the record and those that are seeking v. A. Care. In a statement and those that the false belief among veterans that the v. A. Was to take away our guns that has the accurate message to seek out Mental Health care and fortunately the consequences determination that my bill the veterans Second Amendment protection act because unless there is an order from judge or magistrate because thats not a partisan concern. I am grateful to congressman peterson as the democrat cosponsor. Im grateful to the American Legion and the vfw for endorsing this bill. This past the house of bipartisan support and then to protect and then to protect this legislation hr 7469 the modernizing fell on eligibility act to enroll in the v. A. Healthcare system depended on a series of Priority Groups established in 1996. Think about the v. A. Healthcare system look like in 1996 and now think of what these things look like today. The difference is almost night and day so to ensure the v. A. Healthcare system that greets them when they hang up their uniforms is tailored to meet their needs not those of their parents and grandparents. And those that had toxic exposures and those important issues of this jurisdiction comes down to questions of who is eligible within the v. A. Healthcare system and those on the agenda. And by expanding access to veterans who serve in combat other than honorable conditions and with a Bipartisan Panel with Industry Experts and with that eligibility enroll in that to it that i care that they earned and to update with the consequence instead and then and that is congresses job and that has the recommendations coming out this seriously being considered and did that quagmire in the bicameral support to prevent veteran suicide using the objective bipartisan expert commission, and then to insulate vitally important sensitive issues that all too often characterized congress to ensure the veterans forces and not politics are driving decision the bill is based on a bipartisan recommendation established under president bill one obama thank you to the chairman for placing on the agenda and just before i leave my screen has gone blank. I have no idea why. Thats why mr. Chairman i understand the frustration of technology does not always work. We use the commission on care and as an example with that militarized zone near the dmz but i wasnt eligible for v. A. Care. Because of that category them in. Thats not the cause of our Economic Situation just exactly what we did with the mission act thank you for including this on the agenda. Your recognized for five minutes. Thank you mr. Chairman. And then to discuss the bill to improve the health of our veterans including the veterans Prostate Cancer and treatment act september has been recognized as national Suicide Prevention but also National Prostate health month. The timing of the two bills could not be more timely. I would like to enter support into the two bills. But then veterans are twice as likely to be diagnosed with Prostate Cancer as civilians and then considered a presumptive condition and then that discovery rate compares effective treatments with those Prostate Cancer is not where it should be. Despite major improvements in recent years. M that is critical with the comprehensive critical guidelines to ensure the veteran Prostate Cancer patients have the most current validated Treatment Options available a recognized leader and then to have an opportunity to build on this success. I am encouraged by the Precision Initiative and its expansion of fiscal year 21 budget request. Having said that the targeted guidelines for the number one most diagnostic on diagnosed cancer is overdue there so much confusion that leads to under treatment and quite frankly mistreatment the act directs the v. A. To establish and National Clinical setting noncompulsory guidelines for Prostate Cancer treatment from Early Detection through endoflife care to create a Prostate Cancer registry for the v. A. The bill outlines a number of considerations for Prostate Cancer treatment guidelines and is important to the development of these guidelines of multidisciplinary a basic translation and then federal and academic stakeholders that pushing the frontiers of medicine. And then to remain on the cutting edge of the most prevalent diagnosis. 16000 veterans diagnosed with Prostate Cancer each year in our system i like to think my colleague for working through Prostate Cancer research and with the most promising treatments of covid19 with the metabolism of Prostate Cancer thank you for home to introduce hr veterans serious Mental Health illness act and im grateful to the witnesses for participating in todays discussion. I yield back. Thank you doctor. So i thank you chairman and with the issues of Mental Health affecting veterans. Im proud to work with this committee and im proud of the work they are doing to receive the care benefits they have earned with the new director of the syracuse v. A. Medical center in i was pleased to hear that Mental Health Care Services were continuing unabated during the pandemic and then outreach by the Suicide Prevention coordinator. I believe this work is essential especially now when the pandemic impacts the Mental Health of so many people. Last month i introduce the access to suicide coordinator act along with my republican colleagues our bill ensures every v. A. Medical center has at least one Suicide Prevention coordinator and staff to oversee veterans Mental Health care regarding Suicide Prevention. Our bill implements recommendations coming out of the support for the act a bill introduced last year with my colleagues. There is an urgent need for action. Veterans and servicemembers die by suicide every day we cannot stop working on this issue until the number drops down to zero im pleased the committee places such a high priority on v. A. Mental health care and we continue to work with republicans and democrats for the best bipartisan reform to help nations veterans. I yield back. Thank you congressman i now recognize representative. Thank you mr. Chairman im so proud my bill is included in todays hearing. This is a data driven approach to create valuable time and space between those at risk with suicide and a lethal means. And to increase Safety Measures with the access of potential means the policies of my bill supported by the evidence and the experts the v. A. In the white house has to end veteran suicide crisis. And this last year the National Director for Suicide Prevention we would train the entire v. A. To talk about lethal means and the white house the science supporting lethal means safety is robust and compelling and that is a key component of Suicide Prevention by bill has been endorsed by veterans advocates and Suicide Prevention experts including the disabled american veteran. Paralyzed veterans of america, American Foundation for Suicide Prevention, american Mental Health counselors association, American Association of biology and many more. In fact the v. A. Community care workers from the association the v. A. Psychologist leader said this bill will do as much or more to prevent suicide than any legislation to date. I also would like to request or ask unanimous consent to enter a letter in support of my bill of two dozen leading academics. Mr. Chairman . I was just pausing. Without objection so ordered. My bill directs v. A. To have basic training annually to all employees who interact with veterans. This includes vocational rehab facilities compensation and pension examiners Community Care Network Providers and caregivers. My bill also includes reporting requirements to ensure that this training and the resources are probably available to broader use. Developing the Current Training and Mental Health experts and Firearm Safety organization to limit the providers to receive valuable training. Death by suicide is a short time between deciding and acting so to equip them with tools to limit access during a critical period can make all the difference so to have the resources and the training they need with veteran change with Mental Health we owe it to our veterans to ensure the men and women are prepared to have thes lifesaving conversations. In closing my greatest appreciation to the professionals who helped develop this bill thank you to doctor heather and others from the committee and all the others have spent their time on this legislation. I yield back. Thank you representative underwood i now recognize the congresswoman brownlee and please remember to pause before beginning. Can you hear me . Yes we can. I am proud to introduce hr 8068 American Indian alaskan native Mental Health act which the majority of todays panel has already endorsed. Grateful to their support. American indians and alaska natives they are in a higher risk for suicide the American Indian alaskan native adult that dies by suicide add a rate 20 percent higher than white adults according to hhs in 2017 the second leading cause of death for native the government must do more to address this crisis to uphold the trust and treaty obligations that continue to lack appropriate access and was Suicide Prevention through the v. A. My bill would mandate every facility has a minority veteran coordinator to ensure every minority veteran coordinator is trained on Mental Health care for veterans. And then to work with the facilities prevention coordinator to contact local tribal leadership and to contact the director with a witch and plan for a specific outreach and with the Mental Health care provided. And with the tribal enrollment. And then natives americans to defend our nation and its time we provide them with a culturally appropriate Mental Health of nonnative veterans received from the v. A. And with that i yield back. I now recognize representative lamb for five minutes. Thank you mr. Chairman. I am thrilled today to report we will be marking up three of my bills all introduced with lead republican sponsors. And your leadership we spent our years very focused on Mental Health treatment and make it more effective in speaking for myself at least there is a lot we still need to know its a very tricky and difficult problem. So the lesson a check from that is to go back to the drawing board and then to give more complementary and Integrative Services and to allow them treatment in the holistic form in terms of yoga and that we think will make a big difference for scientific reasons. Also thank you to the representative for partnering with me in entering into a new era both psychological and psychiatric and we believe the biomarkers that can be detected and analyze better than ever before may be connected to ptsd and all the things veterans are experiencing. And with our better investment. Finally thank you to the representative and our Ranking Member on the subcommittee modernization and we were looking at the data from the Electronic Health records to have artificial intelligence. Are there links between that information we have and the data set and the outcomes of our veterans . Theres a lot of work we need to do and then to demonstrate success of the entire Health Care System as a whole. Thank you mr. Chairman and to my cosponsors and to the Ranking Member to uphold that tradition of bipartisanship. We are very lucky and i yield back. Thank you mr. Lamb. I know recognize the representative for five minutes. Thank you chairman for speaking about this today. The v. A. Research Technology Act is a bipartisan bill and i will also speak about the exposure and recognition bill. So the v. A. Research Technology Act so to talk about veteran suicide and as a market on a markup. So every day 20 veterans die by suicide and that is too many perk im honored to be part of the work to be suicide among veterans which is with the v. A. s ability of a Clinical Trial it established within the v. A. To have those views of research to ensure accountability here in coastal virginia had the privilege of 92000 veterans one of my Top Priorities in congress and the support they need during the challenging times and then to prevent veteran suicide i look forward to bringing this bill to the committee the second bill i would like to discuss today that bill that is in draft form contending with much more exposure to other regional matter with the media longterm medical conditions my bill would remove barriers hindering the need with that exposure in airborne hazards since 1990 and also with the claims for disability benefits as they have the approach to these exams. And those four Research Findings this bill considers the evidence we have today to include the disability claims process thank you for allowing us to discuss this. Thank you representative. I now recognize myself for five minutes to discuss these bills but before i discuss these provisions, i want to underscore veteran suicide so half of my staff our veterans serving members of the military lead staffers who have been working tirelessly on Mental Health are not only scientists but also come from large military families that have personally experienced veteran suicide with their loved ones. I have felt this tragedy strike close to home and thats why we are determined to pass truly comprehensive legislation. As you have just heard from her members and as you will hear from our witnesses there a number of studies reports and Data Analysis in the senate bill on which we agree we cannot waste the most important opportunity to advance Suicide Prevention legislation without adding provisions that are more comprehensively reduce the actual suicide rate experts that the white house convened is a President Task force agree on the most critical of these additions our native veterans have an incredibly high suicide rate and ongoing problems with access to care at the v. A. And we added provisions to address this gap. The study tells us the Community Providers well many outstanding are not as wellprepared as the v. A. Own staff to have competent and effective Mental Health treatments to our veterans. We added a division to address the gap that v. A. Has piloted its own very successful Safety Training in partnership with the City Sports Foundation and American Foundation to prevent suicide. And those contractors in talking with veterans about safe storage is highly Effective Research tells us safely storing firearms in the home is one of the few actions that reduces the death rate. So to expand the staff and contractors who get this training and we have closed this gap as well and after decades of research we know that making sure people have networks of coordinated care surrounding them is vital to health and wellbeing. Many of us in many of you working in the veteran space have tried to get the department of defense and v. A. To Work Together to enroll servicemembers in the database prior to separation for those services for which they are eligible. States do this already and with my bill we will finally make this happen. New veterans dont have the bureaucracy of v. A. At the time it is already stressful and the suicide risk. For others because they are already in the system. And finally, few words about my bill to provide care to those who have served our country in uniform and now for whatever reason find themselves in the acute crisis and imminent risk of selfharm. As a committee we approach Suicide Prevention legislation within the cdc Public Health framework to emphasize the upstream prevention targeted intervention for veterans a higher risk and Emergency Care ending in suicidal crisis. We are removing barriers to get stabilization care by saying that anyone who served can get this without ever worrying about getting a bill for that care. Every new edition we make to the senate bill has been carefully designed to fill a gap of the Public Health approach to veteran Suicide Prevention to reach more upstream to get targeted help for those already at risk for challenges of suicide and Mental Health and those in acute distress. We improve the systems of care by better recruiting and training the workforce and getting veterans what they need in every aspect of their lives. I look forward to working with the Senate Counterparts to pass the comprehensive additions included in the house companion and deliver for our veterans and crisis. We cannot waste our chance to do it right i yield back. Now we will hear from our witnesses appearing before this committee and we have with us ms. Lindsay Church Executive director of the minority veterans of america. Government relations paralyzed veterans of america and the National Legislative director of the disabled American Veterans. Mr. Patrick marie director of legislative service of the vfw. And doctor russell from the Healthcare Policy Institute and the president and ceo of americas warriors partnership. I want to advise the witnesses your written statements will be included in the hearing record. I remind you to please pause for two or three seconds before speaking so without objection you are recognized for five minutes. And the executive director and cofounder our Organization Works to create to advance justice thank you for the opportunity to testify today with impacting the Mental Health of veterans for generations to come. As executive director and navy veteran and then with over the 1500 members throughout the world. And with the Us Army Veteran suicide by firearm was broadcast on social media last week. And that that video was so disturbing leaving members shaking and triggered that it just doesnt seem to and. And then to show the community that it mattered. And that would require us to be bolder and braver and more innovative with solutions that we have ever been. And those that are intrinsic to one another and in a matter of gun ownership in the suicide epidemic with the Second Amendment rights of constituents and we are forced to reconcile for the individual protection of government overreach with the necessity of government to protect the most vulnerable among us and in moments of crisis. Seven out of ten veterans and then veterans are almost twice as likely to be gun owners. From ideation to action is less than 60 minutes. If were going to curb the epidemic we have to be willing to accept the conversation of gun ownership a Mental Health crisis must be had as a veteran living with Mental Health challenges i have battled Mental Health ideation i can honestly say im grateful today for every barrier that stood in my way as i was on a path of selfdestruction headed for death by suicide. These are the reason i am alive today. For these reasons we do not support these bills. Additionally for consideration hr 774 the police improvement and accountability act. We appreciate the efforts to have that deep need for reform, this legislation will only further resource to find body cameras and equipment and not provide the desired oversight. Further Police Reform legislation that is foundational he rooted is systemically racism does not truly address the greatest issues. And these are merely educational in nature. And with that v. A. Police reform. To support the minority veterans at the heart of the problem is inextricably bound to those forces to require structural change his time before we move that program and then to serve minority veterans. And thank you for the opportunity to testify today in support of the minority veteran community and happy to answer any questions you may have. Thank you for your testimony. Thank you ms. Church the next witness may begin. Chairman, Ranking Member and members of the committee , pva paralyzed veterans of america thank you for the opportunity to provide legislation to the department of Veterans Affairs and those to address veteran suicide pending before the committee. There are a number of important bills. So most of my comments will focus on the bill to directly impact our members. We are pleased at the efforts we are taking to stem the veteran suicide rate. Among individuals with spinal cord injuries and diseases , the suicide rate is between three and five times higher than the general population. We are unable to have an incomplete picture how suicide impacts veterans with catastrophic visibility. And those to begin incorporate and then to have those unique perspective. Over the past few months we enjoy the opportunity to make these more inclusive with catastrophic stability. And those with catastrophic and those that fall under the purview and whose mobility may be impeded. And then to play a factor hr 7879 the telehealth expansion act that provides through the Community Care program. So we strongly believe eligibility must be contingent for accessibility including restrooms. And such as hallways that are not wide enough for wheelchairs or bathrooms not accessible those that have to sit out and working at the veterans compact act we are grateful that grant recipients meet the needs of veterans including those a spinal cord injury and in section six oh seven and 612 we also strongly support those associated with mental and physical Health Improvement and then participation in these events with formal and informal opportunities. Pd on pva supports the act to that v. A. Taking into consideration many cannot work full time and do volunteer work in the community. Its important to remember looking at Service Connections many veterans have those not from the military service not factored into the ratings. The model may end up skewed with many false positives. We would like to think the representative to incorporate our suggestion for protecting the veterans to care for support veterans families act. We support the intent of the bill we are concerned it defines a Family Caregiver that falls under interpretation only those eligible for the program we asked the language be amended so support is intended for all recipients. To recognize the Early Warning sides of early signs of suicide is the goal of the lethal means basic training act we recommend the training for the noncritical part such as caregivers be developed separately from the v. A. System. It should be done in a format easy to understand. We also suggest allowing more time for caregivers to receive training. Stemming the tide a veteran suicide for community and Service Organization we would once again like to thank the committee for the opportunity that the legislation is considered today we look forward to working with you and happy happy to answer any questions. Thank you for your testimony. The next witness is recognized for five minutes. Thank you chairman, Ranking Member, members of the committe committee. We appreciate the committees hard work and legislation committed today. Its from those meaningful bills to dedicate the existing gap in the Health Care Program to reduce veteran suicide. Those are written on written testimony. We are pleased the senate was Suicide Prevention legislation covering the same issues addressed today and that this committee as well as the Senate Counterpart is to ensure has access to Critical Care and support services they need and deserve. Now is the time for all of us to Work Together to move legislation forward as soon as possible. Standing ready to achieve this goal and i remarked today to highlight a few of the bills most important we are pleased to support many of the provisions of the bill with the safety counseling with the guidelines for Mental Health conditions and to disseminate best practices for Suicide Prevention services. The Grant Programs for health and wellness providing research on outreach are promising and they warrant attention. Other bills include hr 8107 screening and counseling in the mandated followup with the department in crisis however it is critical they not only get timely access to care but also high quality care provided by Mental Health providers to understand military culture, service that veterans face. For this reason supporting hr 75 oh four the legislation that requires enhanced training and standards for providers to ensure delivery of appropriate Mental Health services. Mr. Chairman, as you know suicide by firearm is a frequent method among veterans this will help to address the issue requiring v. A. To develop a Safety Training initiative to ensure frontline medical staff and providers and caregivers and other employees can discuss during the Mental Health crisis. And then should be a part of any Health Strategy that is evident as we have noted and then with the Suicide Prevention initiative and programming. Also pleased to support the bill to support enough family therapist are available with the interdisciplinary Mental Health and then to expand integrative Health Services as well as 7747 with the draft to ensure veterans with the transition of the strongly support this bill be have some concerns of emerging diseases and we look forward to working with the committee and to advance the legislation. The tragedy of suicide has impacted far too many and we feel a sense of urgency to address this issue. The legislation considered today is to make a positive and meaningful impact on the lives of many veterans to save the life. Mr. Chairman again we appreciate the opportunity to share our views on various pieces of legislation under consideration i look forward to addressing members of the community. Thank you. Thank you for your testimony. I call on mr. Murray excuse me. Good morning chairman and Ranking Member and members of the committee. On behalf of the men and women of the four board thank you for the opportunity. With the womens suicide among veterans is what is shared as a top priority. The most recent analysis of veteran suicide data found suicide is fairly consistent in recent years an average of 20 veterans and servicemembers die by suicide every day. Those who are not using healthcare has an increase of risk of suicide. It comes as no surprise members have continued to inform us because of the high quality of veteran centric care that v. A. Provides. To better assist organizations and v. A. Congress must know more about the two thirds of veterans to die by suicide each day without contact from v. A. Thats why this discussion is so important the compact act is seeking to change the focus on Suicide Prevention. Working with Community Partners and engaging holistic programs about pharmaceuticals and for extended eligibility and rigorous studies to determine as many quantitative factors that lead to suicide as possible are some of the proposals discussed today that may finally help decrease the number of veteran suicides. At the vfw we know the value. Any separation with time and distance to their only means is an important step in preventing preventing a fatal decision. We may not be here if the intervention was not discussed ptsd after following years of service he realized he needed serious help one of the first steps he needed to take was to give his weapons to his father to hold until he was better a very real fear he may not be here today if he had access to his firearms during these difficult times. They were returned to him when he was ready i cannot personally think of another individual who is more passionate about their mission as a leader in our community that the organization embraces the intervention and with the effects that could have had the right intervention not taken place we could be a leader or friend to the vfw. For those that interact we believe training could be a lifesaving tool. Individuals who are not trained these discussions could become cumbersome and unnecessary with these interactions we recognize the value and then more judiciously through every v. A. Employee immediately without additional training. The vfw recognize a potential barrier to seek emergency Mental Health and financially driven caused by different criteria. The vfw from recent Actions Services to discharge veterans for those other than honorable discharges. However v. A. Is required to charge the full cost of emergent Mental Health care. But they cant build other Health Insurances but they must not be required to put the undue burden on veterans who survive a Mental Health crisis particularly because financial instability is a contributing factor to a Mental Health crisis. The fear of being turned down for care should never be preventing for seeking healthcare they need Congress Must exempt those who have served for urgent eligible on Mental Health care from having to pay the full cost of such care. There are a few proposals discussing today with due process taken into account in discussion those certain rights should be given due process. Regarding government prohibitions and government contracts for those individuals rights should be part of due process. No person with life or liberty or property. Mr. Chairman and mr. Ranking member thank you for the opportunity to share today at important hearing. So ge proceed to a thank you for the privilege to testify. On behalf of the veterans Healthcare Policy Institute, nonprofit think tanks Whose Mission is to furnish analyses for Optimal Health care for veterans. Spent decades as a clinician and administrator and was a contributor to the task force. This is a Pivotal Moment in the care of the congress has provided resources to address veteran suicide and thinking is show for it. One reason is the resources remain short of what is needed to keep up with demand despite the increases in the number of providers that ratio that has been shown to prevent suicide and more basic reason has been to capitalize on the known impact of access to firearms and suicide. Firearms out of every ten veterans suicide deaths and the strategies to save lives or underutilized. The proposed discussion includes mechanisms to correct these deficiencies as well as much else. Foforemost, they embraced embrae approaches that it would take a veteran with suicidal impulses. If an agreement that this kind of policy is needed. For starters, the white house june 17 report proclaims, quote, the key component of Suicide Prevention is voluntary reduction in the ability to act in respect particularly during suicidal crazies. Gee whiz crisis. The prevention training and another route t works to increae implementation of the programs focused on the safety. Gerard stakeholders to subscribe to the utility of the prevention strategies. The foundation, the industry restricting access to firearms for those with a risk of suicide in the provincia potential to uo accomplish this. The u. S. Concealed Carry Association had a recent video webinar preventing suicide and the Second Amendment organization educates the distance is the Second Amendment and state the right to bear arms comes from the responsibilities for the firearm suicide. The atrisk for the privately owned firearms to ask if they voluntarily started with safekeeping. Many of us across the spectrum have given clear direction. To the acceptability of the policies need to underscore the temporary nature of the state because a crisi the crisis while conveying the respect for the firearm ownership of a. There is far more being considered to help them achieve into the particular note it has a range of bills that much further to strengthen the legislation and these examples will have large beneficial consequence of the escalating military service when they are the most vulnerable to suicide. They act as sure as well as the va Mental Health staffing they furnish its expert and as noted to ensure the training and Suicide Prevention. In this mode of time not able to further delineate i would refer you to the written testimony analysis and i do thank you for this opportunity and im happy to take questions. I now call upon carl. Please remember to pause for a few seconds before beginning her testimony. Ranking members of the committee thank you for the invitation to testify today. I would like to add not only the written testimony that was already added that the letter of august 18, 2020 is submitted and be added for the record. Without objection so ordered. Since the congress convened on january 32019, the president of the department of Veterans Affairs and both the senate and the house committed to addressing veteran suicide epidemic. In those 615 days approximately 12,300 veterans died by suicide and despite increasing the budget the number continues to rise. In the last 18 months, the president signed an executive order to prevent veteran suicide. They established the present task force and the Senate Passed one of the most impactful prevention bills of the last ten years. Yet we continue to lack a comprehensive integrated law implemented by the va and the veteran suicide. In early august partnership with 30 of the Community Partners provided this committee a letter strongly supporting the senate bill 785 also known as the veterans Mental Health care improvement act of 2019. As the breadth and depth to getting the stream from veteran suicide, innovative, the integration of Community Grants to practically connect before the crisis of suicide. Combined with a Critical Community enablers such as Research Studies correlating opioid related programs with sports, posttraumatic growth and Recreational Therapy and research in this Mental Health biomarkers which is key. The families of the nation are losing hope that the government will act. Especially during the summer when times. The need is great and the need is now. The partnership is leaning the suicide study called Operation Partnership with the university of alabama and funded by the bristolmyers foundation. This study is showing some of the states are undercounting veteran suicide by as much as 25 . Today we have learned the rate among the dishonorably discharged Veterans Service members is far less than that of honorable discharged. Veterans younger than the age of 64 dot if all causes of death for times greater than veterans sadly between the ages of 18 and 34 died at ten times greater rate than non veteran. I would like to publicly thank the Suicide Prevention team to the department of defense for partnering with us as we peel back another layer to this is like an onion. We are currently working and welcome incorporating any Committee Members and states of the future. We seek to provide Community Insight to help them get upstream for veterans of the site and increase the quality of life for veterans and their family. Getting upstream is not just Mental Health but it includes Mental Health. Introducing access to Reliable Transportation and maximizing education opportunities. Its working in sustainable employment and its increasing volunteer opportunities and having access to 22nd century physical and Mental Health care. Getting upstream is achieved when the veterans what the future with hope. But again, on this issue time is not our friend. The nations veterans and families provided us their opinion through a program. When we have over 600,000 veterans and families as they learned of 93 percent do not believe the country is doing enough for the Mental Health of our veterans. 77 believe dishonorably discharged servicemembers should receive health care and 86 feel the va must partner with nine governmental organizations to prevent veteran suicide. In summary, the time to act is now. We strongly encourage the committee and house of representatives to about 785 as passed by the senate which gives communities, veterans and their families the means to save lives. To currently address what he is identified and propose for the consideration prior to the end of congress, senate bill 785 is the right buil bill for right nd i joined the leaders of the largest veteran community, but this in urging immediate action. In closing, i am hopeful for a military success ending veteran suicide. Thank you for the opportunity to present to the community today. The thank you for your testimony. Before i begin to questio the qd im trying to bring up on my screen i can now see the clock if members, there should be a timer im trying to make sure im able to see it and make it bigger but i do see it now. There is a timer that you can put before you. With that im going to recognize myself for five minutes of questions and im going to begin my questioning as a clinical psychologist and former chief of psychology within the va and a member of the task force, what is your biggest concern about 785 if nothing is added to it before it is an active and be sure to pause for a couple of seconds before you respond. As i said during my oral testimony, that would be an absolute critical edition that isnt in the Senate Legislation at this point. Do you have any concerns about passing 785 as it is . Thank you for your question. We will followup in writin foln your office. Okay. It is an important issue that needs to be addressed as it was stated in our testimony. They were actually asked by some of our members why we are not having numbers that attempted suicide as some of the spokesman for these issues and frankly, the problem is veterans dont attempted suicide, they commit suicide. Because of the use of how they die by suicide. What priority is our there that we could address with the proposed addition by the house . Please pause for a couple of seconds before responding. Thank you, mr. Chairman. I think that as my colleagues just indicated, a it is a very important one and in a couple f others that i mentioned in my testimony in my oral statement with the safety planning that is essential and has evidencebased results from the as well as the clinical culture act is another point we want to make sure that the standards for those providers in the community are the same as those three bills over essential. What priority is can we address to the bills we are discussing a . Thank you for that question. I think for us its important to finish it to be able to receive it. We appreciate that they listen to us and put in requirements to ensure programming for the accessibility. No matter how great the programming is, they can access them and we hope that these requirements are put into any future legislation. Thank you. I understand the urgency of the past as 785 but what gives me pause or the veterans we leave behind in legislation that is not inclusive of the veterans that have been excluded. It rings hollow when there are those that have come to expect less. Who do we continue to leave behind without any additions as they try to provide in the bills today, can we close the gap if we offed out of the legislation before us . Our greatest recommendation and the people we continue to leave behind our veterans of color. We have continued to leave veterans of color and infected intersection of that out behind. In addition, most of the data and research being proposed is impactful but doesnt include race and ethnicity when talking about most of the data that they are looking at so one of the greatest acts is veterans of color and it doesnt include race or ethnicity as a component of what we are looking at. We have a few seconds left to give an answer to the question. You want to make sure everything put forth is meaningful legislation and we hope the committees can Work Together to get legislation passed. Its common sense that they should be included. That is inclusive of a number of issues. Thank you. I appreciate a response. My time has expired and i now call on the Ranking Member to ask questions for five minutes. Thank you, mr. Chairman. I want to get a couple of shout outs i dont know if i will have the chance or not while im still in congress as it is my last four months to see and give a shout out. I have really enjoyed working with you and i want to publicly say that youve been a great advocate and i just want to let you know how much i have enjoyed your professionalism and working with you in the congress and the second i want to give a shout out to captain butler, the ceo that just got promoted. I never understood all that stuff since i never understood what the rank meant, but congratulations. And i do want to start with a couple of quick questions. In your statement you said one of the advantages of the wellbeing to prohibit the veterans at risk of suicide from receiving individual or Group Counseling care from guarantees. How can you be aware of the right and believe in good conscience preventing them from receiving counseling through a va supported society prevention program, how could that possibly be a good thing . What you said is right. In my statement i was talking about several veterans. Sometimes you dont know that. Someone could become known suicidal, but thank you for clarifying that. I appreciate that. And my question, and this is one that has bothered me a lot and any of you do you agree that with the Wounded Warrior project you have provided care for individuals without veteran status that would divert scarce resources to that is a dishonorable discharge those members with dishonorable discharges we believe that its where we patrol the line in the sand. There is a lot of veterans out there that have made mistakes in their Service Careers but that shouldnt affect them for years to come. We do feel they shouldnt be afforded the same right. You need to cross a line that is very severe and those are not individuals we are here to advocate for a. You are right many of them it is criminal acts and so i appreciate that. Why are they concerned condescension and im taking lethal means training as they would be under 80 for . Our concern is the way that its currently written they a gd interpreted in a way that would allow the training to go to veterans that have caregivers under that specific statute and so we want to make sure that its written for all. A couple of things i want to get to because my time is short, to form a commission to look at our providing benefits and categories, its an extension of what we did in the act and i would like to know why theres any objection to that. To me it is an extension of what we have already done. Weve done a tremendous job and i get asked all the time why cant i get in the va and i cant answer it. Many people the threshold income is by 30,000 or something which isnt a lot of money these days so i will stop before my time expires. Your explanation is helpful with regards to looking at the Priority Group and some of the things you expand on. Again we dont understand why it would be necessary and right from the get go. They havent been addressed by any committee that i can remember. I think that would be a good starting point for discussion. As you know its been a while since the reform was established so looking at that we dont have enough staff but we would ask that congress and the appropriate committee to be looking at it first and having that discussion may be before the commission. Thank you mr. Chairman i will yield back. Thank you, Ranking Member. I will now call upon ms. Bromley for five minutes. I think that your microphone is on mute. Thank you mr. Chairman. My first question you reference the university of alabama studies. Do you have any data that breaks down specifically suicide by ethnicity, race, sex, do you have a breakdown with regards to that . We do have that data. We are going through it right now but we have ethnicity, religion, all of the areas that you talked about. We do not have that is something we would obtain through our prospective case diving into the counties but on the retrospective we have everything but that. Can you share that data with us click yes we can. But can you share it with us right now . I will be able to. University of alabama researchers are combing through it, we polled 494,000 records from the department of defense with 55 different fields so we are going through it right now and we will make it available to you and the committee as soon as we have it. If the data is coming directly from the department of defense, will that include all veterans . Yes it will include everyone that served. Its not only of those who are honorably discharged but its a characterization and the reason for their discharge, the reason why they were discharged for service. With regards to that breakdown is very much like to see it but i think what we do know is the suicide rate is higher than native americans and we do know that when insisted the site is higher than women not in the military. We know some of these facts and so i guess obviously you have been a very strong supporter of the senate bill which is a good bill just feel like its not comprehensive enough. Wouldnt you agree that we should be including the Mental Healthcare support a are fully supportive of the work with native americans and actually all veterans. Regardless of your race, ethnicity can religion, belief, you raised your hand and served honorably and we believe everyone should be served. We just feel we grew up in the schoolhouse rock house legislation and appoint his spleen of thlenothat time is rud through the Senate Unanimously we dont want to have the time ran out before something gets passed. As i said, the bills that are proposed through the house have a great deal of merit its just candy work concurrently for the bulk of the bill passed quickly can you hear me okay . That relates to the act in which it requires our Community Providers to have not only military filter but psychotherapeutic skills confidence as well and thats a bill that would bring us to the same level of qualifications and standards analysis to the va. We dont have equivalent standards by the same measure. Thank you. I see that my time has run out and i will yield back. Thank you for the questions. Representative, you are recognized for five minutes. Thank you mr. Chairman. Thank you so much. Im glad to see that continued focus on Suicide Prevention and Mental Healthcare. Im hopeful again we ca that wea bipartisan bicameral agreement including on the Senate Passed through 75 time is running out of the session, but again this is critical that we get this done. My question is for the whole panel. Hr 74 the teen culture act that requires the Community Care providers to adhere to the same Mental Health standards as providers and ensure military culture to continuing education providers participating in the communities. Some have expressed concerns about the potentially burdening them on th va providers by makig the standards greater than those required. I understand the concerns and we wouldnt want to have them on providers unnecessarily go beyond what the baseline is, and perhaps we can clarify that language and protect the language. This question is for the panel do you have any suggestion for approving the snow and do you agree that there should be robust but not overly burdensome standards across the board . Whoever would like to present first, that would be fine. Thank you for that question as it was stated in the testimony of the reason the vfw members prefer the va is because of the high quality veteran centric care that it provides. We would expect that all contractors and Community Providers adhere to the same standards. Those are mean were meant to bea supplemental addition to the va health care, and we do not want that to be lesser than the va. We want it to be the same or better. This type of standards need to be set to keep the high quality of care for veterans coming. Thank you. Anybody else on the panel . I would add to that we feel strongly as well about that and we were disappointed when they were developing the network and we were told developing the contract of some of those standards were burdensome. Anybody providing the care if the standard we all appreciate and its evidencebased and based on the understanding of military service. Okay so you are pleased with the language and our bill in other words you shouldnt be amended and you do not feel that its overly burdensome for the private providers . We can make the same standards as the providers to. Anyone else. Mr. Bilirakis answering the previous question i think that you are right you dont necessarily have to go beyond the standards but we do want them to come up to that at this point in time. They do not match the va standards. Okay. Do they have any suggestions, does anyone feel the standards are overly burdensome . But they go on to the next one. The next question that testimony acknowledges the discussion of the draft bill an, the exposure recognition act that the report from the National Academies of science and medicine are the respiratory Health Effects of airborne hazards exposures to end the report is due at the end of the week. As it is based on the Bipartisan Senate bill from senator sullivan, it departs the bill is adjusting emerging disabilities without knowing what the consensus and the medical community has concluded. Can you elaborate on the position on emerging disabilities in the draft bill and suggest that the language forward that provides a confession of exposure on why this is important for the veterans please. Sure. Appreciate the question. We want to make sure what type of chemicals theyve been exposed to and should be able to file the claim for the direct Service Connection based on those related conditions were present at the disability we believe that if National Academy finds this disabilities or related we just dont want it to be so limited to those for because there may be other emerging ones that we just would like to see a slight adjustment to reflect that. I wanted to start by talking about the wii would attempt to use and expand the complementary integrated alternative Health Services available to the the therapy, chiropractor act, you name it does a lot of things available, and i think what strikes me about these programs is how popular they are with such a variety of veterans. It got the chance to visit the h the office of the washington, d. C. Va where they went from people younger than me to just really enjoying. So to me, one of the benefits of deepening our knowledge of these things and not just sort of staying and expanding on one but using pilot programs to figure out what we can learn and how we can smartly expand and deepen the services, they give veterans a little bit of a sense of control and hopefully will invite more veterans in. We all know one of the spots we had if they are not going t to e va for whatever reason white house there is a certain extent we can get some things that they might want. We might be able to. So lets move on and talk about the way that the words used and perceived these options would refusoptions wouldrefuse entry r there is anything you can tell us about what it is that your members would like to see are the impacts expanded . Thank you for that question. Excellent bill. The i appreciate the look out what is the effectiveness of these types of integrated health alternatives. Theyve had an opportunity working with other veteran. Its done wonders for them and theyve developed lifelong friendships with other veteran especially women that are installed as they benefited from these programs and i think it we know so many people we have to turn this into cover up symptoms but theyve led the way in saying i dont want to be able to gee whiz i dont want to take medication if they dont have to. I want to try alternative thing so these are excellent programs and making sure veterans have access to them is important. We want to make sure everyone has access to. That is our goal is also thank you for emphasizing that because that is the biggest thing that i learned is a lot of times they require sort of voluntary interest by the va staff and personnel at different clinics and hospitals that want to get the whole Health Training and provide the services on their own without much budget or for leadership and so if we can push them we can help make sure they get access to this stuff everywhere and dont drive as far to see an acupuncturist for example. So we appreciate your input and thank you again for taking part in this new way of hearing and mr. Chairman, i will yield back. I know recognize the representative for five minutes. Be sure to pause for two seconddegree began to. I want to express how proud i am to be part of task force. I think weve done some good work so far and i hope it lays the groundwork for real change well into the future. Thanks to the chairman and Ranking Member for holding this hearing. Thank you to all of my colleagues that have worked on all of the Bipartisan Legislation on todays agenda and thank you to the panel. I have a question for ms. Church. Your testimony reads congress should, quote, mandate the vas ability to pay child care sectorschildcaresectors, childcr Childcare Providers, all individuals employed b by such organization has been charged with a crime involving minors to undergo training relevant to crime and be deemed fit for work [inaudible] with childcare workers in the state which the organization operates, end of quote. Do they believe that they should be required to pay for individuals that have been charged with, say, child molestation and they are awaiting trial so long that as they receive training how they shouldnt molest children, why or why not . Thank you for the question. Admittedly this is a difficult question for myself. I am a survivor of childhood molestation myself. This bill isnt helpful to me as the daughter of a military veteran who was interested in the care of a caregiver that molested me while my mom was serving. If i put my personal testimony of side i also have to recognize people of color and a lgbtq aree likely to be affected. We need to be able to be rehabilitated gee whiz excuse me, i am a little bit nervous. By making it so the va doesnt pay for facilities to employ these folks even if charged we are actually eliminating pathways to employment for folks have been involved in the Justice System and continuing to perpetuate recidivism in our society. We have to be looking at these issues in a very different way and complex way than looking at it only as parents. We are also parts of society that are working to undo a racist and Homophobic Society that builds our criminal Justice System to impact our community greatly, so i do believe that this legislation has merit but also needs to be interrogated further to make sure that its not actually creating more systemic oppression by our society and continuing to perpetuate. The testimony expresses support appropriate candidate and staffed to ensure that they are safe and properly cared for. Do they support hr 3788, why or why not . Yes, representative. We referenced in the testimony that we have resolution to support in general childcare for veterans who are seeking care for the Service Connected disability. The legislation goes a bit beyond that and our resolution is pretty narrow on the bill that may comment it didnt have an objection to the recommendations made in the bill. Thank you mr. Chairman. I yield back. Thank you for your questions. Mr. Levin you are recognized for your question. Thank you, chairman. I appreciate your work to improve upon s. 785, the commander of veterans mentalhealth care improvement act and i look forward to swiftly pass a comprehensive solution to prevent veterans beside. In particular im glad that the veterans compact discussion draft hr 5516, the commitment to the veterans support and outreach act. This bipartisan bill establishes a funding stream to support the work of the county Veterans Service officers. Cbs knows are an invaluable resource to help the veterans and their families understand resources at their disposal, final benefit claims that represent the veterans in the hearings. The Services Deliver more than 52 billion in benefits to veterans each year, therefore strengthening the veterans access to care and economic support which we know are the key strategies to prevent suicide. We also know that they are trusted and communities and often the first day reach out tt to the media for other forms of assistance. They are in a key position to reach and engage and identify atrisk veterans who may not be utilizing the care or other support systems and we must empower them with more resources to do so which is exactly what hr 5516 means to do. They would use these funds not only to support the benefit claims but also to help this health and Wellness Programs for Suicide Prevention and outreach out and im proud that this bill has been endorsed by Orange County and San Diego County where i represent, and im grateful to all of our local cbs in the communities. Elsewhere through the state and country including in wisconsin, arata, texas, minnesota, alaska and new york as well as National Organizations such as the National Association of counties, National Association of county Veterans Service officers, National Association of state department of Veterans Affairs and disabled American Veterans. The ten new each expand on the importance of assistance to fore Member Service officers to your members . One of the primary missions is to help assist veterans acrosstheboard, whether they are our members are not in helping to adjudicate the claims. Its one of the primary missions so we recognized the value of the Service Officers around the country. The biggest thing is to always make sure whether they are accredited and we do want to make sure there are not flybynight folks coming in to put a dollar in their own pocket. Its a Critical Service for veterans and we highly endorse it. Thank you and i share your concern. I would add that the same. Our Service Programs or paramount program. These are the first touchstones for veterans who may need assistance and those people out there to make sure veterans can learn about their benefits or other resources that they need, so we are very supportive of that. Think. One related question. Can you share the fun thing limits affect the officers work or have additional fun and might improve the service is . That is for any of you. We were proud to partner with the National Association of officers. Your bill is on track. What we see is the health and welfare of the veterans in the relationship thats close. The Service Officers are close, consistent and have the means to end additionally they are appointed by their counties and to the accreditation the point is they are the closest Government Entity and most that i know most. Very true and out of time but i just want to begin complement those here in san diego and orange counties think you and i will yield back. You are recognized for five minutes for questions. Thank you mr. Chairman. First i want to start by thinking that representative for their leadership on both procession medicine and access to Suicide Prevention. Both of these pieces of legislation will help the va better understand and treat those that are at risk for suicide unfortunately, they havent been taking enough progress over the past decades in reducing the number of Service Members and veterans who are committing suicide. The va procession medicine act should also go a long way to identify the brain Health Markers to determine which veterans are at risk for depression, posttraumatic stress and other treatments, other threats of Mental Illness. The legislation also requires the va create a data privacy and security measure to keep veterans information secure. In your testimony they said they had some concern about the Data Security and privacy of the veteran. Can you please expand upon your testimony and do you have any specific proposals to secure that data . We do want to make sure that the amount and we know wit windf the Genomics Program as well but this is the concern of some veteran sweeper to make sure its not used in a way that would be benefiting the for treatment purposes. Over the genomics and medicines and things like that so they will cope to get to feel comfortable if it is used for Research Purposes and to better provide treatment everybody agrees with you on that and we want to make sure that information is secured. Its always a risk what they come up with. The access will also make it more accessible for risk. It builds upon the previous legislation that we worked on to better understand the Suicide Prevention Coordination Program i want to thank the witnesses here for their support and also implicitly say i want to express my support for the Second Amendment protection act and hr 3450 from the representative as the Ranking Member i believe the Second Amendment right shouldnt be taken away by a government bureaucracy. This is a bill that would ensure that wouldnt happen. Many do not come forward and seek the help they so much provide because they are afraid of that particular possibility and with that mr. Chairman i would yield back. By now recognize the representative for five minutes. Please pause for a couple of seconds before you begin. Thank you mr. Chairman. I want to thank the panelists for being here this morning. Last year the House Armed Services committee. I joined with a letter following thought they worked together to ensure a warm handoff as the servicemembers transitioned into this question is for everyone on the panel. All of you on the panel have expressed support for ensuring the smooth transition act discussion draft to automatically and all eligible veterans into the Patient Enrollment system. Can you speak to the importance of this small change ensuring a warm handoff and why this can represent a hybrid period for suicide . I think your bill is important entering the former handoff, care is critical and i will speak personally when i transitioned out, life got in the way and have i been abl hado enroll when i was in active duty but when we transition out come of veterans is really busy and access shouldnt be something that gets in the way. Anyone else care to comment . Transitioning during the period where we know they can still feel disconnected and having a difficult time in the readjustment. We want them to know there is a seamless way to transition and we will be focused on helping them and whatever may come up during the period. Its a great bill and we appreciate that. So many dont have the support they need any more, they get into trouble in the struggle which we dont want to happen. We want them to know that they have access to the va. I want to echo what was just said. Supporting the notion that that single transition is going to be helpful and i want to just ask but also in the compact act, section 101 is providing benefits for these transitioning servicemembers its just a complementary way in which its going to increase utilization of the va during its first year and as you noted the first year after discharge is the time of the highest rate of suicide. Thank you all for those answers. This is important to me because as mentioned, i did miss my window. Wife took over, i got out, found a job and committed to working the new job. But its very important we make the transition smooth. And then to disseminate to share the best practices can you give a better understanding of how the intersection between Mental Health and Substance Abuse and how they impact veterans on military Sexual Assault . Your comments are exactly right. Substance abuse is a co occurring disorder with the Risk Assessment for suicide and the basic premise is right and so within the v. A. And outside the v. A. I yield back. Representative done you are recognized for five minutes. First thank you to the chairman for scheduling this hearing for veteran suicide and also the number one cancer concern which is Prostate Cancer. I would like to spend more time on the subject and i am very grateful to you to address these topics now. I would like to close by the former chairman and the Ranking Member. Its a pleasure to serve the last four years and thats a great credit will be talking about you long after your grandchildren. I yield back. Thank you for those kind words and appropriate compliments. Representative you are recognized for five minutes. I thank you chairman for holding todays hearing and everyone for joining us so the morning of september 11th with the victims and families of 9 11. I ask unanimous consent of my bill 1524. Without objection. Thank you. I want to ask my two questions. Let me start with mr. Marie. Thank you very much for the vfw support including that active Guard Service status. Why is it important those separating from the service of the National Guard are eligible for this coverage . So do you think that would require more facilities that currently do not have them in the district . Thank you for the question. We are thinking that componentbased is a unique challenge going back into normal society and to provide that care provides a very heavy burden from everyday life we think its a great start any with disabilities or illnesses are taken care of but then we see if we can get that program going. Thank you. So to look at those with the army reserve and activeduty its been difficult in many servicemembers sign off on other parts of the country. One last question. In my district the single year is jurisdiction at home. But sadly you serve as the chief psychologist the San Francisco v. A. Speaks to the role of the willingness to seek Mental Health services and those that are necessary with that eligible population with the veterans. You are saying in that location there is lack. So the premise of your question is right so then where do they go . We need this to land in the v. A. System. With the veterans compact act is enacted into law give us an educated guess on what needs to be established from the country . Any idea . Or what needs to be established. Im sorry i dont know the number thats needed but your premise is right it is a great landing spot for veterans to articulate. And its a good extender for the v. A. Care. I way over time. Thank you. It is nice to see all of you. Before you leave your questioning was spotty did you ask to insert a document into the record . Yes hr 5024 seeking unanimous consent and also support from the committee to incorporate the language into what i think will be part of the act you will introduce. With regard to your request to insert the document into the record, without objection so ordered. Thank you sir. General you are recognized for five minutes. Good afternoon mr. Chairman can you hear me . Thumbs up. Thank you for doing the hearing. This reminds me of a lot of operations ive been in around the world to do that teleconference while the troops are out fighting. Not get to the point very quickly. Can anyone on our panel time not panel explain to me why the wording of the compact bill Group Counseling what is left out and only Family Counseling is included for the veteran . I will just start by saying in individual and Group Psychotherapy or general domains for outpatient non urgent care. And that is what is intended for Emergency Care to identify those services that tend to be identified. Spent the vast majority of young men and women who separate or are released are single. Then if the personal on person has suicidal ideations a last place you want to do is do Family Counseling. So the goal is to prevent suicide so i am more than a little concerned we just flat and this by eliminate that Group Counseling. So when we get back to dc i would like to set facetoface whoever from the v. A. Committee wants to sit because i believe we will spend all this time and effort trying to do the right thing and miss the forest for the trees by eliminating that. The goal is to hit the target market. I will not belabor that point other than to say i believe the individual needs to be able to seen and dont write the bill so there is a reason not to include them in this new effort. Second, section two oh two gives perspective to grantees to offer a collective impact model. You previously submitted testimony about the flaws in that collective impact model. Can you please for the group to explain the flaws do you have concerns of the ability to function in rural and remote communities . The issue that we have is we support the agnostic not onesizefitsall but the community should have a choice it is more impactful when those that are available to veterans. That impact is organizing organizations that is a veteran centric approach for when those are not available then you reach outside of the network. The reason why we support 785 is because it was agnostic. They didnt describe the method you should use. By describing it you will exclude it wont work in the rural issues of montana or michigan where they are from. My time is rapidly approaching but thanks to everybody for all the efforts you put into this. And we need to bring senate 785 to the floor and the house. I yield back. Im wondering if i could amend word i said earlier the issue around psychotherapy is differentiation there is a compact act is intended to say those are not be available for outpatient care. We dont want to make it confusing to the locals who try to implement this a different way. Because you understand it and i would understand it but to the average Small Organization now included in this to make the outreach to the veterans who are outside the system, the goal is to bring them in. To give them the care they need but not to make it too confusing for those rural organizations. I yield back. Thank you general i now who is the next person . I guess were going to miss under word. Thank you to all of our witnesses and then to develop my bill for the Safety Training act. According to the v. A. National strategy for a veteran crisis to reduce access is intervening saving lives starts by training v. A. Providers and staff you have proven important conversations how does lethal means training fit into a Suicide Prevention strategy . So with the National Strategy the v. A. Suicide prevention strategy all three have nearly identity identical core goals with suicide risk and to provide training. You briefly describe how the lethal means training has evolved over the years . And with that course and to refine the training. The private sector is coming on board with that roadmap. Its also important to give recognition to all the organizations in my a testimony to have access to firearms those for Suicide Prevention and department of defense. Leaders agree on the importance of training in some see it is already defeated we have a wider pool of interactive veterans contractors and Community Care providers. And then to ensure quality of care. It is essential with the autonomy to work collaboratively and then that population especially half of those who have died from suicide had no Mental Illness this is optional for someone who has never had training and to see those commensurate. Could you tell us from the veterans perspective why this is expanded . From the veterans perspective i was able to attend a conference in San Francisco earlier this year hearing for veterans directly and when the provider occurred talk to them directly if they have firearms available to them if they were having a difficult time in making a plan to work with a loved one to make sure that they were accessible during this period when they were strugglin struggling. Is very impactful and it shows veterans and to talk to that about that in a way and thats to make essential to make it work. Those that are in attempts less than half took place less than five minutes that is why it is so important. Veteran to sacrifice so much for us to empower all those to create barriers from a suicidal threat thought thank you to the witnesses for being here today and the work we have done for the veteran community. Are there any pet one members of this hearing who have not ask questions and would like to . Any members who have not ask questions and would like to ask questions . If not you may have any closing remarks. Also it is a privilege to serve in this committee clarify the statement on the senate bill earlier because my fear is remember the fiasco at the end of the 115 . That we had to take up his chair in a 116 to get past. Our staff and vigorous discussions we were so to speak to each other directly and we have a pathway there well find in a way for the agreement to move forward with both of our pieces of legislation and i think we are very close. But we still have some final touches given how important this legislation is i am more than hopeful. But if we change it, we dont take it up next week as is. And then we understand that completely the senate will look seriously. And with the bill that i would agree that the senate word hotline the bill. s so on this point to amend the senate bill i have not been made aware of. And the bill would be debated next week and that you would work those out and then they would mark them up and the senate would take them up. We dont have any amendment and to look for some reciprocity. And then that would constitute the committees legislation. And then it gets very close. And we appreciate the member members. This is not your swansong with a couple more things to do but it certainly is not too premature. With that sentiment i recognize myself for five minutes for closing comments and thank you to our guests for appearing today and thank you witnesses and for all the work you have put into this hearing its been incredibly important that most of you agree we need to do more than just 785 and your Mental Health organizations see to bring about real change we have their very real risk to waste opportunity of veteran suicide to reduce suicide death if we bow to political pressure the most promising evidencebased approach today with the power to enact these just as quickly as 785. Will need to rise above party and expediency and to the occasion that the tragedy demands as secretary mcdonald eloquently said it referencing yesterday it is our duty to choose the hard right not that easy wrong. All members have five legislative days to revise and extend remarks with any extraneous material i thank you all for appearing today. The hearing is adjourned