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

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 begi i am going to begin my questioning with Russell Lemle. As a clinical psychologist and former chief of psychology and member of the Defense Task Force what is your biggest concern about after 785 if none of the house priorities are added to it before it is enacted and pause for a couple seconds before you respond . As i said in my oral testimony i spent most of my time it would be a critical edition that is not in the Senate Legislation that would make a huge difference. Thank you. Lindsay church, any concerns about passing 785 as is . We will follow up in writing with you in your office. Patrick murray, same question, what gaps do you see in 75 that we can address . The lethal means Safety Training is an important issue that needs to be addressed as stated in our testimony. We were asked why we dont have the fw members who have attempted suicide as spokesman for these issues and the problem is attempted suicide. Veterans commit suicide, something that is very effective because of the use of they died by suicide. What priority does dav have with the proposed position by the house, pause for a couple seconds before responding. Thank you, mister chairman. The lethal means safety planning a very important one and a couple others i mentioned in my testimony an oral statement, the emergency department, gotten some evidencebased results, 7504 hr 7504, another point on so many of our veterans in the community, providers in the community the same as the va, and essential one. What parties can we address for the bills we are discussing today . For us it is important that all veterans who need these benefits be able to receive them and the committee listen to us and shift requirements for veterans with disabilities so they can access them and we hope these requirements are put in any future list. Thank you. I understand the urgency to pass 75 but what gives me pause our veterans we leave behind in legislation that is not inclusive to those who are excluded, to brush at their expense. Saying perfect is the enemy of the good rings hollow when there are veterans who have come to expect the yogurt. Who do we continue to leave behind without any additions as we provide the deal today. Can we close the gap now with the legislation before us, Lindsay Church . Our greatest recommendation to people we leave behind, veterans of color, most of our panel, all our panelists are white and we view veterans of color and the impact and intersection analogy behind and in addition most of the data and research being proposed is impactful but does not include methods when talking about most of the data they are looking to collect. One of the greatest disparities are veterans of color, with multiple legislation that doesnt include race or ethnicity as a component of what we are working on. A few seconds left to get an answer to my question. You want to make sure everything put forth is meaningful, thoughtful legislation and we hope the committees can Work Together, do it expeditiously and get this past so they dont seem controversial and common sense that theyd be included and not pulled back moving forward on legislation including a number of issues. Appreciate that response. My time is expired. I now call on the Ranking Member to ask questions for five minutes. Before i started i want to give some shout outs, i dont know if i will have a chance or not in congress, my last four months to give a shout out, i have enjoyed working with you. Youve been a great advocate and i want to let you know how much i have enjoyed your professionalism. Secondly i want to give a shout out to captain butler, Jeremy Butler who just got promoted. Never understood all that stuff. I am an army guy, congratulations captain butler. And i want to start with a couple quick questions about Russell Lemle. You said one of the advantages of the wellbeing for veterans act would prohibit suicide for receiving individual and Group Counseling care. As a clinical psychologist, aware of the suicide rate believe in good conscience preventing suicidal individuals from Suicide Prevention program, how could that be a good thing . What you said is right. I was talking about nonsuicidal veterans. Sometimes you dont really know that. Someone can become nonsuicidal, thanks for clarifying, appreciate that. A question, this is one that has bothered me a lot, you can answer or new zealand or whoever, do you agree with the Wounded Warrior project that providing care for individuals without veteran status, what the excess act would allow would diverge scarce resources a dishonorable discharge . Mister Ranking Member, those ask servicemembers with dishonorable discharges reveal the line is a little too far, we draw the line in the sand. A lot of veterans made mistakes in their Service Careers but that maybe shouldnt affect them for years to come. We feel dishonorable discharge for ask servicemembers should not be afforded the same right, to get a dishonorable discharge you need to cross the line it is very severe and those are not individuals we are here to advocate for. That function, you are right, that is a line people cross that is very severe. Many are criminal acts so i appreciate that. Why is pda confirmed with the Caregiver Program continuing on the caregiver taking lethal means training as it would be under hr 84 . Our concern is the way the bill is currently written for va could interpret it in a way that would allow it to go to veterans but have caregivers under that specific statute so we want to make sure the way the language is written is open for all caregivers and veterans. A couple of things i want to get to because my time is short. On the bill i have to form the commission to look at how we provide benefits and categories. It is an extension of what we did with the mission act and i would like to know and certainly why there is any objection because we dont the eligibility act to me is just an extension of what we have already done. We have tremendous job with the mission act. I get asked all the time why cant i get in the va . I cant answer, many people the income threshold is 3,500 which is not a lot of money these days. I will stop before my time expires and get a shot at that. From dav. Your explanation was very helpful with regard to that bill in terms of looking at priority groups and some of the things you expanded on. We dont understand why the commission would be necessary, these issues havent been addressed by either committee that i can remember, that would be a good starting point for the discussion. As you know it has been a while since eligibility reform was established for priority groups and everything that has happened in between so looking at that we dont have an objection to that but we ask congress and the Different Committee for you to be looking at first and having that discussion would be important. I yield back. Thank you. I now call upon miss brown for five minutes. Excuse me. I think your microphone is on mute. You might want to begin again, we will start the clock. Thank you, mister chairman. My first question is to Lieutenant Colonel jim lorraine. You reference the university of alabama, a different data set, do you have any data that breaks down suicide by ethnicity, race, sex, lgbt q, native americans, any breakdown with regard to that . I have to waive my two seconds. We have that data. We are currently going through it but we have race, age, ethnicity, religion, all of the areas you talk about we do not have the lgbt q, that is something we would obtain from diving into the counties but on the retrospective data we have everything but lgbt q. Can you share that data with us . Yes we can. But you cant share it right now . I will be able to, university of alabama researchers are pouring through it. We pulled 494,000 data records with 65 deals that include that. For you and to the committee. If the data is coming directly from the department of defense will include all veterans . It will include everyone who served. Not only those who were honorably discharged. Characterization of discharge and the reason for their discharge, the reason. With regards to the breakdown you could share with us i would like to see but suicide rate is higher than native americans, we know women suicide is higher than women not in the military. We know some of these facts. You have been a strong supporter of the senate bill which is a good bill, wouldnt you agree we should include Mental Health care support for women veterans, africanAmerican Veterans, native veterans and the like. Just specific to those groups with different cultural needs and experiences. A program that works in the navajo nation. We are fully supportive of native americans and all veterans. Regardless of race, ethnicity, you raised your hand and served honorably we believe everyone should be served. We grew up in the schoolhouse right, how legislation is made and we know time is running out, 785 is a bill that passed, through the Senate Unanimously and we dont want to have time run out in congress before something is passed. The bills that are proposed through the house have a great deal of merit but can we work them early to get the bulk of a bill passed quickly during this congress. My time is running out. Russell lemle, as a clinical psychologist can you talk about confidential healthcare . Can you hear me okay . That relates to the team culture training act in which requires Community Providers to have military culture, confidence as well and that is a bill that in Community Care Network Providers for qualifications in the va. We dont have equivalent standards by a large measure. I yield back. Thank you for your questions. You are recognized for five minutes. Appreciate it. Glad to see the continued focus on Suicide Prevention and Mental Health care, i am hopeful we can reach a bicameral agreement with these initiatives on the Senate Passed bill 785 with veterans Mental Health healthcare improvement act. I urge quick passage of that legislation, time is running out of the session but this critical we get this done. My question is for the whole panel. Regarding a bill with congresswoman rochester the va Clinical Team culture act which requires care providers to adhere to the same Mental Health standards as va providers and their culture competency training and continuing education for providers participating in the community. Some have expressed concern about potentially burdening the nonva providers by making the standards greater than those required by the va. I understand the concerns. And agree that we wouldnt want to have the nonva providers unnecessarily go beyond what the va baseline is and clarify that language and perfect the language to reflect that incident. For the panel the question for the panel do you have any suggestions for improving this bill . And would you agree there should be robusta but not overly burdensome standards across the board . Thank you for that question. As stated in our testimony the reason the vfw numbers are for va is for the sensitive area provides. We would expect all contractors and Community Providers adhere to the same standards, both are meant to be a supplemental addition to va healthcare and do not want that to be lesser but the same or better but those standards need to be met to keep the high quality of care for veterans going. Anyone else on the panel . I would add to that the same as my colleague in vfw. We were very disappointed when developing the network that we were told developing the standards for those providers and they didnt feel they could get those contracts and i think that shouldnt be an excuse. Anyone who is going to provide veterans care should be able to meet the standard that va does that is evidencebased and based on culturally competent understanding of military service. You are pleased with the language in our bill. Should not be amended or feel it is overly burdensome for private providers. They may feel that way. They dont feel that way. Should meet the same standards as va providers. Thank you. Anyone else . This is Russell Lemle answering a previous question. Standards for the community have to be the same. You are right that you dont necessarily have to go beyond va standards but they do not match the va standards. Anyone else want to comment . Any suggestions . Anyone feel these standards are overly burdensome . Let me go to the next one. For joy ilem. The draft bill, the exposure recognition act, the report from the National Academies of science and medicine on the respiratory Health Effects of airborne hazards on soldiers oh. The report is due at the end of the week. Lets hope that happens. While this draft bill seems based on a Bipartisan Senate bill, it departs from the bill by suggesting emerging disabilities without knowing what consensus in the medical community has concluded. Can you elaborate on the position on emergency emerging disabilities in this draft bill and discuss your suggestions for exposure to why this is so important for these veterans please. Appreciate the question. We do have some concerns with emergent disease being limited to what we are expecting coming from the National Academy. The concession of exposure we envisioned we want to make sure any veteran exposed to a burn pit and we understand what chemicals they have been exposed to should be able to file a claim for direct Service Connection based on a related condition. For presumptive disability is the National Academy find those disabilities are related most likely to exposure and have no problems with disabilities. We dont want it to be limited to those four because there may be other emerging ones, we would like to see a slight adjustment to reflect that. Makes sense. I dont see 00. I dont want to go over. I want to follow the rules. You can bring the clock up. I appreciate sounds good. Thank you. Mister lamb recognized for five minutes. Thank you, mister chairman for joining us today. I want to talk about my bill, the treat act which we attempt to use to expand the suite of complementary alternative Health Services available throughout the va, things like nutritional yoga, meditation, even equine therapy, chiropractor, acupuncture. A lot of things available. What strikes me about these programs is how popular they are with such a variety of veterans. I got a chance to visit the washington dc va where they offer a lot of things, they went from people younger than me to 72, really enjoyed this and felt like it worked. One of the benefits of trying to deepen our knowledge of these things, not just paying for them and expanding them but using pilot programs to figure out what we can learn and how to smartly expand the services, they give veterans a little bit of a sense of control over their own health and hopefully allow more veterans in. We know one of the problems we have with veteran suicide is a lot of veterans are not going to the va, to where we can make it more attractive given things they might want, they get more than that. I want to start with talking about the way members use and perceive the options and therapies of treatment and you can tell us what members would like to see your the impact this might have. Thank you for that question. Excellent bill, hr 8137, appreciate that it does look at the effect of these integrated Health Alternatives and so many veterans have told us retreat studies where they had opportunities to network with other veterans not in the strict traditional clinical setting, that they develop lifelong friendships with folks they met, other veterans they met on those retreats especially women veterans, they really benefited from these programs and i think we know so many people, we have to turn to medicine to fix the problem or coverup symptoms but so many of our younger veterans led the way in terms of saying i dont want to take meditation if i dont have to for stress or anxiety, these programs, very supportive of them and making sure veterans have access which is the most important thing we brought up in our bill, we want to see the standardized system and make sure everybody has access equally. That is our goal as well. A lot of times they required voluntary interest by va staff and personnel at clinics and hospitals who want to get the training and provide these services almost on their own without much budget or leadership, to push the resources for this stuff everywhere and seeing acupuncturists so appreciate that, for taking part of this. Representative, be sure to pause two minutes. Going into the womens Veterans Task force. We have done some good work so far, real change on behalf of veterans, welcome to the future. Thank you for holding this hearing and thank you to colleagues, on todays agenda, i have a question for Lindsay Church. Your written testimony reads congress should, quote, mandate va ability to paint Child Care Centers and infancy, all individuals employed by said organization charged with a crime, rounded to that crime and fit for work by the state agency in the state in which the organization operates. Is mine already veterans of america believe that va should be required to pay for individuals charged with child molestation. For training for how to molest children, why or why not . Thank you for this question. A difficult question, i am a survivor of childhood molestation and this is impactful to me as a daughter of military veteran myself. I was interested in the care of a caregiver. To have to recognize folks are more likely to be impacted by the, Justice System and recognize that we have to look at folks to be able to be rehabilitated. It does not pay for facilities even if charged. We are eliminating pathways, for recidivism in society. We have to look at these issues in a different way. Only as parents, we are also parts of society, looking to undo a racist and Homophobic Society that builds the criminal Justice System to impact our communities or greatly. This legislation has merit and also needs to be interrogated further to make sure it is not creating more systemic oppression by our society and continuing to perpetuate the prison industrial complex. Reporter testimony regarding hr 37, va childcare probe for its insuring the va Trial Program appropriated veterans and staff, support enactment of hr 37, why or why not . We have resolution to support child care, veterans seeking care for serviceconnected disability and power resolution is pretty narrow. The recommendation made in the bill. I yield back. Thank you for your questions. Mister live in, you are recognized for questions. Appreciate your work to improve upon f785, the commander john scott Mental Health care improvement act and look forward to passing comprehensive legislation to prevent veteran suicide. Im glad youre veterans compact discussion draft includes hr 5516, commitment to veteran support and outreach, this bipartisan bill establishes funding stream to support the work of veteran Service Officers, and resources at their disposal to represent veterans in va hearings, 52 billion of veterans each year, economic support for key strategies for suicide. They are trusted in their communities and often the first context to which out to with other forms of assistance. They are in a key position to reach, engage, and identify at risk veterans who may not be utilizing va care, we must empower them with more resources to do so which is what hr 5516 aims to do. They use these funds not only to support claims but to support health and wellness programs, Suicide Prevention and outreach and this bill was induced by Orange County in san diego where i represent and grateful to all local cvs ohs in the community. Elsewhere throughout the state and country including wisconsin and colorado, minnesota, alaska, new york, National Organizations of counties, National Association of county Service Officers, with disabled American Veterans. Miss maureen elias, can you expand on the assistance for veteran Service Officers to your members . The vfw, one of the primary missions his Service Officers to help assist veterans across the board whether they are members or not. We recognize Service Officers throughout the country. And reserve officers are accredited. And to help veterans, in their own pocket. With a highly endorsed. Maureen elias or joy ilem want to add anything . Some of these positions, the first touchstones for veterans who need assistance and people far and wide, to learn about their benefits, the resources that they need, very supportive. One related question. Can you share how funding limitations affect veteran Service Officers or how additional funding might improve services . That is for any of you. Proud to partner with Service Officers, your bill is perfect and on track. The health and welfare of veterans served to a relationship that is close, county veteran Service Officers are close, consistent and have the means, appointed by their counties to the accreditation, they have their accreditation but the point, the closest government to the veterans and most of the veterans in their county. Very true, out of time but want to complement san diego and Orange County and i yield back. Thank you. Esther boss, recognized for five minutes. Thank you, i want to thank representative lamb for leadership on the va decision medicine acted access to Suicide Prevention or coordination, both of these pieces of legislation will help the va to better understand and treat our veterans who are at risk of suicide. The va has not made enough progress over the last decades in reducing the number of servicemembers and veterans who are committing suicide. The va medicine act should go a long way to finding brain and Health Markers to determine who is at risk for depression, posttraumatic stress and other treatment, threats of Mental Illness. The legislation requires that the va create data privacy and security measures to keep veterans information secure. Joy ilem, in your testimony they had concerns about the Data Security and privacy of veterans. Can you please explain your testimony and do you have any specific proposals to secure that data . We want to make sure their data is kept safe and with the Genomic Program it is a concern of some veterans, we want to make sure the language is very tight. It does make those protections but we want to make sure any research is used in a way that would be other than benefiting veterans for treatment purposes, lots of concerns over biomarkers and things like that and information being used but we know the benefit from that so veterans will feel comfortable as long as they know their data is safe to better provide better treatment. Everybody agrees with you on that. Make sure that information is secure. It is a risk what they come up with but access to suicide Coordination Act makes care for the va more at risk for veterans, the bill, builds upon previous legislation, easy for me to say, we worked on to better understand the Suicide Prevention program. I want to thank all the witnesses here for their support of this legislation, it has been a Long Time Coming and lastly say i want to express my support for the va Second Amendment protection act, hr 3454 representative roy, i firmly believe the veterans Second Amendment right should not be taken away by a government bureaucracy. This is simply a bill that would ensure that wouldnt happen. When i talk to veterans many do not come forward and seek the help we can so much provide because they are afraid of that particular possibility. With that i yield back. Thank you. I now recognize representative cisneros for five minutes complete parts for a couple seconds before you begin. Thank you, mister chairman, i think our panelists. Last year the House Armed Services subcommittee military personnel and testimony on a joint hearing on suicide epidemic affecting veterans and service members. I join with representative bergman talking about working together to ensure a warm hand off of servicemembers transitioning to veterans and this question is for everyone on the panel, express support for smooth transition act discussion draft to moderate radically and all that are burns in this meeting, paycheck and roman. Can you speak to the importance of the small change in a warm hand off to widen the transition period representing a high period for suicide . I think that bill is important and doing that is critical. I would also say i speak personally, life got in the way and had i been able to enroll in active opt in, that wouldnt happen. When veterans transition out, they get really busy. This shouldnt be something that gets in the way. Anyone else care to comment . They can feel disconnected and having a time in readjustment, you want them to know there is a distinct way to transition, whatever came up with that, it is a great bill, it got into trouble and struggle when you dont want them to know about access to the va. Supporting the notion of transition, wanted to add in the compact act, section 101 in providing benefits transitioning servicemembers are complimentary way to increase utilization of the va in the first year and the first year after discharge, with veterans. As mentioned i did miss my window, and the job, we make this transition smooth the. With Substance Abuse issues, with Sexual Assault concurring problems on. With evidencebased guidelines, dealing with multiple issues at once. Hr 5667 which was incorporated into it, developing and disseminating clinical practice guidelines. Russell lemle, give us a better understanding of the intersection between Mental Health and Substance Abuse and how they impact veterans. What about traumas with Sexual Assault. Your comment is right, Substance Abuse, and in suicide. The basic premise is right. With those disorders with more confident providers in the va, to handle the issue. I am out of time. Thank you very much. Thank you. I now recognize representative done for five minutes, please number to talk a couple seconds before we begin. I dont have any questions. Thank you for scheduling this hearing on what is the number one concern, and the number one cancer concern. I would like to spend more time on this but very grateful to address this plan. I would like to close by thanking former chairman, what a pleasure it has been to serve the last four years, we passed or substantive legislation and that is great credit, turn us over for your grandchildren so thank you very much. I yield back. Thank you for those kind words. Compliments to chair brownlee and Ranking Member rove. You are recognized for five minutes. Turn on your microphone. Good morning, everyone. Thank you for holding todays hearing. And asking everyone victims from 9 11. In the interests i ask unanimous consent for the hearing record, hr 1524. Thank you. I seek support for hr 1524 of the veterans compact act. Let me start with mister murray. The vfw supportive 1524, one year of healthcare, why is it important those separating from their service in the National Guard are eligible, and one year for transitioning veterans to have this in the area thank you for the question. Faces a unique challenge with normal society and providing that care, very heavy burden to stop the transition back to everyday life. It is a great start. Garden reserve number with disabilities, illnesses to to be taken care of throughout their lives but see if we can get that rolling. One of the things i am trying to do is subject the number of veterans at surface, the army reserve and activeduty in the country has just been difficult because the department of defense uses many servicemembers sign up in guam and other parts of the country. One last question, a single us jurisdiction, for my veterans, in 25 years. The San Francisco va moved the locations, and to seek Mental Health services would be necessary with increased eligible populations. Their location is lack, yes, no . I dont know about that. The premise, where do my veterans go . It is exactly right. The veterans compact into law. Can you give us an educated guess about the establishment for the country, what needs to be established to provide services. Sorry if i dont know what the number is but your premise is right. The reasons you articulated. It is a good extender for va care. I am way over time. Before you leave the connection was spotty at the beginning, into the record. My statement on hr 5024 and the community, incorporating the language of hr 54, to introduce. With regard to your request into the record. Moving forward. General bergman recognized for five minutes, please pause for a couple second. Youve me a thumbs up. This reminds me of a lot of operations doing all this video teleconference. In support of the troops. Can anyone explain to me in the wording of the compact bill, individual and Group Counseling included in that veteran. This is Russell Lemle. Let me start by saying individual and Group Psychotherapy are general domains for nonurgent care. It is intended for emergent care, to be identified. Let me ask you a question. The majority of young men and women who separate from active service are released from a recall to gordon reserve are single. If a person has Suicidal Ideation i would suggest to you the last places to do a Family Counseling so the goal of this bill is to prevent suicide. I am concerned individual or Group Counseling. When we get back to dc, whoever from the va committee, we spend all this time, all this effort trying to do the right thing, we are going to miss the forest for the trees by eliminating that because the goal is to hit the target market. Im not going to belabor the point other than to say, the individual needs to be able to be seen and dont write the bill so theres a reason not to include them in this new effort. And mister lorraine. Gives preference to perspective grand keys, we submitted testimony about the flaws. And to function in rural and remote communities. The issue we have, and agnostic one says, not 1sizefitsall, but a one size fits one. We support that the community should have a choice. Collective impact came out, more impactful when there are a lot of Services Available to veterans, a focus on organizing organizations. We support a Community Integration approach which is a veteran centric approach that connects to available services, then you reach outside the network to get it. We support 785, the methods you should use. By prescribing it you will exclude, it wont work in rural areas of michigan or montana or where many of the representatives 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 i meant to also say the issue of around psychotherapy is differentiation for outpatients, that there is an Outpatient Care in psychotherapy and i believe the compact act is just intended say those wouldnt be available for Outpatient Care. I guess the point is we dont want to make it confusing to the local to try to implement this and try to do a different way to make the outreach to the veteran. You understand it and and i wod probably understand it after studying, but to the average, Small Organization whos going to be now included in this to make that outreach to those veterans who are outside the v. A. System when the goal is to bring them in. The goal isri to stop emergency, bring them in, get them the care they need. We dont want to make it to technical and confusing for those little local remote rural organizations who will provide this outreach. And again thank you, everybody. Mr. Chairman, i yield back. I no 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 and if nothing else, im going to now say that this hearing is adjourned. You are watching cspan2, your unfiltered view of government. Created by americas cabletelevision companies as a public service, and brought you today by your television provider. And now federal and state officials take part and discussion on election and voting machine security with election day less been too much away. Held by the billington cybersecurity annual summit this is about 35 minutes. Good morning, and welcome to this most Important Panel called election cybersecurity safeguards during the pandemic. It is a a great pleasure to introduce to you this worldclass moderator and panel. Let me first introduce our moderator, john simone is the Vice President of cybersecurity cranium services at raytheon and intelligence and space where he oversees the strategy and