Transcripts For CSPAN3 Veterans Suicide Prevention Hearing 2

The committee for increased hiring authorities. This hearing is two hours and 20 minutes. Let me call this meeting of the Senate Veterans committee, this hearing to order. Thank all of you for coming today. Especially our witnesses. We have a number of members who are on the way, but were going to in the interest of time, were going to get started. Todays hearing is about the issue of suicide. As many people in the room know, this month in america is National Suicide Prevention Month across the country. Suicide is a terrible, terrible, terrible loss and wasteful loss of life, and preventable loss of life. I think john will remember when we first came in as a committee three years ago, our first bill that we passed was the clay hunt Suicide Prevention bill. Passed this committee 990, and well ask the secretary and the other members from the v. A. To give us any report they might have on the progress of the implementation in terms of the act, but its a very important act. In august of 2014, i held a hearing at Georgia State university as a member of this committee. It was a field hearing on the issue of suicide. The reason i did it was because in that year, in the months leading up to august of 2014, the georgia v. A. , principal v. A. Hospital on clairemont road and decatur had three suicides, two on campus. Mishandling of available tools for suicide Like Pharmaceuticals and things of that nature. Others for a lack of awareness. And many for a lack of capacity. And that was the real thing that concerned me, so we began working in the clairemont v. A. Hospital in atlanta to improve v. A. s response to suicide and to Mental Health issues. Suicide is a disease. And it is preventable. There are many things we can do, and to set our example, our staff director did a great job of seeing to it that every member of the staff, majority and minority has been through the safe training for Suicide Prevention. It stands for signs of suicide thinking should be recognized. Ask the most important question of all, are you thinking about committing suicide, which is a tough thing to dress, but a key question to ask. Validate the veterans experience, and encourage treatment and expedite getting help. And i can tell you from what we learned in atlanta and have learned in the v. A. , timing is everything, as it is in health care in most things. The golden hour, we know about in health care. When someone is contemplating suicide, its not something you put off to an appointment on wednesday or to another day. Its something you deal with immediately and you deal with quickly, and you expedite the response to it. I want to thank the staff for going through the training. And just like the heimlich maneuver has saved many a life in a restaurant, when somebody was choking and somebody else knew how to apply that maneuver and they freed their air passages. Just like cpr has helped people who had untimely heart attacks, just like cpr has helped people who might be drowning or might have drowned and brought back to life, but being aware of training necessary to save a life is critically important. Were going to see to it in our committee that we promote this training throughout the v. A. And throughout the government to see to it that we are saving lives and helping people to recover and restore their lives. I want to thank bob thinky for his commitment for doing it on the staff and thank all the Staff Members for doing it, and thank the members of the committee for their effort as well. We have two panels today on the issue of suicide. Our first panelist, mr. John day, assistant Inspector General for health inspections. The second is dr. Craig brian, executive director National Center for veteran studies, and dr. Matthew kuntz of montana. We appreciate all three of you being here today. Youll be allowed to give up to five minutes of testimony. We dont have a whistle that blows at the end of five minutes, but after ten, youll be in big trouble. And all your statements will be printed for the record and be memorialized in the record by unanimous consent. With that, well start with you, dr. Day, and go down the list from there. Welcome. Thank you, chairman isaacson and Ranking Member tester, members of the committee. Its an honor to testify before you today on the subject of Suicide Prevention. This topic is important to mr. Missile and all of the staff at the oig. We work to insure veterans receive the highest quality Mental Health care. We have reviewed in depth facts surrounding the death of many veterans who took their own lives. Often, we find these veterans suffered the effects of chronic Mental Illness and Substance Use disorder. In the aftermath of these deaths, we frequently hear from members of the veteran family, significant friends and v. A. Providers that they would have acted sooner or differently only if they had known. After the Virginia Tech incident shootings, a serious review of the privacy laws that impact the disclosure of medical information was undertaken. My staff met with and talked with a number of the individuals who were involved in this review to determine if there were Lessons Learned that could be applied to v. A. Changes to law seem too difficult to design, however changes in practice that utilize advanced directors or similar devices may often offer a way to improve communication at the critical point when a patient needs the help the most. I think there is a chance to improve communication by expanding the situations under which these and similar devices are used. V. A. Has thoughtfully derived a model to predict who may suicide. The question is when would an atrisk veteran take action to harm themselves or harm others . When would intervention be most effective . Research using social media and other more timely data has shown promise in understanding the human emotional state and therefore may assist in identifying when intervention for these atrisk individuals would be most successful. I think research and pilot studies in this has great potential. The testimony of others at this table point out that veterans, many veterans do not obtain their care primarily from the v. A. Hospital system. And so an effort to reach those veterans who are at risk is most appropriate and essential if we are to make a significant improvement in veteran suicide data. This concludes my oral testimony. And i would be pleased to answer your questions. Mr. Chairman, mr. Ranking member and members of the committee, i appreciate the opportunity to appear here today to discuss recent advances in veteran Suicide Prevention. I will not read my written testimony in full but will highlight a number of key points. The response to raising suicide rates the v. A. Has implemented numerous measures intended to prevent suicide among veterans. They have led to improved access to care as an example of how they can aggressively prevent the cause of Suicide Prevention. Suicide related outcomes among military veterans have been published in the last two years. Although most of these studies involved military personnel, theyre applied to the community as a whole. All of the interventions reduce suicidal ideation, but only two are related with reduction in suicidal behavior. Cognitive behavioral therapy reduced suicidal behavior by 60 to 76 . Theyre currently the only strategies shown to reduce suicidal behaviors among those who have served in the military. These treatments now serve as a foundation for studies in the v. A. As well as the dod. The latest findings not only confirm that suicidal behavior can be prevented among military personnel and veterans, they also show us how to do it. If these stud as tell us anything, its this. Some strategies work better than others, and simple things save lives. Tragically, few veterans are likely to receive these potentially life saving treatments for a number of reasons. Today ill focus on one particular barrier, inadequate training in medical health professionals. Two recent studies highlight this issue. In these studies, researchers found that a key Suicide Prevention strategy used by the v. A. Was not associated with subsequent reductions in suicidal behavior as what expected. The lack of effectiveness was attributed to poor quality implementation. V. A. Personnel often did not implement them. Researchers from both of the studies concluded the results were from insufficient training and additional training could change this course. The problem with insufficient training is not confined to the v. A. , though. Tragically, deficient training is endemic across the Mental Health Training System. A recent report highlights this issue. The Main Findings of that report are also sum husbanded in the attachment to my testimony. As you can see, a shockingly low number of Mental Health Training Programs provide any education or training about suicide to its students. Furthermore, state licensing boards, the very bodies charged with protecting the Publics Health and safety from unqualified professionals, typically do not require any exams or demonstration of competency in suicide Risk Assessment or intervention. The implications of this report are disturbing. The vast majority of our nations Mental Health professionals are unprepared to effectively intervene with suicidal veterans. This has critical implications for all veterans, both within and outside the v. A. We have long talked about the many barriers that stand in the way of a veteran receiving Mental Health treatment, and have invested heavily in removing those barriers. What unsettles me the most as a veteran is knowing that when a fellow veteran overcomes these barriers, he or she is unlikely to receive the treatments that are most likely to save their lives. The sobering and uncomfortable truth is that we have made it easier for veterans to obtain treatment that doesnt work, especially those veterans who receive services from nonv. A. Providers in their communities. If we want veterans to benefit from the most recent advances in Suicide Prevention research, we will need to insure implementation is accompanied by a comprehensive and robust training program. Luckily, the past few years have also led to considerable advances in our understanding of the most effective ways of teaching these methods to others. Much of this knowledge has actually been obtained by the v. A. And their researchers. In order to reverse the trend of veteran suicide, we must therefore think boldly and must be willing to disrupt the status quo. We need to adopt the newest strategies even though they may depart from existing procedures. We need to invest more heavily in Training Clinicians to use these procedures and create new initiatives to implement these in clinical trainings. These should not just target the v. A. And dod, but all clinicians in all settings as well as our universities and Training Programs that are possible to the readiness and preparedness of our Mental Health professionals. In conclusion, were at a critical turning point for veteran Suicide Prevention. Answers are now clear and effective strategies have been identified. We must now take the steps needed to insure these treatments and interventions are easily available to all veterans, both within the v. A. And in our communities. Thank you very much. We appreciate your testimony. Now from the great state of montana, the executive director of the National Alliance for Mental Illness in montana, mr. Kuntz. Yes, sir. Chairman isakson, Ranking Member tester and distinguished members of the committee, on behalf of montana, i would like to extend our gratitude for the opportunity to share with you our views and recommendations. We applaud the committees dedication in addressing the Critical Issues around veteran suicide. As someone who has personally lost a Family Member who was a veteran to ptsd, i want to appreciate my sincere thanks. Montana has the highest suicide rate in the country with 68. 6 per 100,000. This is significantly higher than both the National Veterans suicide rate and the Western Region veteran suicide rate. As an organization thats immersed in Suicide Prevention, we think its very important that you have a framework to understand suicide. The model that we use is a combination of biological susceptibility and environmental factors then lead to malfunctioning Neuron Communications which develop into suicidal ideation, behavior, and other symptoms. Examples of the factors of biological susceptibility are genetics and physical trauma, examples of factors on the environmental side are emotional trauma, but on the positive, therapy and supportive family. Youll note that i will not be covering lethal means restriction because i believe its incredibly hard to legislate that. But it is an important factor. Montana is a very rural state with an average of fewer than six persons per square mile. This creates unique challenges for our health care providers, and were deeply in need of more Mental Health providers. Ill move on to our recommendations. The first, to offer a Public Health intervention proven to reduce suicide during critical points in the military and veteran experience. Montana was influential in bringing the youth aware Mental Health program to the united states, and we would like to offer it as a template of something thats proven to work in another population and would be perfect to bring over to this one. Second recommendation, establish a clear policy goal to improve the diagnostic treatment system. The target that montana recommends to the committee is tasking v. A. To work with the department of defense, the National Institute of Mental Health and private partners to identify and prepare two additional brain diagnostic measurements for clinical work in the v. A. By the fall of 2020. Our next recommendation is to develop a plan for treatment resistant Mental Health conditions. Roughly a third of Mental Health conditions do not respond to traditional treatments. And this is a big issue, and its an issue thats not addressed in montana. The montana v. A. Has nothing in our state to address treatment resistant depression. This is very personal to me because i lost a dear friend who was a veteran in september 2015 to treatmentresistant depression, and to watch his options slowly slip away was one of the hardest things i have ever seen. Montana Blue Cross Blue Shield supports tms treatment for treatment resistant depression. I do not know why the montana v. A. Does not. Next recommendation, expand access to telepsychiatry, then make online Cognitive Behavioral Therapy available to all veterans. We also believe that the v. A. Should expand the availability of automated suicide Risk Assessment, develop a prize to create and validate a screening tool to determine which patients are at risk of developing side effects from closapine. Develop a public facing Online Research directory for nonv. A. Resources. Create a more synergistic relationship between the v. A. And community Mental Health centers. There are over 1,300 Community Health Centers Across the country, and we should be working with those to care for our veterans. Increase the v. A. s collaboration with outside researchers, and finally, establish a continuity of care pipeline for veterans directly from the department offense defense to v. A. Community providers. Thank you again for the opportunity to testify in front of this honorable committee. Your attention to this issue means a lot to me. Our entire organization, and their families. Thank you, mr. Kuntz. We appreciate your being here today. What im going to do is reserve my time since we have three members that are here and i know we have different meetings that are going to take place and go straight to our members for questions and ask my later when senator tester returns. Hes doing a presentation on another hearing. Hell be here in a little bit. Let me start off with john. Thank you very much, mr. Chairman. And thank you for holding such an important hearing, and again, also to senator tester, i cant think of anything thats more important to discuss, certainly, we all agree that this is a crisis. In arkansas, i think were number ten in suicide rate overall. Of that group, veterans represent about 8 of the population, but represent about 20 of the suicides. So were a state that is like so much of the rest of the country, in fact, the rest of the country, period, is experiencing significant problems. Dr. Br