1 00:00:00,500 --> 00:00:03,180 - What's it called, the Veterans Affairs Health Committee? 2 00:00:03,180 --> 00:00:04,650 Will come to order. 3 00:00:04,650 --> 00:00:08,010 I'm Jackie Speier and we will now 4 00:00:09,310 --> 00:00:12,550 have a discussion on a very serious issue. 5 00:00:12,550 --> 00:00:14,760 I'd like to thank Chairwoman Brownley 6 00:00:14,760 --> 00:00:17,910 for partnering with us on this incredibly tough issue. 7 00:00:17,910 --> 00:00:20,310 The statistics are staggering. 8 00:00:20,310 --> 00:00:23,430 There were 321 active duty suicides 9 00:00:23,430 --> 00:00:28,430 and 144 Reserve component suicides in 2018. 10 00:00:28,850 --> 00:00:32,870 This is the highest number of suicides since 2012. 11 00:00:32,870 --> 00:00:34,740 An estimated 20 service members 12 00:00:34,740 --> 00:00:38,273 and veterans combined committed suicide a day. 13 00:00:39,560 --> 00:00:41,880 It is an epidemic but it's more than an epidemic 14 00:00:41,880 --> 00:00:42,950 and it's more than numbers. 15 00:00:42,950 --> 00:00:44,800 These are people's lives and the lives 16 00:00:44,800 --> 00:00:47,750 of their families that are impacted by it 17 00:00:47,750 --> 00:00:50,800 and we have got to come up with a means by 18 00:00:50,800 --> 00:00:54,520 which we can address this in a holistic fashion. 19 00:00:54,520 --> 00:00:58,010 They're not numbers but these are service members 20 00:00:58,010 --> 00:00:59,810 who are willing to die for our country 21 00:00:59,810 --> 00:01:02,380 but took their own lives instead. 22 00:01:02,380 --> 00:01:03,970 Service members we failed. 23 00:01:03,970 --> 00:01:06,170 Behind each of them is a person 24 00:01:06,170 --> 00:01:09,310 and their family, friends, and comrades in arms. 25 00:01:09,310 --> 00:01:12,630 Two weeks ago I met with Patrick and Teri Caserta. 26 00:01:13,840 --> 00:01:17,080 Their son Brandon was an active duty sailor in the Navy. 27 00:01:17,080 --> 00:01:20,040 He had high aspirations for a Navy career 28 00:01:20,040 --> 00:01:23,370 but something changed and tragically, he took his life. 29 00:01:23,370 --> 00:01:25,910 His parents knew something was wrong, tried to intervene, 30 00:01:25,910 --> 00:01:28,130 and were turned away by the Navy. 31 00:01:28,130 --> 00:01:30,410 The request so that other parents will 32 00:01:30,410 --> 00:01:32,690 not have to endure their grief and pain 33 00:01:32,690 --> 00:01:35,610 was that Congress ensure that service members and veterans 34 00:01:35,610 --> 00:01:39,240 receive the help they need without fear of retribution. 35 00:01:39,240 --> 00:01:41,930 We must do everything we can to break the chain of suicide 36 00:01:41,930 --> 00:01:44,910 that has afflicted our military and veteran community. 37 00:01:44,910 --> 00:01:48,000 This problem could not be more urgent. 38 00:01:48,000 --> 00:01:49,700 The reason we're here meeting jointly, 39 00:01:49,700 --> 00:01:51,540 the subcommittees responsible 40 00:01:51,540 --> 00:01:54,770 for tackling suicide in the DoD and VA, 41 00:01:54,770 --> 00:01:56,730 is because we need to treat service members 42 00:01:56,730 --> 00:02:00,060 and veteran suicide as one issue. 43 00:02:00,060 --> 00:02:01,940 Veterans are about twice as likely 44 00:02:01,940 --> 00:02:04,300 as civilians to commit suicide. 45 00:02:04,300 --> 00:02:06,850 Military service appears to be a casual pathway 46 00:02:06,850 --> 00:02:10,180 for increased suicide risk due to the access 47 00:02:10,180 --> 00:02:12,830 to and familiarity with firearms, 48 00:02:12,830 --> 00:02:15,360 post-traumatic stress syndrome, depression, 49 00:02:15,360 --> 00:02:17,530 loss of community, alienation, 50 00:02:17,530 --> 00:02:20,780 head injuries, and substance dependence. 51 00:02:20,780 --> 00:02:23,810 These factors take root, manifest, 52 00:02:23,810 --> 00:02:28,810 and worsen across an individual's DoD, VA experience. 53 00:02:29,040 --> 00:02:30,790 We need to react to this reality 54 00:02:30,790 --> 00:02:32,950 by preventing, detecting, and treating 55 00:02:32,950 --> 00:02:37,000 suicide risk from the moment an individual signs up, 56 00:02:37,000 --> 00:02:39,870 to well after they leave the service. 57 00:02:39,870 --> 00:02:42,000 Today we'll hear from a panel of experts 58 00:02:42,000 --> 00:02:43,300 from the Department of Defense 59 00:02:43,300 --> 00:02:45,360 and the Department of Veterans Affairs 60 00:02:45,360 --> 00:02:46,770 to help us understand the scope 61 00:02:46,770 --> 00:02:48,620 and magnitude of the suicide challenge 62 00:02:48,620 --> 00:02:51,740 effecting our military and veterans communities. 63 00:02:51,740 --> 00:02:53,730 We will also learn about suicide prevention 64 00:02:53,730 --> 00:02:55,500 efforts within the Department of Defense 65 00:02:55,500 --> 00:02:57,120 and the Department of Veterans Affairs 66 00:02:57,120 --> 00:03:00,060 and try to better understand ongoing collaborations 67 00:03:00,060 --> 00:03:02,680 and potential future partnerships 68 00:03:02,680 --> 00:03:04,620 related to suicide prevention efforts 69 00:03:04,620 --> 00:03:06,770 between the Department of Defense 70 00:03:06,770 --> 00:03:08,580 and the Department of Veterans Affairs 71 00:03:08,580 --> 00:03:10,983 to try and end the epidemic. 72 00:03:12,710 --> 00:03:15,900 Before I welcome the panel I would like 73 00:03:15,900 --> 00:03:18,440 to ask if Ranking Member Kelly 74 00:03:18,440 --> 00:03:22,220 would like to say some introductory remarks. 75 00:03:22,220 --> 00:03:24,670 - Thank you, Madam Chairwoman. 76 00:03:24,670 --> 00:03:27,230 You know, I'd first like to say I've had the opportunity 77 00:03:27,230 --> 00:03:29,450 to command at the battalion level in combat 78 00:03:29,450 --> 00:03:33,100 and I was in Iraq in 2005 as an operations officer. 79 00:03:33,100 --> 00:03:37,733 We lost 29 soldiers in our brigade formation. 80 00:03:39,340 --> 00:03:44,340 Coming back in '06, we buried way too many in that year 81 00:03:44,580 --> 00:03:47,810 following who had survived the traumas of war 82 00:03:47,810 --> 00:03:50,070 and who came back and who are no longer with us. 83 00:03:50,070 --> 00:03:52,670 And so, unless you've experienced that firsthand, 84 00:03:52,670 --> 00:03:54,290 it's difficult to understand 85 00:03:54,290 --> 00:03:58,230 the impact on the family and on the soldiers 86 00:03:58,230 --> 00:04:00,550 and on the hearts and minds of the community 87 00:04:00,550 --> 00:04:03,400 knowing that they so bravely served this great nation 88 00:04:03,400 --> 00:04:06,670 and then came home and something went awry 89 00:04:06,670 --> 00:04:08,040 and we have to fix it. 90 00:04:08,040 --> 00:04:09,590 It is that important. 91 00:04:09,590 --> 00:04:12,050 I understand why we lose soldiers in combat. 92 00:04:12,050 --> 00:04:16,013 I cannot understand why we lose them when we get home. 93 00:04:16,013 --> 00:04:17,860 I wish to welcome our witnesses to today's hearing 94 00:04:17,860 --> 00:04:20,260 and want to thank them for being here. 95 00:04:20,260 --> 00:04:21,950 The fact that we're holding a joint hearing 96 00:04:21,950 --> 00:04:23,260 with both the Department of Defense 97 00:04:23,260 --> 00:04:25,460 and Department of Veterans Affairs testifying together 98 00:04:25,460 --> 00:04:28,330 underscores the importance of suicide prevention 99 00:04:28,330 --> 00:04:31,580 and the need for a unified solution to the problem. 100 00:04:31,580 --> 00:04:33,410 We're at a crisis point. 101 00:04:33,410 --> 00:04:36,300 Last year suicide rate among active duty forces 102 00:04:36,300 --> 00:04:38,293 was the highest it's been since 2012. 103 00:04:39,290 --> 00:04:41,020 And ties for the highest on record 104 00:04:41,020 --> 00:04:43,500 since the Services began tracking it. 105 00:04:43,500 --> 00:04:48,030 Meanwhile, approximately 20 veterans commit each day. 106 00:04:48,030 --> 00:04:49,970 This is unacceptable and we all have 107 00:04:49,970 --> 00:04:52,380 a responsibility to fix this issue. 108 00:04:52,380 --> 00:04:54,680 I'm concerned that the high rate of suicide among 109 00:04:54,680 --> 00:04:57,430 service members and veterans will soon become a fact of life 110 00:04:57,430 --> 00:04:59,460 and that we're beginning to accept it 111 00:04:59,460 --> 00:05:02,530 as a natural consequence of military service. 112 00:05:02,530 --> 00:05:04,640 We cannot let that happen. 113 00:05:04,640 --> 00:05:06,890 We must take decisive action to disrupt 114 00:05:06,890 --> 00:05:09,780 the status quo and reverse this epidemic. 115 00:05:09,780 --> 00:05:12,100 When a service member takes his or her own life, 116 00:05:12,100 --> 00:05:15,690 it is a tragedy for both the surviving family and the unit. 117 00:05:15,690 --> 00:05:17,970 While suicide has an often irreparable 118 00:05:17,970 --> 00:05:19,940 effect on the service member's family, 119 00:05:19,940 --> 00:05:23,600 it can also cause lasting effects on the unit. 120 00:05:23,600 --> 00:05:24,850 In addition to the emotional 121 00:05:24,850 --> 00:05:27,050 impact on fellow service members, 122 00:05:27,050 --> 00:05:29,710 we know that one suicide in a unit can sometime lead 123 00:05:29,710 --> 00:05:33,090 to additional suicides or the contagion effect. 124 00:05:33,090 --> 00:05:35,330 That is why suicide must continue to be treated 125 00:05:35,330 --> 00:05:37,790 as not just a personal mental health issue 126 00:05:37,790 --> 00:05:39,650 but as a readiness issue. 127 00:05:39,650 --> 00:05:41,480 I'm interested to hear from today's witnesses 128 00:05:41,480 --> 00:05:43,440 about the behavioral health treatment available 129 00:05:43,440 --> 00:05:45,280 for service members and veterans. 130 00:05:45,280 --> 00:05:47,270 Particularly I'm concerned that there 131 00:05:47,270 --> 00:05:49,480 continues to be a stigma associated 132 00:05:49,480 --> 00:05:51,810 with seeking behavioral health treatment. 133 00:05:51,810 --> 00:05:54,520 In fact, as the VA notes in their written statement, 134 00:05:54,520 --> 00:05:57,260 over half of those who die by suicide had no mental 135 00:05:57,260 --> 00:05:59,980 health diagnosis at the time of their deaths. 136 00:05:59,980 --> 00:06:02,210 I'm interested to hear how the Services mandate 137 00:06:02,210 --> 00:06:05,470 periodic behavioral health checkups for all service members 138 00:06:05,470 --> 00:06:07,900 and whether those interventions are effective. 139 00:06:07,900 --> 00:06:10,130 Just like required yearly physicals 140 00:06:10,130 --> 00:06:12,440 and dental checkups are not an option, 141 00:06:12,440 --> 00:06:13,830 should a substantive session 142 00:06:13,830 --> 00:06:15,830 with a behavioral health provider, 143 00:06:15,830 --> 00:06:19,113 not just an assessment by a medical provider, be required. 144 00:06:20,010 --> 00:06:22,800 I'm also convinced that small unit leaders involvement 145 00:06:22,800 --> 00:06:26,100 is critical to identifying behavioral health issues. 146 00:06:26,100 --> 00:06:28,790 The Services must leverage the NCO leaders closest 147 00:06:28,790 --> 00:06:31,780 to the service members at the team and squad level 148 00:06:31,780 --> 00:06:34,090 to help identify self-destructive behaviors 149 00:06:34,090 --> 00:06:36,230 and get help for service members. 150 00:06:36,230 --> 00:06:37,610 I would like to know what training 151 00:06:37,610 --> 00:06:39,330 is provided to these leaders to help them 152 00:06:39,330 --> 00:06:42,090 in identifying problems and getting assistance. 153 00:06:42,090 --> 00:06:43,940 I hope that today's hearing will bring renewed 154 00:06:43,940 --> 00:06:46,410 attention to the problem of military suicide. 155 00:06:46,410 --> 00:06:47,960 While I'm interested in the actions that 156 00:06:47,960 --> 00:06:50,980 the Defense Department and VA have done to prevent suicide, 157 00:06:50,980 --> 00:06:52,960 I'm also focused on the practical things 158 00:06:52,960 --> 00:06:55,590 we can do today to reverse this disturbing trend. 159 00:06:55,590 --> 00:06:57,880 Thank you, Madam Chairman and I yield back. 160 00:06:57,880 --> 00:06:59,050 - Thank you, Ranking Member Kelly. 161 00:06:59,050 --> 00:07:02,260 Now we're gonna hear from Chairwoman Brownley. 162 00:07:02,260 --> 00:07:03,540 - Thank you, Chairwoman Speier 163 00:07:03,540 --> 00:07:06,150 and thank you for hosting us today. 164 00:07:06,150 --> 00:07:09,390 Your dedication to the prevention of suicide among 165 00:07:09,390 --> 00:07:12,590 not only veterans but also our service members 166 00:07:12,590 --> 00:07:15,060 is evidenced by your willingness to host 167 00:07:15,060 --> 00:07:17,710 this joint hearing among our subcommittees. 168 00:07:17,710 --> 00:07:20,050 As a member of the Committee on Veterans Affairs, 169 00:07:20,050 --> 00:07:22,090 our jurisdiction is limited to 170 00:07:22,090 --> 00:07:23,970 the Department of Veterans Affairs. 171 00:07:23,970 --> 00:07:27,110 While we may inquire as to the activities 172 00:07:27,110 --> 00:07:28,350 of the Department of Defense, 173 00:07:28,350 --> 00:07:30,760 I cannot remember the last time we had 174 00:07:30,760 --> 00:07:33,610 the opportunity to receive testimony from the agencies, 175 00:07:33,610 --> 00:07:37,223 so I thank the DoD for being here today. 176 00:07:38,340 --> 00:07:41,360 Despite this the actions of the Department of Defense, 177 00:07:41,360 --> 00:07:44,850 significantly impact the lives of our veterans 178 00:07:44,850 --> 00:07:47,520 from the status of a service member's discharge 179 00:07:47,520 --> 00:07:50,470 to the location of a service member's service 180 00:07:50,470 --> 00:07:53,960 to the responsibilities of a service member while on duty, 181 00:07:53,960 --> 00:07:57,230 all of these decisions have been shown to impact 182 00:07:57,230 --> 00:08:02,200 the likelihood that a veteran will experience suicidality. 183 00:08:02,200 --> 00:08:04,890 According to VA, of the 20 veterans 184 00:08:04,890 --> 00:08:07,530 per day that die by suicide, 185 00:08:07,530 --> 00:08:11,270 nearly four are either active duty service members 186 00:08:11,270 --> 00:08:14,640 or members of the Guard that have never been activated, 187 00:08:14,640 --> 00:08:18,140 thus ineligible for VA healthcare. 188 00:08:18,140 --> 00:08:21,500 Yet VA is committed to reducing the staggering statistic 189 00:08:21,500 --> 00:08:23,890 through a public health approach. 190 00:08:23,890 --> 00:08:26,750 By identifying which individuals are most in need 191 00:08:26,750 --> 00:08:30,450 and targeting effective, preventive, interventions 192 00:08:30,450 --> 00:08:33,330 to those individuals by creating a system 193 00:08:33,330 --> 00:08:36,240 of health throughout the population as a whole, 194 00:08:36,240 --> 00:08:39,170 VA is ensuring our most vulnerable 195 00:08:39,170 --> 00:08:41,700 and high-risk veterans and service members 196 00:08:41,700 --> 00:08:45,240 are surrounded by the resources they need most. 197 00:08:45,240 --> 00:08:48,500 The quicker VA is able to identify those in need 198 00:08:48,500 --> 00:08:50,510 and connect them to resources, 199 00:08:50,510 --> 00:08:54,930 the more effective suicide prevention efforts will become. 200 00:08:54,930 --> 00:08:57,020 If the Department of Defense is willing to create 201 00:08:57,020 --> 00:09:00,130 a fluid movement of data between the two agencies, 202 00:09:00,130 --> 00:09:03,810 then the efforts of VA would only be magnified. 203 00:09:03,810 --> 00:09:06,570 VA would be able to identify high-risk service members 204 00:09:06,570 --> 00:09:08,620 before their transition is complete 205 00:09:08,620 --> 00:09:11,530 and DoD would be better able to assist 206 00:09:11,530 --> 00:09:14,370 in ensuring vulnerable service members 207 00:09:14,370 --> 00:09:17,180 are aware of, and have access to, 208 00:09:17,180 --> 00:09:20,240 VA and community provided resources 209 00:09:20,240 --> 00:09:22,790 that might reduce the turmoil caused by 210 00:09:22,790 --> 00:09:25,950 the service members service and assist the veterans 211 00:09:25,950 --> 00:09:30,373 and his or her family as the veteran transitions home. 212 00:09:31,460 --> 00:09:34,440 For instance, VA offers a variety of counseling services 213 00:09:34,440 --> 00:09:38,290 to active duty service members, members of the Guard, 214 00:09:38,290 --> 00:09:40,940 veterans, and their families at Vet centers 215 00:09:40,940 --> 00:09:43,740 throughout its readjustment counseling service. 216 00:09:43,740 --> 00:09:47,386 However, service members only make up about 5% 217 00:09:47,386 --> 00:09:50,750 of the population that Vet centers serve. 218 00:09:50,750 --> 00:09:54,470 Also, in 2017 Congress expanded eligibility 219 00:09:54,470 --> 00:09:56,870 for mental health care to certain veterans 220 00:09:56,870 --> 00:10:00,520 with other than honorable discharge statuses. 221 00:10:00,520 --> 00:10:02,560 However, two years later we are seeing 222 00:10:02,560 --> 00:10:04,680 in the media that veterans have not been 223 00:10:04,680 --> 00:10:08,220 adequately notified of this benefit. 224 00:10:08,220 --> 00:10:11,070 While VA was ultimately tasked with sending letters 225 00:10:11,070 --> 00:10:14,470 to veterans that may be eligible under the expansion, 226 00:10:14,470 --> 00:10:16,920 there is no reason the Department of Defense 227 00:10:16,920 --> 00:10:18,580 could not assist in ensuring 228 00:10:18,580 --> 00:10:20,870 that these former service members 229 00:10:20,870 --> 00:10:24,440 are connected with the care they qualify for. 230 00:10:24,440 --> 00:10:26,990 Again, I'm thankful for today's opportunity 231 00:10:26,990 --> 00:10:29,940 to engage in this much needed dialogue 232 00:10:29,940 --> 00:10:33,180 and hope it is the beginning of a productive relationship 233 00:10:33,180 --> 00:10:36,340 between our two committees and our two agencies. 234 00:10:36,340 --> 00:10:38,440 And I yield back, Madam Chair. 235 00:10:38,440 --> 00:10:42,510 - [Brownley] Thank you, thank you, Chair. 236 00:10:42,510 --> 00:10:45,053 Now we'll hear from Ranking Member Dunn. 237 00:10:47,254 --> 00:10:49,570 - Thank you, Chairwoman Brownley, Chairwoman Speier. 238 00:10:49,570 --> 00:10:51,870 I'm grateful to be here this afternoon with my colleagues 239 00:10:51,870 --> 00:10:53,570 from the committee on Veterans Affairs 240 00:10:53,570 --> 00:10:55,990 and the Committee on Armed Services to discuss 241 00:10:55,990 --> 00:10:59,930 the tragedy of suicide among service members and veterans. 242 00:10:59,930 --> 00:11:04,430 Joint hearings like this are not standard for Congress. 243 00:11:04,430 --> 00:11:07,420 But the fact that we're holding one here today 244 00:11:07,420 --> 00:11:11,160 is testament to our dedication to address this crisis. 245 00:11:11,160 --> 00:11:12,970 Congress has passed legislation 246 00:11:12,970 --> 00:11:15,727 and provided funding to stem the tide of suicide 247 00:11:15,727 --> 00:11:17,740 in the military veterans communities 248 00:11:17,740 --> 00:11:19,970 but stubbornly, tragically, 249 00:11:19,970 --> 00:11:22,420 these rates have refused to budge. 250 00:11:22,420 --> 00:11:25,060 I'm hopeful that by bringing these subject matter 251 00:11:25,060 --> 00:11:27,510 experts from both Departments here together 252 00:11:27,510 --> 00:11:29,840 and holding a conversation that crosses 253 00:11:29,840 --> 00:11:31,760 our jurisdictional boundaries of both committees, 254 00:11:31,760 --> 00:11:33,050 we'll be able to shed some new light 255 00:11:33,050 --> 00:11:37,280 on this complex topic and start saving lives 256 00:11:37,280 --> 00:11:39,650 among those who've served and are still serving. 257 00:11:39,650 --> 00:11:42,030 I thank you, our witnesses, for joining us 258 00:11:42,030 --> 00:11:44,220 and our audience for joining us. 259 00:11:44,220 --> 00:11:46,680 And Madam Chair, I yield back. 260 00:11:46,680 --> 00:11:48,210 - Thank you, Ranking Member Dunn. 261 00:11:48,210 --> 00:11:50,410 I ask unanimous consent to allow members 262 00:11:50,410 --> 00:11:52,860 not on the subcommittee to participate in today's hearing 263 00:11:52,860 --> 00:11:54,640 and be allowed to ask questions after 264 00:11:54,640 --> 00:11:55,760 all subcommittee members 265 00:11:55,760 --> 00:11:58,840 have been recognized without objection. 266 00:11:58,840 --> 00:12:00,990 All right, now we welcome our panel. 267 00:12:00,990 --> 00:12:02,990 Thank you all for joining us. 268 00:12:02,990 --> 00:12:07,350 Dr. Elizabeth Van Winkle is no stranger to his committee, 269 00:12:07,350 --> 00:12:08,370 thank you for joining us. 270 00:12:08,370 --> 00:12:10,690 She's the Executive Director of the Office of Force 271 00:12:10,690 --> 00:12:13,780 Resiliency in the Department of Defense. 272 00:12:13,780 --> 00:12:17,030 Sitting next to her is Captain Mike Colston, M.D., 273 00:12:17,030 --> 00:12:19,840 United States Navy, Director of Mental Health Policy 274 00:12:19,840 --> 00:12:22,460 and Oversight at the Department. 275 00:12:22,460 --> 00:12:26,160 Next is Dr. Keita Franklin, National Director of Suicide 276 00:12:26,160 --> 00:12:28,580 Prevention at the Department of Veterans Affairs. 277 00:12:28,580 --> 00:12:30,890 And finally, Mr. Michael Fischer, 278 00:12:30,890 --> 00:12:32,940 Chief Readjustment Counseling Officer, 279 00:12:32,940 --> 00:12:34,500 Department of Veterans Affairs. 280 00:12:34,500 --> 00:12:36,380 Welcome to all of you 281 00:12:36,380 --> 00:12:39,703 and I think we will start with Dr. Van Winkle. 282 00:12:41,410 --> 00:12:44,550 - Thank you, Madam Chairs Speier and Brownley, 283 00:12:44,550 --> 00:12:46,010 Ranking Members Kelly and Dunn, 284 00:12:46,010 --> 00:12:48,050 and distinguished members of the Subcommittees, 285 00:12:48,050 --> 00:12:51,170 thank you for the opportunity to appear before you today 286 00:12:51,170 --> 00:12:53,930 with our colleagues from the Department of Veterans Affairs 287 00:12:53,930 --> 00:12:55,600 to discuss the Department of Defense's 288 00:12:55,600 --> 00:12:57,610 suicide prevention efforts. 289 00:12:57,610 --> 00:12:58,810 As many of you are aware, 290 00:12:58,810 --> 00:13:00,290 I serve as the Executive Director 291 00:13:00,290 --> 00:13:02,460 of the Office of Force Resiliency, 292 00:13:02,460 --> 00:13:05,120 a portfolio that oversees several priority efforts 293 00:13:05,120 --> 00:13:07,890 including the Defense Suicide Prevention Office, 294 00:13:07,890 --> 00:13:10,360 which we commonly refer to as DSPO. 295 00:13:10,360 --> 00:13:12,650 As many of you also know, the Department recently 296 00:13:12,650 --> 00:13:16,040 announced a new director of DSPO, Dr. Karin Orvis. 297 00:13:16,040 --> 00:13:18,100 Unfortunately Dr. Orvis was unable 298 00:13:18,100 --> 00:13:20,260 to attend today's hearing but would be happy 299 00:13:20,260 --> 00:13:23,790 to meet with you or your staff moving forward. 300 00:13:23,790 --> 00:13:26,420 Today I can discuss the Department's efforts on suicide 301 00:13:26,420 --> 00:13:29,310 prevention from my role at Force Resiliency 302 00:13:29,310 --> 00:13:31,230 where I oversee the Department's policies 303 00:13:31,230 --> 00:13:34,100 on the prevention of suicide, sexual assault, 304 00:13:34,100 --> 00:13:37,510 harassment, hazing, bullying, and drug use. 305 00:13:37,510 --> 00:13:41,300 I also oversee the DoD/VA collaboration office. 306 00:13:41,300 --> 00:13:43,780 In this position, I recognize the intersection 307 00:13:43,780 --> 00:13:46,570 of many of these difficult and challenging issues 308 00:13:46,570 --> 00:13:50,520 and work to align prevention efforts within this continuum. 309 00:13:50,520 --> 00:13:52,640 Although each of us at the witness table represents 310 00:13:52,640 --> 00:13:55,460 different efforts within both the DoD and VA, 311 00:13:55,460 --> 00:13:56,840 we are all committed to the same 312 00:13:56,840 --> 00:13:59,260 critical mission of suicide prevention. 313 00:13:59,260 --> 00:14:02,430 Both Departments work in strong partnership. 314 00:14:02,430 --> 00:14:05,580 With me today is my colleague Captain Mike Colston, 315 00:14:05,580 --> 00:14:08,710 the Director of Mental Health Programs for Health Affairs. 316 00:14:08,710 --> 00:14:12,010 Captain Colston and I can discuss what we are currently 317 00:14:12,010 --> 00:14:15,450 doing within the Department to prevent suicide in our ranks. 318 00:14:15,450 --> 00:14:16,670 We at the Department of Defense 319 00:14:16,670 --> 00:14:18,640 have vowed time and time again to ensure 320 00:14:18,640 --> 00:14:19,830 that we do everything possible 321 00:14:19,830 --> 00:14:21,770 to support our service members 322 00:14:21,770 --> 00:14:24,930 and all of us work tirelessly to do just that. 323 00:14:24,930 --> 00:14:28,630 Yet our rates of suicide are devastating and unacceptable 324 00:14:28,630 --> 00:14:31,420 and they're not going in the desired direction. 325 00:14:31,420 --> 00:14:32,880 Although our data helps drive 326 00:14:32,880 --> 00:14:34,900 and improve our efforts in this space, 327 00:14:34,900 --> 00:14:37,500 my colleagues and I know that every single life lost 328 00:14:37,500 --> 00:14:41,460 is a tragedy and each one has a deeply personal story. 329 00:14:41,460 --> 00:14:43,320 With each death we know there are families 330 00:14:43,320 --> 00:14:45,730 and often children with shattered lives. 331 00:14:45,730 --> 00:14:48,330 We cannot rest until we have pursued every opportunity 332 00:14:48,330 --> 00:14:51,580 to prevent this tragedy among our nation's bravest. 333 00:14:51,580 --> 00:14:53,250 We know this is a shared challenge. 334 00:14:53,250 --> 00:14:56,420 Nationwide, suicide rates are alarming and increasing. 335 00:14:56,420 --> 00:14:58,850 None of us has solved this issue and no single case 336 00:14:58,850 --> 00:15:01,750 of suicide is identical to any other case. 337 00:15:01,750 --> 00:15:03,820 The scientific research surrounding prevention 338 00:15:03,820 --> 00:15:07,100 of suicides is both complex and ever evolving. 339 00:15:07,100 --> 00:15:09,800 Suicide is the culmination of complex interactions 340 00:15:09,800 --> 00:15:13,310 between biological, social, and psychological factors 341 00:15:13,310 --> 00:15:16,900 operating at individual, community, and societal levels. 342 00:15:16,900 --> 00:15:18,330 Our data also tells us that it 343 00:15:18,330 --> 00:15:21,060 is often a sudden and impulsive act. 344 00:15:21,060 --> 00:15:23,900 To address this complexity, we leveraged scientific evidence 345 00:15:23,900 --> 00:15:27,390 and formed practices to constantly pull every idea, 346 00:15:27,390 --> 00:15:30,660 every possible effective initiative into our toolkit 347 00:15:30,660 --> 00:15:32,810 to help service members and their families. 348 00:15:32,810 --> 00:15:35,330 We seek ideas and new solutions from everywhere, 349 00:15:35,330 --> 00:15:38,260 whether that's within the Department or from stakeholders 350 00:15:38,260 --> 00:15:40,670 such as researchers outside of the government 351 00:15:40,670 --> 00:15:43,610 or within Centers for Disease Control and Prevention 352 00:15:43,610 --> 00:15:44,840 and also from Congress. 353 00:15:44,840 --> 00:15:47,180 Indeed your inputs and your engagement 354 00:15:47,180 --> 00:15:49,510 have been critical to our efforts. 355 00:15:49,510 --> 00:15:51,070 Because data informs our ability 356 00:15:51,070 --> 00:15:53,400 to take meaningful steps and fulfill our commitment 357 00:15:53,400 --> 00:15:56,140 to transparency with you and the American public, 358 00:15:56,140 --> 00:15:57,540 the Department will soon expand 359 00:15:57,540 --> 00:15:59,990 our reporting on suicide related data. 360 00:15:59,990 --> 00:16:03,530 This summer we will publish our first annual suicide report 361 00:16:03,530 --> 00:16:05,330 which will supplement our longstanding 362 00:16:05,330 --> 00:16:07,640 DoD suicide event report. 363 00:16:07,640 --> 00:16:09,300 We address this in our written testimony 364 00:16:09,300 --> 00:16:11,420 and I'm happy to discuss any questions you may have 365 00:16:11,420 --> 00:16:13,880 about our reporting and how we use data 366 00:16:13,880 --> 00:16:15,900 to inform our research and initiatives 367 00:16:15,900 --> 00:16:18,350 in the area of suicide prevention. 368 00:16:18,350 --> 00:16:21,480 We are grateful for the opportunity to speak with you today. 369 00:16:21,480 --> 00:16:24,210 Suicide prevention is among the most complex challenges 370 00:16:24,210 --> 00:16:27,080 we face and one of the most devastating to bear. 371 00:16:27,080 --> 00:16:29,860 The root causes vary from one individual to another 372 00:16:29,860 --> 00:16:32,910 and the signs are often difficult to detect for friends, 373 00:16:32,910 --> 00:16:35,350 family members, and even for clinicians 374 00:16:35,350 --> 00:16:38,240 who work so closely with many of these individuals. 375 00:16:38,240 --> 00:16:39,930 More than likely, each of us on this room 376 00:16:39,930 --> 00:16:41,630 has been impacted by suicide. 377 00:16:41,630 --> 00:16:45,220 Friends, family, loved ones, lost to this decision 378 00:16:45,220 --> 00:16:47,430 that will forever impact our lives. 379 00:16:47,430 --> 00:16:49,780 Leaving us with far more questions than answers 380 00:16:49,780 --> 00:16:53,620 and a weight on our shoulder that often never recedes. 381 00:16:53,620 --> 00:16:56,030 Within the military community, this loss reverberates 382 00:16:56,030 --> 00:16:58,350 beyond the unit, beyond the commander, 383 00:16:58,350 --> 00:16:59,730 and beyond the Service. 384 00:16:59,730 --> 00:17:02,580 It is a loss for our country and one we cannot afford 385 00:17:02,580 --> 00:17:04,340 and we should not accept. 386 00:17:04,340 --> 00:17:05,970 Many of you have heard me say this before 387 00:17:05,970 --> 00:17:08,080 but we truly must show as much commitment 388 00:17:08,080 --> 00:17:09,420 and dedication to the wellbeing 389 00:17:09,420 --> 00:17:11,800 of our service members as they have demonstrated 390 00:17:11,800 --> 00:17:12,930 on the day they stepped forward 391 00:17:12,930 --> 00:17:15,130 to volunteer and serve our country. 392 00:17:15,130 --> 00:17:16,840 We must meet that sacred obligation 393 00:17:16,840 --> 00:17:19,010 because we need each and every woman and man 394 00:17:19,010 --> 00:17:21,920 who bravely signs up to fight for this nation. 395 00:17:21,920 --> 00:17:24,830 Those who choose to serve are an inspiration to us all. 396 00:17:24,830 --> 00:17:26,540 They are the front lines. 397 00:17:26,540 --> 00:17:28,880 We depend on them and we need them. 398 00:17:28,880 --> 00:17:30,370 We must fight for their safety 399 00:17:30,370 --> 00:17:33,140 at least as hard as they fight for ours. 400 00:17:33,140 --> 00:17:36,100 In closing, we thank you Chairwomen, Ranking Members, 401 00:17:36,100 --> 00:17:37,900 and the members of your subcommittees 402 00:17:37,900 --> 00:17:40,760 for your steadfast dedication and support of the women, 403 00:17:40,760 --> 00:17:43,760 men and families who defend our great nation. 404 00:17:43,760 --> 00:17:45,710 I look forward to the discussion today. 405 00:17:46,670 --> 00:17:48,100 - Thank you Dr. Van Winkle. 406 00:17:48,100 --> 00:17:51,190 Dr. Colston, do you have a, you do not, okay. 407 00:17:51,190 --> 00:17:53,540 Let's move then to, is it Keita? 408 00:17:53,540 --> 00:17:54,373 Did I pronounce it? 409 00:17:54,373 --> 00:17:55,513 Dr. Keita Franklin. 410 00:17:56,360 --> 00:17:59,300 - Good afternoon Chairwoman Speier, Chairwoman Brownley, 411 00:17:59,300 --> 00:18:00,900 and members of the subcommittees. 412 00:18:00,900 --> 00:18:03,280 I appreciate the opportunity to discuss the critical work 413 00:18:03,280 --> 00:18:05,400 that the VA is undertaking to prevent suicide 414 00:18:05,400 --> 00:18:07,080 among our nation's veterans. 415 00:18:07,080 --> 00:18:09,240 I am accompanied today by Mr. Michael Fisher, 416 00:18:09,240 --> 00:18:11,390 Chief Officer Readjustment Counseling Service 417 00:18:11,390 --> 00:18:14,800 who leads our veteran, our Vet Center work. 418 00:18:14,800 --> 00:18:16,210 I've been in this permanent position 419 00:18:16,210 --> 00:18:19,120 since April of last year, but like many in the room today, 420 00:18:19,120 --> 00:18:20,320 the military has always been 421 00:18:20,320 --> 00:18:22,370 a significant aspect of my life. 422 00:18:22,370 --> 00:18:24,200 My father is a 20 year Navy veteran, 423 00:18:24,200 --> 00:18:26,410 and my husband is an Air Force veteran. 424 00:18:26,410 --> 00:18:28,150 Prior to joining the VA, I served as 425 00:18:28,150 --> 00:18:30,610 the Director of the Defense Suicide Prevention Office. 426 00:18:30,610 --> 00:18:32,710 And my career has focused on deployment, 427 00:18:32,710 --> 00:18:34,770 and trauma, and how that impacts families 428 00:18:34,770 --> 00:18:36,720 and marital relationships. 429 00:18:36,720 --> 00:18:38,220 I'm a social worker by training, 430 00:18:38,220 --> 00:18:39,810 and I focused on child welfare 431 00:18:39,810 --> 00:18:42,580 and have led various programs around domestic violence, 432 00:18:42,580 --> 00:18:44,100 sexual assault, substance abuse, 433 00:18:44,100 --> 00:18:45,620 and combat operational stress, 434 00:18:45,620 --> 00:18:48,460 before narrowing in on suicide prevention. 435 00:18:48,460 --> 00:18:50,990 So this mission at the VA is both critical and personal 436 00:18:50,990 --> 00:18:52,980 to me and I understand the urgency of it. 437 00:18:52,980 --> 00:18:55,610 At my level I respond to text, emails, 438 00:18:55,610 --> 00:18:57,100 and phone calls from service members, 439 00:18:57,100 --> 00:19:00,010 veterans and their family members who are seeking support. 440 00:19:00,010 --> 00:19:01,730 Just two weeks ago, I spent two days 441 00:19:01,730 --> 00:19:03,570 with one of our partners, the Independence Fund. 442 00:19:03,570 --> 00:19:06,170 And approximately 80 veterans who deployed together, 443 00:19:06,170 --> 00:19:07,960 and they faced an incredible amount 444 00:19:07,960 --> 00:19:09,420 of trauma in that deployment, 445 00:19:09,420 --> 00:19:11,590 the third to the 67th Armored Regiment, 446 00:19:11,590 --> 00:19:13,440 the 4th Infantry Division. 447 00:19:13,440 --> 00:19:16,310 And led critical work to build resilience in that group. 448 00:19:16,310 --> 00:19:18,280 It was great to hear from those veterans 449 00:19:18,280 --> 00:19:20,640 how access to care and support from peers 450 00:19:20,640 --> 00:19:22,940 impacted their journey through recovery. 451 00:19:22,940 --> 00:19:25,020 And it is these stories that keep me focused 452 00:19:25,020 --> 00:19:26,930 on the work at hand. 453 00:19:26,930 --> 00:19:29,500 I am pleased to talk about VA's continued partnership 454 00:19:29,500 --> 00:19:31,100 with the Department of Defense. 455 00:19:31,100 --> 00:19:32,997 Our collaboration with DoD personnel 456 00:19:32,997 --> 00:19:35,910 and readiness leadership is critical to our success, 457 00:19:35,910 --> 00:19:38,270 as we continue to examine how best to address 458 00:19:38,270 --> 00:19:41,060 suicide prevention across our entire military 459 00:19:41,060 --> 00:19:42,480 and veteran community. 460 00:19:42,480 --> 00:19:44,530 We are jointly committed to reaching those 461 00:19:44,530 --> 00:19:48,030 who have worn the uniform where they live, work, and thrive. 462 00:19:48,030 --> 00:19:49,520 Already we have worked diligently 463 00:19:49,520 --> 00:19:51,290 on a number of important collaborations 464 00:19:51,290 --> 00:19:53,840 to reach people at risk of falling through the cracks. 465 00:19:53,840 --> 00:19:55,800 Bolstering support for service members 466 00:19:55,800 --> 00:19:57,510 as they transition out of service, 467 00:19:57,510 --> 00:19:59,920 and facilitating their access to care, 468 00:19:59,920 --> 00:20:03,300 and yet we realize there's so much work left to do. 469 00:20:03,300 --> 00:20:05,320 We look forward to this continued partnership. 470 00:20:05,320 --> 00:20:07,580 Suicide is a serious public health tragedy. 471 00:20:07,580 --> 00:20:10,140 It affects communities across the nation. 472 00:20:10,140 --> 00:20:11,520 In the United States alone, 473 00:20:11,520 --> 00:20:13,930 we know that there are 123 people 474 00:20:13,930 --> 00:20:15,630 that die each day by suicide. 475 00:20:15,630 --> 00:20:20,520 And globally, 800,000 people die by suicide. 476 00:20:20,520 --> 00:20:22,820 That's one person every 40 seconds. 477 00:20:22,820 --> 00:20:25,610 And we know inside the VA that an average 478 00:20:25,610 --> 00:20:28,520 of 20 people who've worn the uniform die by suicide. 479 00:20:28,520 --> 00:20:30,020 This is a figure that has remained 480 00:20:30,020 --> 00:20:32,220 relatively stable over the last few years. 481 00:20:32,220 --> 00:20:33,800 But that has not stopped us from learning 482 00:20:33,800 --> 00:20:35,710 everything we can about the data. 483 00:20:35,710 --> 00:20:37,370 Of those 20 tragic deaths, 484 00:20:37,370 --> 00:20:39,900 we know only six have access to VA healthcare. 485 00:20:39,900 --> 00:20:42,550 In the two years leading up to the death by suicide, 486 00:20:42,550 --> 00:20:44,170 the majority, 14 have not. 487 00:20:44,170 --> 00:20:45,890 And when you look at this data even closely, 488 00:20:45,890 --> 00:20:47,790 and Chairwoman Brownley already mentioned it. 489 00:20:47,790 --> 00:20:49,810 Two to three of those individuals have died, 490 00:20:49,810 --> 00:20:51,270 that have died by suicide are former 491 00:20:51,270 --> 00:20:52,880 National Guard and Reserve members, 492 00:20:52,880 --> 00:20:54,140 never federally activated. 493 00:20:54,140 --> 00:20:55,330 And if you account for the one other 494 00:20:55,330 --> 00:20:56,600 that's on active duty status, 495 00:20:56,600 --> 00:20:59,150 you come to the four that the Chairwoman mentioned. 496 00:21:00,210 --> 00:21:02,550 This issue cannot be solved through mental health alone. 497 00:21:02,550 --> 00:21:04,570 In fact national data shows that more than half 498 00:21:04,570 --> 00:21:06,860 of American's who die by suicide in 2016 499 00:21:06,860 --> 00:21:08,470 had no known mental health issue 500 00:21:08,470 --> 00:21:09,420 at the time of their death. 501 00:21:09,420 --> 00:21:11,490 And this is also true for our veterans. 502 00:21:11,490 --> 00:21:13,730 A massive expansion of mental health providers, 503 00:21:13,730 --> 00:21:15,820 and a world class mental health access 504 00:21:15,820 --> 00:21:17,440 has done little to reduce the total 505 00:21:17,440 --> 00:21:19,210 number of suicides among veterans. 506 00:21:19,210 --> 00:21:20,470 Maintaining the integrity 507 00:21:20,470 --> 00:21:22,760 of VA's mental healthcare system is vitally important 508 00:21:22,760 --> 00:21:24,170 but it is not enough. 509 00:21:24,170 --> 00:21:27,250 VA cannot end veteran suicide alone. 510 00:21:27,250 --> 00:21:29,250 This understanding is why we have expanded 511 00:21:29,250 --> 00:21:31,410 our efforts into the public health approach. 512 00:21:31,410 --> 00:21:33,210 Our national strategy for preventing 513 00:21:33,210 --> 00:21:35,180 veteran suicide is a multi year effort 514 00:21:35,180 --> 00:21:38,070 that provides the framework for identifying priorities, 515 00:21:38,070 --> 00:21:39,750 organizing our efforts, and focusing 516 00:21:39,750 --> 00:21:42,530 community level resources to prevent suicide. 517 00:21:42,530 --> 00:21:44,340 It's intended to move us from a focus 518 00:21:44,340 --> 00:21:46,280 on crisis intervention to a set 519 00:21:46,280 --> 00:21:50,010 of bundled strategies across multiple sectors. 520 00:21:50,010 --> 00:21:51,620 Our readjustment counseling services 521 00:21:51,620 --> 00:21:53,230 is a critical element in our strategy 522 00:21:53,230 --> 00:21:55,130 to provide a wide range of confidential 523 00:21:55,130 --> 00:21:57,180 social and psychological services 524 00:21:57,180 --> 00:21:59,560 to eligible veterans, active duty service members, 525 00:21:59,560 --> 00:22:02,470 and members of the Guard and Reserve, and their families. 526 00:22:02,470 --> 00:22:04,930 These services are designed to increase barriers to care 527 00:22:04,930 --> 00:22:08,170 such as providing services after non traditional hours, 528 00:22:08,170 --> 00:22:10,870 away from brick and mortar facilities. 529 00:22:10,870 --> 00:22:12,870 The Vet Centers aggressively focus 530 00:22:12,870 --> 00:22:14,670 on preventing suicide through partnerships 531 00:22:14,670 --> 00:22:16,990 including with the National Guard and the Reserve. 532 00:22:16,990 --> 00:22:19,810 And the Vet Centers have consistently increased services 533 00:22:19,810 --> 00:22:21,490 to veteran, service members and families. 534 00:22:21,490 --> 00:22:24,730 In 2018 alone, we saw that increase by 4% 535 00:22:24,730 --> 00:22:26,970 with an 18 bump among service members. 536 00:22:26,970 --> 00:22:29,013 An 8%, I'm sorry not 18, 537 00:22:29,013 --> 00:22:31,470 8% bump among service members. 538 00:22:31,470 --> 00:22:33,150 We are also working with federal partners, 539 00:22:33,150 --> 00:22:35,430 states, local governments to reach veterans 540 00:22:35,430 --> 00:22:37,170 and communities nationwide. 541 00:22:37,170 --> 00:22:40,190 In March 2018, we collaborated with the Department of Health 542 00:22:40,190 --> 00:22:43,260 and Human Services to launch our Mayor's Challenge. 543 00:22:43,260 --> 00:22:46,560 And in October of '18, we took those efforts 544 00:22:46,560 --> 00:22:49,670 to the state level and we launched a Governors Challenge. 545 00:22:49,670 --> 00:22:52,360 This initiative allows VA to work with seven governors, 546 00:22:52,360 --> 00:22:56,270 24 local governments chosen based on veteran population 547 00:22:56,270 --> 00:22:59,260 and veteran suicide prevalence rates 548 00:22:59,260 --> 00:23:00,920 with a focus on all veterans, 549 00:23:00,920 --> 00:23:04,100 not just those that come into our VHA Healthcare System. 550 00:23:04,100 --> 00:23:06,750 We've also recently implemented two executive orders. 551 00:23:06,750 --> 00:23:09,600 Under the first one signed in January of '18, 552 00:23:09,600 --> 00:23:11,410 we're partnering with the Department of Defense 553 00:23:11,410 --> 00:23:13,500 and the Department of Homeland Security 554 00:23:13,500 --> 00:23:15,130 around transitioning service members, 555 00:23:15,130 --> 00:23:16,680 trying to get after that first 12 months 556 00:23:16,680 --> 00:23:17,900 that we know is critical. 557 00:23:17,900 --> 00:23:20,840 We also executed a second one called Prevent 558 00:23:20,840 --> 00:23:24,450 signed in March 2019 to further our efforts in this space, 559 00:23:24,450 --> 00:23:26,830 through the development of a national road map. 560 00:23:26,830 --> 00:23:28,670 So we recognize that we must partner, 561 00:23:28,670 --> 00:23:32,320 empower, and engage communities to reach all veterans. 562 00:23:32,320 --> 00:23:35,040 Not just the ones that come into VA for healthcare. 563 00:23:35,040 --> 00:23:37,160 Our objective is to empower veterans 564 00:23:37,160 --> 00:23:38,600 where they live, work, and thrive, 565 00:23:38,600 --> 00:23:40,740 whenever and wherever they are. 566 00:23:40,740 --> 00:23:42,540 So we thank the committees for their support 567 00:23:42,540 --> 00:23:44,320 of this mission including the members 568 00:23:44,320 --> 00:23:46,680 of Congress who've recently helped us to spread awareness 569 00:23:46,680 --> 00:23:49,440 of veteran suicide through our PSA drive. 570 00:23:49,440 --> 00:23:51,430 Together we know that we can make a difference. 571 00:23:51,430 --> 00:23:53,660 Miss Chairwoman, this concludes my statement. 572 00:23:53,660 --> 00:23:54,810 My colleagues and I are prepared 573 00:23:54,810 --> 00:23:56,910 to answer any questions you may have for us. 574 00:23:56,910 --> 00:23:58,030 - Thank you, Dr. Franklin. 575 00:23:58,030 --> 00:24:00,370 Mr. Fisher? - No, no statement, ma'am. 576 00:24:00,370 --> 00:24:05,370 - Okay, I would like to start by asking a few questions. 577 00:24:06,040 --> 00:24:07,140 And unfortunately at four o'clock, 578 00:24:07,140 --> 00:24:09,700 I'm gonna have to leave for a meeting 579 00:24:09,700 --> 00:24:11,900 with the chair of the full committee. 580 00:24:11,900 --> 00:24:16,390 So I will turn it over to Miss Brownley at that time. 581 00:24:16,390 --> 00:24:20,870 Dr. Van Winkle, let me start off with the question 582 00:24:20,870 --> 00:24:25,870 of embedding behavioral health personnel within the units. 583 00:24:26,940 --> 00:24:31,323 Have we seen any benefit associated with doing that? 584 00:24:32,670 --> 00:24:33,850 - Thank you for the question. 585 00:24:33,850 --> 00:24:35,500 And certainly Captain Colston 586 00:24:35,500 --> 00:24:37,410 can talk specifically about that. 587 00:24:37,410 --> 00:24:40,260 I think any time we provide the opportunity 588 00:24:40,260 --> 00:24:42,763 for service members to receive support, 589 00:24:43,670 --> 00:24:46,460 we are working to prevent suicide. 590 00:24:46,460 --> 00:24:49,210 We do have embedded behavioral health, mental health 591 00:24:49,210 --> 00:24:51,770 individuals that Captain Colston can talk about. 592 00:24:51,770 --> 00:24:55,110 We also embed Military Family Life counselors 593 00:24:55,110 --> 00:24:56,520 to provide support. 594 00:24:56,520 --> 00:24:58,410 And we allow for surge capacity 595 00:24:58,410 --> 00:25:00,400 if there has been a suicide in the ranks, 596 00:25:00,400 --> 00:25:02,850 that we provide more Military Family Life counselors 597 00:25:02,850 --> 00:25:04,680 to support the unit at large. 598 00:25:04,680 --> 00:25:06,230 And I can turn it over to Captain Colston 599 00:25:06,230 --> 00:25:09,070 to talk about the embedded behavioral health. 600 00:25:09,070 --> 00:25:10,830 - So ma'am, we embed behavioral health post 601 00:25:10,830 --> 00:25:14,450 into primary care clinics and into line units. 602 00:25:14,450 --> 00:25:15,283 I found in-- 603 00:25:15,283 --> 00:25:16,510 - [Miss Speier] How many, can you tell us 604 00:25:16,510 --> 00:25:18,447 how many you have you have in the line units? 605 00:25:18,447 --> 00:25:22,130 - Of the 10,000 providers, it's over 1,000 right now, ma'am. 606 00:25:22,130 --> 00:25:24,280 - In units? - Yes ma'am. 607 00:25:24,280 --> 00:25:25,970 Or in primary care clinics. 608 00:25:25,970 --> 00:25:28,560 So we have 10,000 providers right now. 609 00:25:28,560 --> 00:25:30,630 It is really useful. 610 00:25:30,630 --> 00:25:32,500 It some ways, it's a loss leader 611 00:25:32,500 --> 00:25:34,220 because of course you're not seeing 612 00:25:34,220 --> 00:25:37,720 patients in and out in the clinic all day. 613 00:25:37,720 --> 00:25:41,260 But it really speaks to what Mr. Kelly spoke about, 614 00:25:41,260 --> 00:25:43,350 and that's interaction with those line commanders 615 00:25:43,350 --> 00:25:44,950 that's vitally important. 616 00:25:44,950 --> 00:25:47,570 And really getting a pulse of the unit. 617 00:25:47,570 --> 00:25:49,700 I found that my interaction with both 618 00:25:49,700 --> 00:25:52,340 commanders and chaplains in the deployed setting 619 00:25:52,340 --> 00:25:54,470 was really, really important. 620 00:25:54,470 --> 00:25:56,040 And it's something that we've endeavored 621 00:25:56,040 --> 00:26:01,040 to get into doctrine and standardize and optimize. 622 00:26:04,400 --> 00:26:05,673 - I was stunned to find out 623 00:26:05,673 --> 00:26:07,830 that there is such a high percentage 624 00:26:07,830 --> 00:26:10,603 of those who commit suicide who've never been deployed. 625 00:26:11,710 --> 00:26:16,160 So what can you say to that? 626 00:26:16,160 --> 00:26:19,703 - So just historically in what I've seen, 627 00:26:21,240 --> 00:26:25,430 over 40% of people who commit suicide haven't deployed. 628 00:26:25,430 --> 00:26:27,890 They're white, they're male. 629 00:26:27,890 --> 00:26:30,440 They have GEDs or high school degrees. 630 00:26:30,440 --> 00:26:32,693 GEDs, and they're enlisted. 631 00:26:33,934 --> 00:26:35,780 The suicide rate in folks with GEDs 632 00:26:35,780 --> 00:26:40,780 was over 50 in the last DoDSER in 2016. 633 00:26:41,070 --> 00:26:42,860 One thing that I've seen over my service 634 00:26:42,860 --> 00:26:45,050 and I was a line guy before I was a doc, 635 00:26:45,050 --> 00:26:49,940 is we've really tried to treat people on station. 636 00:26:49,940 --> 00:26:53,170 We used to separate over 4000 people a year 637 00:26:53,170 --> 00:26:56,320 for personality disorders or adjustment disorders, 638 00:26:56,320 --> 00:27:00,240 under that type of rubric, a nonmedical separation. 639 00:27:00,240 --> 00:27:02,842 We've reduced that to 300 per year. 640 00:27:02,842 --> 00:27:05,660 And I think finding, meeting people where they are, 641 00:27:05,660 --> 00:27:07,730 or meeting those needs is gonna be part 642 00:27:07,730 --> 00:27:10,893 of the suicide prevention equation. 643 00:27:11,870 --> 00:27:15,570 - Have you, in your evaluation of this population 644 00:27:15,570 --> 00:27:19,070 determined what percentage of those 645 00:27:19,070 --> 00:27:22,853 that commit suicide commit suicide in basic training? 646 00:27:24,930 --> 00:27:25,930 - It does happen, ma'am. 647 00:27:25,930 --> 00:27:27,700 And certainly I've seen it. 648 00:27:27,700 --> 00:27:29,670 It's a very small number. 649 00:27:29,670 --> 00:27:31,420 And the only reason that it's a small number 650 00:27:31,420 --> 00:27:33,140 is because there's a great deal 651 00:27:33,140 --> 00:27:35,600 of supervision in basic training. 652 00:27:35,600 --> 00:27:37,850 And there's specific procedures in basic training. 653 00:27:37,850 --> 00:27:39,600 For instance, if you have a headache, 654 00:27:39,600 --> 00:27:41,590 you're only gonna get 10 Tylenol. 655 00:27:41,590 --> 00:27:43,670 You're gonna be monitored by your squad leader, 656 00:27:43,670 --> 00:27:45,160 things along those lines. 657 00:27:45,160 --> 00:27:49,180 It's the A schools and after that we really struggle. 658 00:27:49,180 --> 00:27:52,513 - And can you provide any light on the fact 659 00:27:52,513 --> 00:27:54,080 that there's a higher incidence 660 00:27:54,080 --> 00:27:56,823 of mental health services in the last year of service? 661 00:27:58,430 --> 00:28:00,760 - Yes ma'am, our DMVC records show 662 00:28:00,760 --> 00:28:05,200 that about 25% of folks avail themselves to care 663 00:28:05,200 --> 00:28:07,420 in the year before they leave. 664 00:28:07,420 --> 00:28:09,390 I think that's a good number in as much 665 00:28:09,390 --> 00:28:13,350 as it helps for continuity of care with our VA partners. 666 00:28:13,350 --> 00:28:16,250 But it also speaks to an opportunity that we miss, 667 00:28:16,250 --> 00:28:20,630 perhaps, in why didn't they come in earlier 668 00:28:20,630 --> 00:28:21,880 if they were struggling? 669 00:28:21,880 --> 00:28:25,340 Or how was care stigmatized in a manner 670 00:28:25,340 --> 00:28:28,110 that made it hard for them to seek care earlier? 671 00:28:28,110 --> 00:28:30,667 - And have you asked those questions? 672 00:28:30,667 --> 00:28:31,560 - Oh, certainly, ma'am. 673 00:28:31,560 --> 00:28:34,350 I've certainly asked them as a clinician. 674 00:28:34,350 --> 00:28:36,410 And you know I think one of the things, 675 00:28:36,410 --> 00:28:38,120 let me just bring up an example. 676 00:28:38,120 --> 00:28:42,360 The incidence of depression in women is about 33%. 677 00:28:42,360 --> 00:28:44,070 And I've spoken to many women 678 00:28:44,070 --> 00:28:45,650 right before they leave service, 679 00:28:45,650 --> 00:28:48,630 and why didn't you get care earlier. 680 00:28:48,630 --> 00:28:51,330 Well, I think that care was stigmatized 681 00:28:51,330 --> 00:28:52,630 for them in one way or another. 682 00:28:52,630 --> 00:28:53,800 And certainly we've made an effort 683 00:28:53,800 --> 00:28:55,700 to meet patients where they are. 684 00:28:55,700 --> 00:28:58,150 And it's just like we need to make sure 685 00:28:58,150 --> 00:29:00,060 that we take care of gynecological care for women, 686 00:29:00,060 --> 00:29:01,300 we need to make sure that we take care 687 00:29:01,300 --> 00:29:03,000 of mental healthcare for women. 688 00:29:03,000 --> 00:29:04,703 - Thank you, Chairwoman Brownley. 689 00:29:07,430 --> 00:29:09,200 - Thank you, Chairwoman. 690 00:29:09,200 --> 00:29:12,490 Over the weekend, there was yet another tragedy, 691 00:29:12,490 --> 00:29:17,490 suicide on the campus of one of our VA facilities. 692 00:29:17,630 --> 00:29:21,990 And at that same facility it was reported, 693 00:29:21,990 --> 00:29:24,990 I have an article here that reported 694 00:29:24,990 --> 00:29:29,630 that a veteran seeking mental healthcare was repeatedly, 695 00:29:29,630 --> 00:29:31,680 at least the article alleges, 696 00:29:31,680 --> 00:29:35,330 was misinformed of his eligibility 697 00:29:35,330 --> 00:29:39,350 due to his other than honorable discharge status. 698 00:29:39,350 --> 00:29:42,580 So I wanted to first, Dr. Franklin, 699 00:29:42,580 --> 00:29:47,580 ask you in terms of the VA's efforts, beyond letters, 700 00:29:47,920 --> 00:29:52,910 what other initiatives are we taking to ensure 701 00:29:52,910 --> 00:29:55,720 that our veteran community 702 00:29:55,720 --> 00:30:00,280 who are aware of the change in eligibility, 703 00:30:00,280 --> 00:30:03,823 regarding other than honorable discharges? 704 00:30:04,660 --> 00:30:06,150 - Thank you, I appreciate the question, 705 00:30:06,150 --> 00:30:07,730 'cause it is an at risk population group. 706 00:30:07,730 --> 00:30:08,900 We know that when people are leaving 707 00:30:08,900 --> 00:30:10,583 the military in a bad way, 708 00:30:11,600 --> 00:30:14,210 back in the day bad paper discharge, 709 00:30:14,210 --> 00:30:16,750 they would call it is definitely a high risk group. 710 00:30:16,750 --> 00:30:21,040 And we did mail out over, close to 500,000 letters. 711 00:30:21,040 --> 00:30:24,450 And of those, you should know 3,500 have come into care. 712 00:30:24,450 --> 00:30:25,970 And I have the breakout in terms of 713 00:30:25,970 --> 00:30:27,140 of those, how many have come into 714 00:30:27,140 --> 00:30:29,430 mental healthcare and/or had a diagnosis. 715 00:30:29,430 --> 00:30:33,750 It's 14, 1,413 have a mental health diagnosis. 716 00:30:33,750 --> 00:30:35,260 And the other group have come in 717 00:30:35,260 --> 00:30:37,480 for some form of care or and/or treatment. 718 00:30:37,480 --> 00:30:39,530 And I think that there is work to be done 719 00:30:39,530 --> 00:30:41,100 to continue to get the word out. 720 00:30:41,100 --> 00:30:42,980 So far, above and beyond just the letters 721 00:30:42,980 --> 00:30:45,730 we're educating all 400 of our local 722 00:30:45,730 --> 00:30:47,910 Suicide Prevention Coordinators so that they know. 723 00:30:47,910 --> 00:30:50,230 They have a requirement to do five outreach events a month. 724 00:30:50,230 --> 00:30:52,590 So if you just do the math over 400 of them, 725 00:30:52,590 --> 00:30:55,900 five a month at key places across the state, 726 00:30:55,900 --> 00:30:59,303 or a community where there are known populations at risk, 727 00:31:00,150 --> 00:31:02,600 where they're educating community members on the fact that 728 00:31:02,600 --> 00:31:04,360 if people leave with this type of discharge, 729 00:31:04,360 --> 00:31:06,080 that they can access care, 730 00:31:06,080 --> 00:31:08,060 and that we want them to access care. 731 00:31:08,060 --> 00:31:10,010 Otherwise we're trying to hit the media 732 00:31:10,010 --> 00:31:13,250 with broad articles and educational spots 733 00:31:13,250 --> 00:31:15,190 where we describe the fact that 734 00:31:15,190 --> 00:31:16,770 we are open to this type of care. 735 00:31:16,770 --> 00:31:17,603 I don't know if Mike Fisher 736 00:31:17,603 --> 00:31:19,770 may have other specific examples. 737 00:31:19,770 --> 00:31:21,000 - Absolutely, thank you. 738 00:31:21,000 --> 00:31:23,800 Our focus is also on outreach and our definition of outreach 739 00:31:23,800 --> 00:31:26,520 is going out and creating face to face connections 740 00:31:26,520 --> 00:31:30,260 with those that we are trying to create access to care. 741 00:31:30,260 --> 00:31:33,410 About 99% of our outreach workers are fellow combat veterans 742 00:31:33,410 --> 00:31:35,550 who are able to speak that same language. 743 00:31:35,550 --> 00:31:38,220 Last year we did 35,000 outreach events, 744 00:31:38,220 --> 00:31:40,720 where we were able to create those face to face connections. 745 00:31:40,720 --> 00:31:42,890 And actually Vet Centers have had the ability 746 00:31:42,890 --> 00:31:45,100 to provide services to people with problematic 747 00:31:45,100 --> 00:31:46,600 discharges for several years. 748 00:31:46,600 --> 00:31:49,390 And that really, we make sure that we focus that, 749 00:31:49,390 --> 00:31:51,620 explaining that when we go out. 750 00:31:51,620 --> 00:31:53,460 And then also now with the updates 751 00:31:53,460 --> 00:31:55,350 with over on the medical center side, 752 00:31:55,350 --> 00:31:57,343 is making those connections as well. 753 00:31:59,217 --> 00:32:03,223 - Thank you and just same question to Dr. Van Winkle. 754 00:32:04,290 --> 00:32:06,650 I feel like this can be a collaborative effort 755 00:32:06,650 --> 00:32:11,380 in terms of outreach and certainly before someone leaves 756 00:32:11,380 --> 00:32:15,873 the military that may be dishonorably discharged, 757 00:32:17,380 --> 00:32:22,230 how can you help us to inform this population of veterans? 758 00:32:22,230 --> 00:32:23,210 - Thank you for the question. 759 00:32:23,210 --> 00:32:25,090 I think that as we start to work 760 00:32:25,090 --> 00:32:26,470 within the transition space, 761 00:32:26,470 --> 00:32:28,400 and some of our governance structures including 762 00:32:28,400 --> 00:32:29,720 the Joint Executive Committee, 763 00:32:29,720 --> 00:32:32,230 we have been having these conversations with the VA 764 00:32:32,230 --> 00:32:34,610 about how can the department work better 765 00:32:34,610 --> 00:32:36,300 to transition our folks, 766 00:32:36,300 --> 00:32:39,030 and provide them all the information that they need. 767 00:32:39,030 --> 00:32:40,610 One of the things that we've been doing 768 00:32:40,610 --> 00:32:42,210 and I've been working directly 769 00:32:42,210 --> 00:32:44,700 with the Veteran Benefits Administration 770 00:32:44,700 --> 00:32:47,060 under the guidance of the Joint Executive Committee 771 00:32:47,060 --> 00:32:49,710 is to codify a transition framework 772 00:32:49,710 --> 00:32:53,010 that goes from 365 days prior to separation, 773 00:32:53,010 --> 00:32:56,260 to the 365 days post separation. 774 00:32:56,260 --> 00:32:59,360 And the goal of this is to make sure 775 00:32:59,360 --> 00:33:01,430 that service members leave the military 776 00:33:01,430 --> 00:33:06,020 with an understanding of, and easy access to all 777 00:33:06,020 --> 00:33:08,750 of the benefits and resources that they require. 778 00:33:08,750 --> 00:33:10,660 And this includes those subpopulations 779 00:33:10,660 --> 00:33:12,990 who may have been other than honorably discharged 780 00:33:12,990 --> 00:33:14,730 or dishonorably discharged. 781 00:33:14,730 --> 00:33:17,150 We are considering those subpopulations. 782 00:33:17,150 --> 00:33:20,130 And making sure that the Department of Defense 783 00:33:20,130 --> 00:33:23,550 and the VA has the burden to get this 784 00:33:23,550 --> 00:33:25,497 to a place where they have that access. 785 00:33:25,497 --> 00:33:27,360 But it's not up to the service member 786 00:33:27,360 --> 00:33:29,750 to have to do the legwork to figure out 787 00:33:29,750 --> 00:33:32,240 all the different resources available to them. 788 00:33:32,240 --> 00:33:33,670 So this is something we're working on 789 00:33:33,670 --> 00:33:36,830 and the Joint Executive Committee has taken on. 790 00:33:36,830 --> 00:33:40,800 - Thank you, I wanted to ask another question. 791 00:33:40,800 --> 00:33:42,910 This is with regards to MST, 792 00:33:42,910 --> 00:33:45,440 and there's been peer reviewed research 793 00:33:45,440 --> 00:33:47,900 that repeatedly finds that the experience 794 00:33:47,900 --> 00:33:52,560 of MST elevates the risk of suicide. 795 00:33:52,560 --> 00:33:56,590 And the risk is even higher for MST survivors 796 00:33:56,590 --> 00:34:00,273 who are also members of marginalized groups, 797 00:34:02,060 --> 00:34:05,727 women, racial minorities, LGBTQ service members. 798 00:34:08,730 --> 00:34:11,050 So over half of the service members 799 00:34:11,050 --> 00:34:15,440 who report MST experience retaliation 800 00:34:15,440 --> 00:34:17,183 by their chains of command. 801 00:34:18,990 --> 00:34:21,920 I know it's a question that is always asked. 802 00:34:21,920 --> 00:34:23,870 But it think we have to keep asking it, 803 00:34:23,870 --> 00:34:28,430 'cause it's such a huge cultural change within the military. 804 00:34:28,430 --> 00:34:33,430 But what are we doing to help to create that environment 805 00:34:34,910 --> 00:34:39,280 in the military to make it safe, safe for survivors, 806 00:34:39,280 --> 00:34:43,103 and really safe for anyone to reach out for help? 807 00:34:43,950 --> 00:34:45,940 - So I appreciate that question as well 808 00:34:45,940 --> 00:34:50,240 considering my position where sexual assault policies 809 00:34:50,240 --> 00:34:52,820 and the suicide policies both fall under me, 810 00:34:52,820 --> 00:34:54,800 as well as the policies on harassment, 811 00:34:54,800 --> 00:34:56,850 hazing, bullying, drug use. 812 00:34:56,850 --> 00:34:58,730 And the reason being is because we know 813 00:34:58,730 --> 00:35:01,820 there's an intersection between all of these behaviors. 814 00:35:01,820 --> 00:35:03,180 And when you have an individual 815 00:35:03,180 --> 00:35:05,080 who's experienced a sexual assault, 816 00:35:05,080 --> 00:35:07,860 this is extremely fragmenting and shattering. 817 00:35:07,860 --> 00:35:11,100 And often they may cope by drinking more, 818 00:35:11,100 --> 00:35:14,680 or having other experiences which will put 819 00:35:14,680 --> 00:35:16,720 them in a place of experiencing depression, 820 00:35:16,720 --> 00:35:20,110 and potential suicidal ideation attempts. 821 00:35:20,110 --> 00:35:22,520 We work within this space on the policy level 822 00:35:22,520 --> 00:35:26,200 under the prevention collaboration forum, which I run, 823 00:35:26,200 --> 00:35:28,740 where all of these policy offices work together 824 00:35:28,740 --> 00:35:30,730 to align our prevention strategies. 825 00:35:30,730 --> 00:35:32,850 So that we make sure that we close any loopholes 826 00:35:32,850 --> 00:35:35,410 for those individuals who may be experiencing 827 00:35:35,410 --> 00:35:37,650 multiple issues at once. 828 00:35:37,650 --> 00:35:39,750 In the prevention collaboration forum is also 829 00:35:39,750 --> 00:35:43,040 the Family Advocacy Program talking about domestic violence, 830 00:35:43,040 --> 00:35:44,880 the care that we provide to our families 831 00:35:44,880 --> 00:35:46,530 and to our children. 832 00:35:46,530 --> 00:35:49,290 And that is one of the structures 833 00:35:49,290 --> 00:35:53,180 that we use in order to address these co-occurring issues. 834 00:35:53,180 --> 00:35:54,910 Captain Colston also can talk a little bit 835 00:35:54,910 --> 00:35:56,470 about the behavioral health treatment 836 00:35:56,470 --> 00:35:58,780 targeted towards these individuals. 837 00:35:58,780 --> 00:36:00,700 - So every evidence based treatment 838 00:36:00,700 --> 00:36:05,000 for sexual assault trauma is available in DoD. 839 00:36:05,000 --> 00:36:08,680 Cognitive processing therapy, a prolonged exposure therapy, 840 00:36:08,680 --> 00:36:12,770 which is an especially good therapy from Edna Foa's lab 841 00:36:12,770 --> 00:36:16,630 in University of Pennsylvania, medication 842 00:36:16,630 --> 00:36:19,450 and certainly wrap around services for these folks. 843 00:36:19,450 --> 00:36:23,400 - I'm convinced that there are lots of programs 844 00:36:23,400 --> 00:36:24,680 and supports around there. 845 00:36:24,680 --> 00:36:28,180 I'm still just continue to be 846 00:36:28,180 --> 00:36:31,163 concerned around the environment, 847 00:36:33,385 --> 00:36:37,040 and I just think there is a lot more, 848 00:36:37,040 --> 00:36:41,470 I hear it anecdotally, time and time and time again, 849 00:36:41,470 --> 00:36:44,310 about retaliation and the chain of command. 850 00:36:44,310 --> 00:36:47,550 And I just think that we have to, 851 00:36:47,550 --> 00:36:49,620 I mean truly address that in a way 852 00:36:49,620 --> 00:36:52,040 that we are really drilling down 853 00:36:53,580 --> 00:36:56,890 every single place within the military, 854 00:36:56,890 --> 00:36:59,453 that it's just unacceptable that that would happen. 855 00:37:00,371 --> 00:37:02,210 And I still hear over and over again 856 00:37:02,210 --> 00:37:06,320 that members of the military, men and women, 857 00:37:06,320 --> 00:37:09,210 around mental health or MST, 858 00:37:09,210 --> 00:37:13,490 the fear of just reaching out to ask for help. 859 00:37:13,490 --> 00:37:17,450 And so I know cultural changes are really, really hard. 860 00:37:17,450 --> 00:37:21,500 But unless the leadership is completely committed to it, 861 00:37:21,500 --> 00:37:23,470 it's not gonna happen. 862 00:37:23,470 --> 00:37:24,760 And certainly on the VA side, 863 00:37:24,760 --> 00:37:28,240 we have the same kind of cultural issues 864 00:37:30,289 --> 00:37:31,623 that we have to address. 865 00:37:33,130 --> 00:37:35,270 I feel like, I've never been on a committee 866 00:37:35,270 --> 00:37:38,560 where the chair people weren't limited by time. 867 00:37:38,560 --> 00:37:42,500 So I wanna be respectful of the time 868 00:37:42,500 --> 00:37:44,560 so I will yield back. 869 00:37:44,560 --> 00:37:47,340 - Captain Colston, along those same lines, 870 00:37:47,340 --> 00:37:52,340 I visited a VA program in Menlo Park for MST survivors. 871 00:37:54,810 --> 00:37:58,680 Not one of them was going to be able to leave the program 872 00:37:58,680 --> 00:38:02,160 and go to a home, they were all homeless 873 00:38:02,160 --> 00:38:05,100 when they were going to leave the facility. 874 00:38:05,100 --> 00:38:10,010 And I'm also concerned that for a long time, 875 00:38:10,010 --> 00:38:11,350 I don't know if we're still doing that, 876 00:38:11,350 --> 00:38:13,280 and maybe one of you can enlighten us, 877 00:38:13,280 --> 00:38:15,740 many of them were discharged 878 00:38:15,740 --> 00:38:18,350 with what was called a personality disorder. 879 00:38:18,350 --> 00:38:21,370 And I'm curious whether or not they were, 880 00:38:21,370 --> 00:38:24,013 in that status, able to access services? 881 00:38:26,120 --> 00:38:29,320 - So under that rubric, they got a general discharge. 882 00:38:29,320 --> 00:38:32,920 But we did make a very large effort 883 00:38:32,920 --> 00:38:35,500 to address injustices in that regard. 884 00:38:35,500 --> 00:38:37,670 I think that I have spoken in other committee meetings 885 00:38:37,670 --> 00:38:41,000 about how we've evolved around 886 00:38:41,000 --> 00:38:43,220 that particular type of discharge, 887 00:38:43,220 --> 00:38:46,373 going from 4,000 a year to 300 folks a year. 888 00:38:47,230 --> 00:38:52,230 In about 2013, Secretary Panetta made a promise 889 00:38:52,850 --> 00:38:54,700 at Senate Appropriations committee 890 00:38:54,700 --> 00:38:57,260 that we'd review all of those cases and in fact, we did. 891 00:38:57,260 --> 00:39:01,410 So we looked at over 200,000 instances 892 00:39:01,410 --> 00:39:03,980 where folks didn't leave with medical benefits, 893 00:39:03,980 --> 00:39:06,970 where they left less than 30% 894 00:39:06,970 --> 00:39:10,160 by our Physical Disability Board of Review. 895 00:39:10,160 --> 00:39:11,830 And the Physical Disability Board of Review 896 00:39:11,830 --> 00:39:13,260 which is run by the Air Force, 897 00:39:13,260 --> 00:39:16,510 and overseen by personnel in Readiness, 898 00:39:16,510 --> 00:39:19,560 scrubbed cases over three years, 899 00:39:19,560 --> 00:39:21,640 and got benefits to lots of folks. 900 00:39:21,640 --> 00:39:23,560 And they also did a lot of outreach. 901 00:39:23,560 --> 00:39:25,140 So they went to homeless shelters 902 00:39:25,140 --> 00:39:27,140 and looked for those folks. 903 00:39:27,140 --> 00:39:30,730 We have Boards of Correction for military records. 904 00:39:30,730 --> 00:39:35,730 And there is a presumption in those Boards of Correction 905 00:39:36,410 --> 00:39:38,360 that a mistake may have been made. 906 00:39:38,360 --> 00:39:40,350 So we've given specific guidance 907 00:39:40,350 --> 00:39:44,400 around those types of cases to our Boards of Correction. 908 00:39:44,400 --> 00:39:46,390 - All right, maybe for the record, 909 00:39:46,390 --> 00:39:47,970 you could just provide us with the numbers. 910 00:39:47,970 --> 00:39:49,380 If you looked at 200,000, 911 00:39:49,380 --> 00:39:53,410 could you let us know how many were changed? 912 00:39:53,410 --> 00:39:55,190 - Yes ma'am, I just got a four year request on it. 913 00:39:55,190 --> 00:39:56,850 So I think I have it-- - Right. 914 00:39:56,850 --> 00:39:58,183 - [Female] May I ask just one more question? 915 00:39:58,183 --> 00:39:59,900 - I would ask that there be equal time. 916 00:39:59,900 --> 00:40:03,520 And I know that the minority party probably is not 917 00:40:03,520 --> 00:40:06,110 entitled to any comments whatsoever. 918 00:40:06,110 --> 00:40:09,390 But this is ridiculous that we have gone through 919 00:40:09,390 --> 00:40:11,990 many, many minutes and we've not even been referred to. 920 00:40:11,990 --> 00:40:14,320 And it's very passive aggressive behavior 921 00:40:14,320 --> 00:40:16,400 and intentionally leaving the minority out 922 00:40:16,400 --> 00:40:17,630 and this is not the first hearing. 923 00:40:17,630 --> 00:40:19,180 And I just ask that equal time 924 00:40:19,180 --> 00:40:22,710 be represented in this hearing and all other hearings. 925 00:40:22,710 --> 00:40:24,530 - Mr. Kelly, you are recognized, 926 00:40:24,530 --> 00:40:26,850 and you have as much time as you would like 927 00:40:26,850 --> 00:40:29,160 to ask your questions as we always do 928 00:40:29,160 --> 00:40:31,073 in our committee hearings, so. 929 00:40:32,210 --> 00:40:33,170 - Thank you, Madame Chair. 930 00:40:33,170 --> 00:40:35,650 Generally, it's the chair, ranking member, 931 00:40:35,650 --> 00:40:37,860 chair, ranking member in all four years 932 00:40:37,860 --> 00:40:38,990 that I've been in every committee 933 00:40:38,990 --> 00:40:40,750 and subcommittee that I've been on. 934 00:40:40,750 --> 00:40:43,260 With that being said, I would first say 935 00:40:43,260 --> 00:40:45,280 that I'm very concerned about 936 00:40:45,280 --> 00:40:47,700 our Reserve component service members and veterans 937 00:40:47,700 --> 00:40:50,370 who return to their civilian communities 938 00:40:50,370 --> 00:40:52,230 where they're may not always be good access 939 00:40:52,230 --> 00:40:53,427 to behavioral health resources, 940 00:40:53,427 --> 00:40:56,693 and the support systems you find on military installations. 941 00:40:58,010 --> 00:41:01,080 There's also the issue when Reserve components come back, 942 00:41:01,080 --> 00:41:02,020 National Guard and Reserve, 943 00:41:02,020 --> 00:41:04,250 they don't demob at the same time. 944 00:41:04,250 --> 00:41:06,670 They go home to different locations. 945 00:41:06,670 --> 00:41:09,910 There is not that unit cohesiveness 946 00:41:09,910 --> 00:41:12,010 and the ability to talk with the soldiers 947 00:41:12,010 --> 00:41:14,403 that they serve with while they've done so. 948 00:41:15,630 --> 00:41:17,400 What are we doing to reach out 949 00:41:17,400 --> 00:41:19,080 to the Reserve and National Guard, 950 00:41:19,080 --> 00:41:20,440 and make sure that these veterans 951 00:41:20,440 --> 00:41:22,240 are getting the help that they need? 952 00:41:25,280 --> 00:41:26,670 - Thank you for the question. 953 00:41:26,670 --> 00:41:29,730 We do have those concerns that you mentioned 954 00:41:29,730 --> 00:41:31,530 about the Reserves and the National Guard. 955 00:41:31,530 --> 00:41:34,060 Simply, pragmatically, they don't have the access 956 00:41:34,060 --> 00:41:37,500 to the same resources that you may have in the active duty 957 00:41:37,500 --> 00:41:39,790 when you are under our purview 24/7. 958 00:41:39,790 --> 00:41:42,130 So that is on us to make sure 959 00:41:42,130 --> 00:41:44,240 that we provide them all of those resources 960 00:41:44,240 --> 00:41:46,620 and we do this in a number of ways. 961 00:41:46,620 --> 00:41:49,170 We do provide all of our resources 962 00:41:49,170 --> 00:41:51,270 in terms of the crisis lines, 963 00:41:51,270 --> 00:41:54,120 and Military Family Life counseling, 964 00:41:54,120 --> 00:41:56,330 and peer to peer support that they can call in, 965 00:41:56,330 --> 00:41:57,330 we provide that. 966 00:41:57,330 --> 00:41:59,420 It's on us to make sure they recognize 967 00:41:59,420 --> 00:42:02,090 that that resource is available to them. 968 00:42:02,090 --> 00:42:03,620 Captain Colston can talk a bit about 969 00:42:03,620 --> 00:42:05,030 how they target their efforts 970 00:42:05,030 --> 00:42:06,570 to Reservists and National Guard. 971 00:42:06,570 --> 00:42:09,610 And Mr. Fisher can talk also about the Vet Centers 972 00:42:09,610 --> 00:42:11,260 which are available to our Reservists 973 00:42:11,260 --> 00:42:12,463 and our National Guard. 974 00:42:16,470 --> 00:42:17,670 - Thank you, one of the things that 975 00:42:17,670 --> 00:42:18,950 we're working on within Vet Centers, 976 00:42:18,950 --> 00:42:21,460 it's actually an initiative with the National Guard Bureau, 977 00:42:21,460 --> 00:42:25,270 where we are taking our assets, both our counseling staff, 978 00:42:25,270 --> 00:42:27,340 our outreach staff, our mobile Vet Centers 979 00:42:27,340 --> 00:42:29,880 and we're going out to drilling units, 980 00:42:29,880 --> 00:42:31,160 and spending time with them. 981 00:42:31,160 --> 00:42:33,600 When it makes sense for them, on a drill weekend. 982 00:42:33,600 --> 00:42:35,250 Our real job there is to go out 983 00:42:35,250 --> 00:42:37,960 and make those connections like we talked about before. 984 00:42:37,960 --> 00:42:41,230 But if they need services, connect them into services, 985 00:42:41,230 --> 00:42:43,510 or provide the services on the ground. 986 00:42:43,510 --> 00:42:45,130 Now we recognize that there will be 987 00:42:45,130 --> 00:42:46,990 individuals that are not truly eligible 988 00:42:46,990 --> 00:42:48,850 for Vet Center services that we meet. 989 00:42:48,850 --> 00:42:52,920 And if they are in crisis we will meet that need 990 00:42:52,920 --> 00:42:56,960 but our job then becomes where can we make that referral to? 991 00:42:56,960 --> 00:42:59,410 Whether that's the VA, or our partners in DoD, 992 00:42:59,410 --> 00:43:00,910 the National Guard Bureau, 993 00:43:00,910 --> 00:43:02,970 or other places within the community. 994 00:43:02,970 --> 00:43:05,560 As we roll out the National Guard, 995 00:43:05,560 --> 00:43:07,930 our next step then is to go into the Reserve Forces 996 00:43:07,930 --> 00:43:11,650 and do the same thing but get connection to those locations. 997 00:43:11,650 --> 00:43:13,480 And really what we're doing is we wanna build 998 00:43:13,480 --> 00:43:16,950 relationships with leadership, so that when we're not there, 999 00:43:16,950 --> 00:43:19,083 we can create bi-directional referrals. 1000 00:43:20,180 --> 00:43:21,013 - I thank y'all. 1001 00:43:21,013 --> 00:43:23,240 I just ask that you look at the soldier level, 1002 00:43:23,240 --> 00:43:27,120 especially combat veterans or like experiences 1003 00:43:27,120 --> 00:43:29,960 because I will tell you, many combat veterans 1004 00:43:29,960 --> 00:43:32,560 will not talk to noncombat veterans. 1005 00:43:32,560 --> 00:43:35,550 More specifically that subset is even smaller, 1006 00:43:35,550 --> 00:43:37,540 the folks, the platoon, or the squad 1007 00:43:37,540 --> 00:43:39,310 that they actually served with. 1008 00:43:39,310 --> 00:43:40,740 They're willing to share with those 1009 00:43:40,740 --> 00:43:43,380 like family members when they won't share with anyone else. 1010 00:43:43,380 --> 00:43:47,040 So that is the key to identifying the issue, 1011 00:43:47,040 --> 00:43:50,260 is those small subsets which they will only share. 1012 00:43:50,260 --> 00:43:54,280 Dr. Van Winkle, thank you for your work in this area. 1013 00:43:54,280 --> 00:43:56,410 What type of training did you and your leaders 1014 00:43:56,410 --> 00:43:59,110 in the military receive to help identify behavior 1015 00:43:59,110 --> 00:44:02,500 in their troops that may be a sign of greater behavioral 1016 00:44:02,500 --> 00:44:04,623 health issues, specifically suicide? 1017 00:44:05,680 --> 00:44:07,140 - There's a number of training efforts 1018 00:44:07,140 --> 00:44:09,160 that we provide to both our junior leaders 1019 00:44:09,160 --> 00:44:11,053 as well as our commanders, and service members 1020 00:44:11,053 --> 00:44:12,230 who are at large. 1021 00:44:12,230 --> 00:44:14,900 The idea is to make everybody part of the solution. 1022 00:44:14,900 --> 00:44:17,330 And so when we talk about risk factors, 1023 00:44:17,330 --> 00:44:21,010 we're looking at often situational factors that cause stress 1024 00:44:21,010 --> 00:44:23,910 and can often predict whether somebody 1025 00:44:23,910 --> 00:44:26,340 is going to go get depressed, 1026 00:44:26,340 --> 00:44:29,850 and go on to die by suicide or attempt suicide. 1027 00:44:29,850 --> 00:44:32,620 Those include relationship problems, 1028 00:44:32,620 --> 00:44:35,040 financial problems, legal issues. 1029 00:44:35,040 --> 00:44:37,010 And so when those issues arise, 1030 00:44:37,010 --> 00:44:38,870 and a commander or a lower level leader, 1031 00:44:38,870 --> 00:44:42,130 the first line supervisor is made aware of it, 1032 00:44:42,130 --> 00:44:44,510 it is a call to action that we may need to provide 1033 00:44:44,510 --> 00:44:46,210 additional support to that individual. 1034 00:44:46,210 --> 00:44:48,050 But we have broadened that to be 1035 00:44:48,050 --> 00:44:49,530 the service members themselves, 1036 00:44:49,530 --> 00:44:52,683 as well as the families to again be part of that solution. 1037 00:44:54,394 --> 00:44:57,133 - And I think Dr. Captain Colston, 1038 00:45:00,890 --> 00:45:02,450 you made an interesting comment. 1039 00:45:02,450 --> 00:45:05,670 And I can tell you in 33 years of military service, 1040 00:45:05,670 --> 00:45:08,410 and through going through PHAs and everything else 1041 00:45:08,410 --> 00:45:10,400 that we've had to go through on a yearly basis. 1042 00:45:10,400 --> 00:45:13,260 And also doing post deployment stuff, 1043 00:45:13,260 --> 00:45:15,700 and seeing other soldiers do those, 1044 00:45:15,700 --> 00:45:18,260 there's a reason people wait till year 19 1045 00:45:18,260 --> 00:45:20,540 or their last year before they report anything. 1046 00:45:20,540 --> 00:45:22,930 And that's not just behavioral health issues, 1047 00:45:22,930 --> 00:45:24,650 that is physical issues. 1048 00:45:24,650 --> 00:45:27,310 And it's from the fear of being removed from the service. 1049 00:45:27,310 --> 00:45:30,260 And that is the stigma which we must 1050 00:45:30,260 --> 00:45:32,300 figure out how to stamp out. 1051 00:45:32,300 --> 00:45:34,240 Because they won't tell you they're hurting. 1052 00:45:34,240 --> 00:45:38,170 They won't tell you either physically or internally 1053 00:45:38,170 --> 00:45:40,860 because they're scared that it will impact their career. 1054 00:45:40,860 --> 00:45:44,020 What can we do to make sure that they 1055 00:45:44,020 --> 00:45:46,540 disclose this earlier, to remove that stigma, 1056 00:45:46,540 --> 00:45:49,430 and that fear of being removed from service? 1057 00:45:49,430 --> 00:45:52,220 - I think the first thing is is we absolutely 1058 00:45:52,220 --> 00:45:54,920 need to get the word out that it's almost impossible 1059 00:45:54,920 --> 00:45:56,230 to lose your security clearance 1060 00:45:56,230 --> 00:45:58,460 from endorsing a mental health history 1061 00:45:58,460 --> 00:46:02,093 on your SF-86 question 21 and we really have data. 1062 00:46:03,155 --> 00:46:07,040 A couple dozen out of nearly 10 million security clearances. 1063 00:46:07,040 --> 00:46:09,080 So when we look at the process of 1064 00:46:09,080 --> 00:46:11,500 okay, let's get down to the data, are we gonna kick you out 1065 00:46:11,500 --> 00:46:14,510 for having a mental health condition, probably not. 1066 00:46:14,510 --> 00:46:16,610 And in fact, there's a presumption 1067 00:46:16,610 --> 00:46:18,670 of nondisclosure with commanders. 1068 00:46:18,670 --> 00:46:19,503 As a commander, 1069 00:46:19,503 --> 00:46:21,640 do I wanna know absolutely everything about anybody, 1070 00:46:21,640 --> 00:46:23,820 any of my troops, I do. 1071 00:46:23,820 --> 00:46:25,390 But there are all kinds of things 1072 00:46:25,390 --> 00:46:28,660 that to create an environment of trust, 1073 00:46:28,660 --> 00:46:30,650 and an environment where you can come to see me, 1074 00:46:30,650 --> 00:46:32,070 that we need to delimit 1075 00:46:32,070 --> 00:46:34,210 things that we speak to commanding officers about. 1076 00:46:34,210 --> 00:46:39,210 So that's imminent harm to self, imminent health to others, 1077 00:46:39,360 --> 00:46:41,290 severe substance use disorders. 1078 00:46:41,290 --> 00:46:45,250 But we really need to have something that's very private 1079 00:46:45,250 --> 00:46:47,280 between clinicians and soldiers. 1080 00:46:47,280 --> 00:46:49,340 - I would ask the rest of you all to submit for the record 1081 00:46:49,340 --> 00:46:52,470 so we can have other people ask some questions. 1082 00:46:52,470 --> 00:46:54,310 But I would also, one thing for the record. 1083 00:46:54,310 --> 00:46:57,230 Just someone give us the information 1084 00:46:57,230 --> 00:46:59,580 on what the disparity and percentages 1085 00:46:59,580 --> 00:47:01,477 for women and men committing suicide. 1086 00:47:01,477 --> 00:47:03,260 I know there's a smaller number of women 1087 00:47:03,260 --> 00:47:05,650 but I would love to know the difference in women, 1088 00:47:05,650 --> 00:47:08,420 or any other differences that you can do for the record. 1089 00:47:08,420 --> 00:47:10,600 So thank you, Madame Chair. 1090 00:47:10,600 --> 00:47:11,433 - Thank you, Mr. Kelly. 1091 00:47:11,433 --> 00:47:15,830 And Dr. Dunn, you have as much time as you need. 1092 00:47:15,830 --> 00:47:17,400 - [Dr. Dunn] Thank you, Madame Chair. 1093 00:47:17,400 --> 00:47:19,880 Dr. Franklin, please elaborate on 1094 00:47:19,880 --> 00:47:21,870 some of the specific changes you're making 1095 00:47:21,870 --> 00:47:25,410 to VA suicide prevention programs. 1096 00:47:25,410 --> 00:47:27,920 - Sure, absolutely, we've made a number of changes 1097 00:47:27,920 --> 00:47:30,300 in the last year that I'd be pleased to tell you about. 1098 00:47:30,300 --> 00:47:31,820 I mean, the first is putting pen to paper 1099 00:47:31,820 --> 00:47:33,680 on a national strategy. 1100 00:47:33,680 --> 00:47:35,080 I think in times past, 1101 00:47:35,080 --> 00:47:37,130 the VA's approach to suicide prevention 1102 00:47:37,130 --> 00:47:39,310 has largely been focused on the Veteran Crisis Line, 1103 00:47:39,310 --> 00:47:42,930 and on providing the best mental health care ever. 1104 00:47:42,930 --> 00:47:45,937 And that alone, we know it will not prevent suicide. 1105 00:47:45,937 --> 00:47:48,680 And so this strategy really gets after making sure 1106 00:47:48,680 --> 00:47:50,870 that we're doing broad sector engagement. 1107 00:47:50,870 --> 00:47:52,810 And we're moving outside the four walls 1108 00:47:52,810 --> 00:47:55,250 of the VA hospital system which is new. 1109 00:47:55,250 --> 00:47:56,860 Traditionally, we've, like I said, 1110 00:47:56,860 --> 00:47:58,570 had an approach where folks come to us, 1111 00:47:58,570 --> 00:48:00,840 and we provide them the best care we can. 1112 00:48:00,840 --> 00:48:04,340 - Do you have metrics you're following those in changes? 1113 00:48:04,340 --> 00:48:06,530 - Yes, so this is all very new within the last year. 1114 00:48:06,530 --> 00:48:09,450 And our ultimate metric that we've come up with on this, 1115 00:48:09,450 --> 00:48:13,140 or the ultimate metric is to lower the 20 a day. 1116 00:48:13,140 --> 00:48:15,990 But left of that metric is a set of bundled metrics 1117 00:48:15,990 --> 00:48:17,080 that we have come up with. 1118 00:48:17,080 --> 00:48:19,720 And it's everything from making sure that 1119 00:48:19,720 --> 00:48:22,130 we have an all hands approach in terms of training, 1120 00:48:22,130 --> 00:48:23,740 so a metric tied to training. 1121 00:48:23,740 --> 00:48:27,810 We have a metric tied to increasing access to healthcare. 1122 00:48:27,810 --> 00:48:30,470 We have a metric tied to our predictive analytics approach, 1123 00:48:30,470 --> 00:48:32,690 when we identify through our predictive modeling. 1124 00:48:32,690 --> 00:48:34,490 Maybe you've heard of it, REACH VET, 1125 00:48:34,490 --> 00:48:38,340 that we get those folks into care, the high risk folks. 1126 00:48:38,340 --> 00:48:40,800 - I think we would like to see some of that. 1127 00:48:40,800 --> 00:48:44,160 Just a white paper kind of answer at your convenience. 1128 00:48:44,160 --> 00:48:46,770 Mr. Fisher, here's a little good news for you. 1129 00:48:46,770 --> 00:48:49,570 H.R.1812 that allows the Guard and Reserve 1130 00:48:49,570 --> 00:48:51,530 to access Vet Centers, 1131 00:48:51,530 --> 00:48:53,930 if they've been activated for natural disasters, 1132 00:48:53,930 --> 00:48:56,480 civil disorder, or drug interdiction operations 1133 00:48:56,480 --> 00:48:59,540 just passed the House by voice vote. 1134 00:48:59,540 --> 00:49:00,880 - [Mr. Fisher] That is great news, sir, thank you. 1135 00:49:00,880 --> 00:49:03,120 - Now in that vein, 1136 00:49:03,120 --> 00:49:05,470 what percentage of your vets that are counseling 1137 00:49:05,470 --> 00:49:07,993 is provided to active duty or Guard? 1138 00:49:09,500 --> 00:49:11,560 - Well, like the Chair Woman before, 1139 00:49:11,560 --> 00:49:15,870 last year it was 5% of the total uniques coming in 1140 00:49:15,870 --> 00:49:17,780 were for active duty service members. 1141 00:49:17,780 --> 00:49:19,150 The Guard is a little less than that. 1142 00:49:19,150 --> 00:49:22,660 But what we are seeing is increases 1143 00:49:22,660 --> 00:49:24,280 in those two populations. 1144 00:49:24,280 --> 00:49:28,230 So last year we had a 9% increase 1145 00:49:28,230 --> 00:49:30,530 in active duty service members, excuse me, 1146 00:49:30,530 --> 00:49:33,130 an 8% increase in active duty service members come in. 1147 00:49:33,130 --> 00:49:35,680 And over this past year as we roll out 1148 00:49:35,680 --> 00:49:38,800 this National Guard initiative, we've seen a 9% increase 1149 00:49:38,800 --> 00:49:41,830 in National Guard individuals coming into Vet Centers 1150 00:49:41,830 --> 00:49:43,780 or connecting with those individuals. 1151 00:49:43,780 --> 00:49:45,720 - Thank you, Captain Colston, 1152 00:49:45,720 --> 00:49:48,360 what kind of outreach does DoD do 1153 00:49:48,360 --> 00:49:51,430 to make sure that the active duty troops know 1154 00:49:51,430 --> 00:49:53,383 that they can use the Vet Centers? 1155 00:49:54,320 --> 00:49:55,360 - So all kinds of outreach. 1156 00:49:55,360 --> 00:49:57,660 I think with regard to the military, 1157 00:49:57,660 --> 00:49:59,290 I'm sorry, all types of outreach. 1158 00:49:59,290 --> 00:50:01,650 So in regard to military sexual trauma, 1159 00:50:01,650 --> 00:50:05,080 Vet Centers have long been available. 1160 00:50:05,080 --> 00:50:07,840 We make an effort to ensure that folks 1161 00:50:07,840 --> 00:50:10,180 know that there's continuity of care. 1162 00:50:10,180 --> 00:50:13,320 That we have a warm handoff between our side 1163 00:50:13,320 --> 00:50:15,380 and the VA side or our side 1164 00:50:15,380 --> 00:50:17,110 and an ongoing TriCare relationship, 1165 00:50:17,110 --> 00:50:19,030 or our side and the civilian side. 1166 00:50:19,030 --> 00:50:21,230 - I think your troops might be more interested 1167 00:50:21,230 --> 00:50:23,300 in finding out there's confidentiality 1168 00:50:23,300 --> 00:50:27,750 rather than continuity of care when they go to a Vet Center. 1169 00:50:27,750 --> 00:50:29,370 - And I agree with you, sir. 1170 00:50:29,370 --> 00:50:32,210 And I think that's an important part 1171 00:50:32,210 --> 00:50:33,867 of everything that we do. 1172 00:50:33,867 --> 00:50:36,130 And also as providers, I think there needs to be 1173 00:50:36,130 --> 00:50:37,820 a presumption of non-disclosures. 1174 00:50:37,820 --> 00:50:39,420 - So General Kelly mentioned that, 1175 00:50:39,420 --> 00:50:42,590 that people are afraid to self report. 1176 00:50:42,590 --> 00:50:44,790 And that I can tell you that's, 1177 00:50:44,790 --> 00:50:46,680 you know it's true, you don't need to hear from me, 1178 00:50:46,680 --> 00:50:48,513 they are afraid to self report. 1179 00:50:51,070 --> 00:50:54,450 Dr. Franklin, I understand your public perceptions 1180 00:50:54,450 --> 00:50:56,930 are powerful and that one of the VA's goals 1181 00:50:56,930 --> 00:50:59,830 is to support responsible reporting of suicide. 1182 00:50:59,830 --> 00:51:02,500 What advice do you have for media outlets 1183 00:51:02,500 --> 00:51:03,650 reporting on this hearing 1184 00:51:03,650 --> 00:51:06,990 and for our audience members sitting here today? 1185 00:51:06,990 --> 00:51:07,823 - Yes, they are critically important. 1186 00:51:07,823 --> 00:51:10,240 And I think the average public doesn't realize 1187 00:51:10,240 --> 00:51:11,660 how much they can influence 1188 00:51:11,660 --> 00:51:14,267 the suicide prevention space by safe reporting. 1189 00:51:14,267 --> 00:51:16,760 And so I have all sorts of advice. 1190 00:51:16,760 --> 00:51:18,800 I mean, first and foremost, 1191 00:51:18,800 --> 00:51:20,900 I don't want the general public to think that the VA 1192 00:51:20,900 --> 00:51:23,340 is ever limiting how folks should report. 1193 00:51:23,340 --> 00:51:26,380 But following the National Safe Reporting Guidelines 1194 00:51:26,380 --> 00:51:27,470 is critically important. 1195 00:51:27,470 --> 00:51:30,490 So making sure that headlines are accurate. 1196 00:51:30,490 --> 00:51:33,180 That they are factual, but that they don't glamorize. 1197 00:51:33,180 --> 00:51:34,760 And making sure that we don't get 1198 00:51:34,760 --> 00:51:37,090 into the details of the method. 1199 00:51:37,090 --> 00:51:38,610 It's not important for the media, 1200 00:51:38,610 --> 00:51:42,800 whether reporting out what type of, the method 1201 00:51:42,800 --> 00:51:44,780 that occurred when the death occurred. 1202 00:51:44,780 --> 00:51:47,273 I'm hesitant to not wanna say it. 1203 00:51:47,273 --> 00:51:48,799 - [Dr. Dunn] I understand, do you have a bullet point list 1204 00:51:48,799 --> 00:51:49,632 like you give for-- 1205 00:51:49,632 --> 00:51:51,240 - Yes, we have a safe reporting guidelines, 1206 00:51:51,240 --> 00:51:52,840 we just published them in the last few months 1207 00:51:52,840 --> 00:51:54,360 and we're trying to get them out near and far 1208 00:51:54,360 --> 00:51:56,030 so every reporter in the nation knows. 1209 00:51:56,030 --> 00:51:58,660 And we're also holding a media round table next week 1210 00:51:58,660 --> 00:52:01,030 where we're bringing in all sorts of media outlets, 1211 00:52:01,030 --> 00:52:04,500 and we're partnering with the national entities 1212 00:52:04,500 --> 00:52:06,880 in this space to really just do an increased awareness, 1213 00:52:06,880 --> 00:52:09,380 and try to help us get it right session. 1214 00:52:09,380 --> 00:52:12,630 - I would once again appreciate sort of that in written 1215 00:52:12,630 --> 00:52:15,390 to the VA Health Committee, we'd be grateful. 1216 00:52:15,390 --> 00:52:17,133 And Madame Chair, I yield back, thank you. 1217 00:52:17,133 --> 00:52:18,860 - [Chairwoman] Thank you, Dr. Dunn. 1218 00:52:18,860 --> 00:52:20,583 Mr. Gallego, you're recognized. 1219 00:52:22,290 --> 00:52:23,750 - Thank you. - For five minutes. 1220 00:52:23,750 --> 00:52:27,060 - Thank you, Captain Colston, or Dr. Van Winkle, 1221 00:52:27,060 --> 00:52:29,480 I know that service members own firearms at a higher rate 1222 00:52:29,480 --> 00:52:33,100 and they come of course in contact with guns more regularly 1223 00:52:33,100 --> 00:52:34,890 than the general population. 1224 00:52:34,890 --> 00:52:37,820 And that guns are the particular preference 1225 00:52:37,820 --> 00:52:40,380 in terms of use for deadly suicides. 1226 00:52:40,380 --> 00:52:44,250 Are there red flag powers that DoD has to seize guns 1227 00:52:44,250 --> 00:52:46,910 from service members if they are deemed a risk? 1228 00:52:46,910 --> 00:52:49,820 Obviously not the weapon you take out of the armory. 1229 00:52:49,820 --> 00:52:51,963 But when I was in the Marines, 1230 00:52:53,030 --> 00:52:55,850 even on base, you were allowed to carry a personal weapon 1231 00:52:55,850 --> 00:52:57,923 provide you told your command about it. 1232 00:53:01,540 --> 00:53:02,628 - Thank you for your question. 1233 00:53:02,628 --> 00:53:04,880 And Captain Colston can talk a little bit 1234 00:53:04,880 --> 00:53:07,220 about how commanders work with behavioral health folks 1235 00:53:07,220 --> 00:53:08,830 to make sure that they're making good decisions 1236 00:53:08,830 --> 00:53:10,420 within this space. 1237 00:53:10,420 --> 00:53:14,270 Firearms are part of the conversation only in so far as 1238 00:53:14,270 --> 00:53:16,000 they are the most common method 1239 00:53:16,000 --> 00:53:18,180 by which a suicide will occur. 1240 00:53:18,180 --> 00:53:19,930 They are the most lethal means 1241 00:53:19,930 --> 00:53:22,277 by which you can attempt a suicide. 1242 00:53:22,277 --> 00:53:24,920 And certainly commanders have a responsibility 1243 00:53:24,920 --> 00:53:28,250 to protect the military members under them. 1244 00:53:28,250 --> 00:53:32,620 If somebody is showing signs of imminent risk to themselves 1245 00:53:32,620 --> 00:53:34,680 or another person, we always wanna make sure that 1246 00:53:34,680 --> 00:53:36,940 we take action across the board. 1247 00:53:36,940 --> 00:53:38,480 And it's not only firearms, 1248 00:53:38,480 --> 00:53:41,410 prescription drugs, any other method 1249 00:53:41,410 --> 00:53:44,930 but it is not done in exclusion of working 1250 00:53:44,930 --> 00:53:47,093 with behavioral health individuals. 1251 00:53:48,350 --> 00:53:50,940 - And in regard to safety and care of service members, 1252 00:53:50,940 --> 00:53:55,130 of course commanders have an abiding interest in that. 1253 00:53:55,130 --> 00:53:57,790 And as a psychiatrist, 1254 00:53:57,790 --> 00:54:00,730 most of the time that someone's acutely suicidal, 1255 00:54:00,730 --> 00:54:03,020 that precipitates an admission, 1256 00:54:03,020 --> 00:54:05,653 an inpatient psychiatric admission. 1257 00:54:06,650 --> 00:54:09,710 Developing rapport with folks, and rapport with commanders 1258 00:54:09,710 --> 00:54:11,810 is really important to execute that. 1259 00:54:11,810 --> 00:54:14,090 Certainly in policy, we have things along the lines 1260 00:54:14,090 --> 00:54:16,703 of command directed mental health evaluations. 1261 00:54:17,654 --> 00:54:21,250 And certainly a young male patient 1262 00:54:21,250 --> 00:54:23,813 who's acutely suicidal and has a weapon 1263 00:54:23,813 --> 00:54:26,313 is someone that you're concerned about clinically. 1264 00:54:27,190 --> 00:54:28,810 - I guess what I'm asking is 1265 00:54:28,810 --> 00:54:31,260 if there is a formal process for this? 1266 00:54:31,260 --> 00:54:34,120 I'm sure some commanders understand 1267 00:54:34,120 --> 00:54:35,650 that they have the right to do it. 1268 00:54:35,650 --> 00:54:38,340 But is there some formal process 1269 00:54:38,340 --> 00:54:40,890 or training that you could give to these commanders 1270 00:54:41,880 --> 00:54:43,780 saying like if someone is suicidal, 1271 00:54:43,780 --> 00:54:48,170 please inquire if they have a weapon in their dormitory 1272 00:54:48,170 --> 00:54:50,190 or whatever they have it. 1273 00:54:50,190 --> 00:54:54,410 Just because I feel, at least on the private sector side, 1274 00:54:54,410 --> 00:54:57,260 what I've seen has been successful when family members 1275 00:54:57,260 --> 00:55:00,400 have identified people that are potentially suicidal, 1276 00:55:00,400 --> 00:55:01,930 that they take their weapon away from them 1277 00:55:01,930 --> 00:55:03,480 until they're stabilized again. 1278 00:55:03,480 --> 00:55:06,610 And I'm just curious to see if at least on the on base side, 1279 00:55:06,610 --> 00:55:08,220 if there's something of that nature. 1280 00:55:08,220 --> 00:55:10,800 Or some program we could teach these commanders, 1281 00:55:10,800 --> 00:55:12,320 the process to go through. 1282 00:55:12,320 --> 00:55:16,540 - So mean safety is part of all interaction with command. 1283 00:55:16,540 --> 00:55:20,143 Not only weapons, ligature risks, 1284 00:55:21,180 --> 00:55:25,023 sharps, medications, things along those lines. 1285 00:55:26,050 --> 00:55:28,350 It's just part of the way that we do business. 1286 00:55:29,360 --> 00:55:33,320 - And there is, is there any type of data 1287 00:55:34,200 --> 00:55:37,610 that has been collected for us to be able to tell 1288 00:55:37,610 --> 00:55:41,470 whether members of the military that saw combat 1289 00:55:41,470 --> 00:55:45,490 have higher rates of suicide or just lower rates of suicide? 1290 00:55:45,490 --> 00:55:47,680 'Cause I've seen conflicting data. 1291 00:55:47,680 --> 00:55:49,290 - Well, you're absolutely right, Congressman. 1292 00:55:49,290 --> 00:55:51,480 So the data are conflicting. 1293 00:55:51,480 --> 00:55:54,190 Rieger et al did not find a nexus 1294 00:55:54,190 --> 00:55:58,270 between deployment histories and subsequent suicides. 1295 00:55:58,270 --> 00:56:02,150 There was a recent study, a STARRS study 1296 00:56:02,150 --> 00:56:05,100 published by Ursano et al that said 1297 00:56:05,100 --> 00:56:08,650 for folks who had deployed exactly two times, 1298 00:56:08,650 --> 00:56:11,290 folks who deployed before the 12 month point, 1299 00:56:11,290 --> 00:56:13,120 or had less than six months to dwell time, 1300 00:56:13,120 --> 00:56:14,523 had higher suicide rates. 1301 00:56:20,760 --> 00:56:24,330 - I guess this just has to be just purely asked. 1302 00:56:24,330 --> 00:56:26,690 What is, in your opinion, 1303 00:56:26,690 --> 00:56:29,370 the cause of the higher rates of suicide 1304 00:56:29,370 --> 00:56:31,823 that has occurred in the last year? 1305 00:56:33,660 --> 00:56:34,493 - [Dr. Colston] I gotta give you 1306 00:56:34,493 --> 00:56:36,200 my very honest answer, Congressman. 1307 00:56:36,200 --> 00:56:38,360 - We appreciate that in Congress every once in awhile. 1308 00:56:38,360 --> 00:56:39,980 - I do not know. 1309 00:56:39,980 --> 00:56:43,830 Obviously there is a disturbing secular trend. 1310 00:56:43,830 --> 00:56:46,230 We have seen our suicide rate double 1311 00:56:46,230 --> 00:56:50,580 between 1999 and 2016 while the secular rate 1312 00:56:50,580 --> 00:56:53,763 increased 25% increasing in every state. 1313 00:56:55,920 --> 00:56:58,300 When I was an intern, suicide rate was low. 1314 00:56:58,300 --> 00:57:00,820 There was, military service was actually 1315 00:57:00,820 --> 00:57:05,120 protective for suicide, so obviously some set 1316 00:57:05,120 --> 00:57:07,080 of circumstances have changed. 1317 00:57:07,080 --> 00:57:08,410 One thing I'd say about suicide is 1318 00:57:08,410 --> 00:57:13,410 there's over 300 separate forensic risk factors for suicide. 1319 00:57:13,500 --> 00:57:15,393 - [Mr. Gallego] Dr. Van Winkle, do you have an opinion? 1320 00:57:17,180 --> 00:57:19,570 - So I would concur with my colleague. 1321 00:57:19,570 --> 00:57:21,740 That we were talking about suicide, 1322 00:57:21,740 --> 00:57:25,350 it is an intersection of a variety of factors 1323 00:57:25,350 --> 00:57:28,870 that are social, biological, psychological 1324 00:57:28,870 --> 00:57:33,080 that operate at the individual, community, societal levels. 1325 00:57:33,080 --> 00:57:37,340 It's fairly complex and often difficult to determine exactly 1326 00:57:37,340 --> 00:57:40,240 what is occurring in a whole population. 1327 00:57:40,240 --> 00:57:42,410 And even within subpopulations where I think 1328 00:57:42,410 --> 00:57:44,280 there are unique considerations. 1329 00:57:44,280 --> 00:57:45,935 - [Mr. Gallego] Thank you, thank you Madame Chair. 1330 00:57:45,935 --> 00:57:47,960 - Thank you, Mr. Gallego. 1331 00:57:47,960 --> 00:57:52,060 Miss Radewagen, you, five minutes. 1332 00:57:52,060 --> 00:57:55,363 - Title four, I represent American Samoa. 1333 00:57:56,250 --> 00:57:58,720 We have a very high percentage of veterans 1334 00:57:58,720 --> 00:58:01,860 in our beautiful islands and we will have perhaps 1335 00:58:01,860 --> 00:58:03,040 even more in the future 1336 00:58:03,040 --> 00:58:06,210 because we have such a very high enlistment rate 1337 00:58:06,210 --> 00:58:07,880 in our armed forces. 1338 00:58:07,880 --> 00:58:10,130 And you know, it just breaks my heart to think of 1339 00:58:10,130 --> 00:58:14,330 any of our veterans losing hope or struggling alone. 1340 00:58:14,330 --> 00:58:16,180 The problem of veteran suicides 1341 00:58:16,180 --> 00:58:18,790 is a national tragedy as we all know. 1342 00:58:18,790 --> 00:58:22,180 And I do wanna thank Chairwoman Brownley 1343 00:58:22,180 --> 00:58:23,680 and Ranking Member Dunn 1344 00:58:23,680 --> 00:58:26,350 for their ongoing efforts on this issue. 1345 00:58:26,350 --> 00:58:28,803 I also wanna thank Chairwoman Speier, 1346 00:58:29,670 --> 00:58:33,590 and Ranking Member Kelly for holding this joint hearing. 1347 00:58:33,590 --> 00:58:35,890 And I wanna thank you and welcome the panel, 1348 00:58:35,890 --> 00:58:40,890 everyone here for their work on behalf of veterans. 1349 00:58:41,100 --> 00:58:44,060 A single veteran suicide is too many. 1350 00:58:44,060 --> 00:58:46,030 And it's my hope that we can make 1351 00:58:46,030 --> 00:58:48,673 some real changes, this Congress. 1352 00:58:49,640 --> 00:58:52,960 My question has been partially answered. 1353 00:58:52,960 --> 00:58:57,640 But let me first direct it at Captain Colston on behalf 1354 00:58:57,640 --> 00:59:02,320 of DoD and then to Dr. Franklin for the VA perspective. 1355 00:59:02,320 --> 00:59:07,120 Now as I understand it, mental health is as complicated, 1356 00:59:07,120 --> 00:59:09,930 if not more so than bodily health, 1357 00:59:09,930 --> 00:59:12,370 and varies from patient to patient. 1358 00:59:12,370 --> 00:59:15,380 For example, some individuals respond well 1359 00:59:15,380 --> 00:59:17,970 to pharmaceuticals while others 1360 00:59:17,970 --> 00:59:20,820 can suffer adverse side effects. 1361 00:59:20,820 --> 00:59:24,400 You may have touched on this in your statements so far. 1362 00:59:24,400 --> 00:59:26,440 But could you please elaborate on 1363 00:59:26,440 --> 00:59:29,760 the different types of treatment that each department 1364 00:59:29,760 --> 00:59:33,280 makes available to service members and veterans, 1365 00:59:33,280 --> 00:59:36,610 and what systems or procedures do you have in place 1366 00:59:36,610 --> 00:59:40,950 for identifying whether a treatment option isn't working, 1367 00:59:40,950 --> 00:59:42,550 and adapting care to each 1368 00:59:42,550 --> 00:59:44,963 individual patient's responsiveness? 1369 00:59:46,400 --> 00:59:47,840 - Thank you, Congresswoman. 1370 00:59:47,840 --> 00:59:49,970 Well, first of all, we have a behavioral health data portal. 1371 00:59:49,970 --> 00:59:52,930 So we measure outcomes on folks 1372 00:59:52,930 --> 00:59:55,780 in regard to whatever the treatment regimen is. 1373 00:59:55,780 --> 00:59:58,500 So for suicide, there are many approaches. 1374 00:59:58,500 --> 01:00:00,380 There's cognitive behavioral therapy, 1375 01:00:00,380 --> 01:00:02,660 there's problem solving therapy, 1376 01:00:02,660 --> 01:00:04,930 you can treat underlying depression. 1377 01:00:04,930 --> 01:00:08,040 As a psychiatrist, I see severely mental ill people. 1378 01:00:08,040 --> 01:00:10,890 So people with schizophrenia 1379 01:00:10,890 --> 01:00:12,803 respond to a drug called clozapine. 1380 01:00:14,540 --> 01:00:18,360 There are probably 12 evidence based 1381 01:00:18,360 --> 01:00:20,790 treatments for suicidal folks. 1382 01:00:20,790 --> 01:00:21,830 The thing that we struggle with 1383 01:00:21,830 --> 01:00:24,390 is they all have really small effect sizes. 1384 01:00:24,390 --> 01:00:28,570 So you need to treat a lot of people to find, 1385 01:00:28,570 --> 01:00:32,300 really help one person become less suicidal. 1386 01:00:32,300 --> 01:00:36,140 Or in fact, not commit suicide. 1387 01:00:36,140 --> 01:00:38,820 So establishing a nexus between our treatments 1388 01:00:38,820 --> 01:00:43,060 and a decrease in suicide has been extremely hard. 1389 01:00:43,060 --> 01:00:45,110 And at the population level, 1390 01:00:45,110 --> 01:00:46,810 we just haven't seen a signal yet. 1391 01:00:49,140 --> 01:00:51,203 - Dr. Franklin. - Yes, the good news is 1392 01:00:51,203 --> 01:00:53,780 that we use the same treatment methodologies as the DoD. 1393 01:00:53,780 --> 01:00:55,500 So we train our providers together. 1394 01:00:55,500 --> 01:00:57,045 We have the annual conferences 1395 01:00:57,045 --> 01:00:59,900 and annual mini residencies where they're trained 1396 01:00:59,900 --> 01:01:02,560 on the same set of evidence based practices and protocols. 1397 01:01:02,560 --> 01:01:04,890 So that's, for what it's worth, 1398 01:01:04,890 --> 01:01:07,373 part of the story in terms of how we train them 1399 01:01:07,373 --> 01:01:09,070 on the evidence based practices 1400 01:01:09,070 --> 01:01:10,700 that Captain Colston spoke about. 1401 01:01:10,700 --> 01:01:13,800 From there, in terms of the latter part of our question 1402 01:01:13,800 --> 01:01:15,020 which was really tied to how do you know 1403 01:01:15,020 --> 01:01:16,880 what you're doing is working? 1404 01:01:16,880 --> 01:01:18,870 We have a system in place similarly 1405 01:01:18,870 --> 01:01:20,110 to this behavioral health portal 1406 01:01:20,110 --> 01:01:22,310 that the Captain mentioned that gets after 1407 01:01:22,310 --> 01:01:25,980 quality reviews and monitoring sort of up the chain. 1408 01:01:25,980 --> 01:01:29,040 And that occurs at the very local level in supervision 1409 01:01:29,040 --> 01:01:32,630 between clinicians and mental health leadership. 1410 01:01:32,630 --> 01:01:35,190 And then is monitored all the way up to VACO 1411 01:01:35,190 --> 01:01:37,230 to make sure that the evidence based practices 1412 01:01:37,230 --> 01:01:38,590 are implemented with a high degree 1413 01:01:38,590 --> 01:01:40,890 of fidelity to the model, sort of making sure 1414 01:01:40,890 --> 01:01:43,420 they're implemented the way they were designed. 1415 01:01:43,420 --> 01:01:46,230 The way that we know will produce the best results 1416 01:01:46,230 --> 01:01:48,600 and get the client going in the right direction 1417 01:01:48,600 --> 01:01:50,150 and relief of symptoms. 1418 01:01:50,150 --> 01:01:52,100 But Captain Colston's absolutely right. 1419 01:01:53,017 --> 01:01:54,440 The efficacy is difficult over time. 1420 01:01:54,440 --> 01:01:56,520 And the work needs to continue in this space. 1421 01:01:56,520 --> 01:02:00,540 And I further offer that that is why we need to focus on 1422 01:02:00,540 --> 01:02:03,380 additional capabilities in the fight for suicide 1423 01:02:03,380 --> 01:02:05,330 because the mental health work definitely is essential 1424 01:02:05,330 --> 01:02:06,660 and needs to continue. 1425 01:02:06,660 --> 01:02:08,300 We need to make sure they leave our offices 1426 01:02:08,300 --> 01:02:10,380 with the Veteran Crisis phone number in hand. 1427 01:02:10,380 --> 01:02:12,160 But then they need life supports 1428 01:02:12,160 --> 01:02:13,050 throughout the course of the week. 1429 01:02:13,050 --> 01:02:15,010 We need to make sure that our veterans are employed, 1430 01:02:15,010 --> 01:02:16,070 that they have homes, 1431 01:02:16,070 --> 01:02:18,580 that they're engaged in meaningful life 1432 01:02:18,580 --> 01:02:20,480 that brings them purpose and passion. 1433 01:02:20,480 --> 01:02:23,310 And that they have the supports to thrive 1434 01:02:23,310 --> 01:02:27,350 during life above and beyond their mental health therapy. 1435 01:02:27,350 --> 01:02:28,850 - [Miss Radewagen] Thank you, Madame Chair. 1436 01:02:28,850 --> 01:02:30,250 I yield back. 1437 01:02:30,250 --> 01:02:32,310 - Thank you, Miss Radewagen. 1438 01:02:32,310 --> 01:02:36,421 Mr. Cisneros, you're recognized for five minutes. 1439 01:02:36,421 --> 01:02:38,350 - Thank you all. 1440 01:02:38,350 --> 01:02:40,063 Thank you all for being here today. 1441 01:02:41,330 --> 01:02:44,760 Dr. Van Winkle, first, how much funding 1442 01:02:44,760 --> 01:02:48,143 does the DoD dedicate to suicide prevention research? 1443 01:02:50,180 --> 01:02:51,660 - I'd have to take that question for the record 1444 01:02:51,660 --> 01:02:54,274 to get you an accurate number on that. 1445 01:02:54,274 --> 01:02:56,100 - [Mr. Cisneros] All right, Dr. Franklin, 1446 01:02:56,100 --> 01:02:57,680 can I get the same question? 1447 01:02:57,680 --> 01:02:59,480 How much does the VA dedicate 1448 01:02:59,480 --> 01:03:01,360 to suicide prevention research? 1449 01:03:01,360 --> 01:03:02,750 - Just research, I would have to pull 1450 01:03:02,750 --> 01:03:04,340 that thread on that as well and get it back. 1451 01:03:04,340 --> 01:03:05,840 I have the entire budget here with me. 1452 01:03:05,840 --> 01:03:07,680 But just research I have to pull. 1453 01:03:07,680 --> 01:03:09,290 - Okay, I'd appreciate that. 1454 01:03:09,290 --> 01:03:10,290 - Yes. - Thank you. 1455 01:03:11,340 --> 01:03:15,163 What is the process, Dr. Colston or Captain Colston, 1456 01:03:16,840 --> 01:03:18,820 you said there was a handoff. 1457 01:03:18,820 --> 01:03:21,460 Well, actually, let me go back and ask this question. 1458 01:03:21,460 --> 01:03:24,060 When an individual, whether they're coming back 1459 01:03:24,060 --> 01:03:26,330 from overseas after serving in combat 1460 01:03:26,330 --> 01:03:28,120 or they're getting ready to separate 1461 01:03:28,120 --> 01:03:31,160 from active duty service, 1462 01:03:31,160 --> 01:03:33,530 what is the process for helping to identify 1463 01:03:33,530 --> 01:03:35,770 whether or not they're suffering from PTSD 1464 01:03:35,770 --> 01:03:38,580 or some other mental health issue? 1465 01:03:38,580 --> 01:03:39,840 Are they self identifying? 1466 01:03:39,840 --> 01:03:42,770 Or do we actually have a process to figure this out? 1467 01:03:42,770 --> 01:03:43,603 - Well, both, sir. 1468 01:03:43,603 --> 01:03:47,810 So the DoD cohort is the most screened cohort 1469 01:03:47,810 --> 01:03:49,560 of folks in human history. 1470 01:03:49,560 --> 01:03:54,040 So you will be asked about suicidality, PTSD, 1471 01:03:54,040 --> 01:03:57,020 depression, and generalized anxiety disorder 1472 01:03:57,020 --> 01:03:58,990 in a periodic health assessment, 1473 01:03:58,990 --> 01:04:01,490 in a separation health assessment. 1474 01:04:01,490 --> 01:04:02,960 And you'll also be asked it every time 1475 01:04:02,960 --> 01:04:04,010 you go to the primary care doc. 1476 01:04:04,010 --> 01:04:05,780 So when I just went to Walter Reed, 1477 01:04:05,780 --> 01:04:07,570 all those questions got asked. 1478 01:04:07,570 --> 01:04:08,890 So that's one opportunity 1479 01:04:08,890 --> 01:04:11,730 where you're self identifying through screening. 1480 01:04:11,730 --> 01:04:14,150 But it's also DoD policy that 1481 01:04:14,150 --> 01:04:17,320 there's a warm handoff between clinicians. 1482 01:04:17,320 --> 01:04:19,730 So you have an obligation as a clinician, 1483 01:04:19,730 --> 01:04:22,970 including as a deployed clinician to make sure, 1484 01:04:22,970 --> 01:04:24,700 because we're all using the same health system, 1485 01:04:24,700 --> 01:04:27,190 and I have access, the electronic health record 1486 01:04:27,190 --> 01:04:29,320 as a deployed physician, to do everything 1487 01:04:29,320 --> 01:04:30,760 that you can to make sure 1488 01:04:30,760 --> 01:04:32,780 that there's a clinic to clinic handoff, 1489 01:04:32,780 --> 01:04:35,133 if not a provider to provider handoff. 1490 01:04:36,490 --> 01:04:38,600 - So once an individual is separating, 1491 01:04:38,600 --> 01:04:40,420 and you talked about this warm handoff, 1492 01:04:40,420 --> 01:04:43,080 and they're getting out, they're no longer seeking 1493 01:04:43,080 --> 01:04:46,210 or getting DoD military healthcare, 1494 01:04:46,210 --> 01:04:47,733 and they're going to the VA, 1495 01:04:48,860 --> 01:04:53,860 how is that handoff being done from DoD to the VA 1496 01:04:54,290 --> 01:04:55,870 to making sure that that individual 1497 01:04:55,870 --> 01:04:57,530 is gonna continue to get care? 1498 01:04:57,530 --> 01:05:01,370 Because one of the things that really does disturb me 1499 01:05:01,370 --> 01:05:03,480 is the number of those individuals 1500 01:05:03,480 --> 01:05:06,720 that are killing themselves out of that 20, 1501 01:05:06,720 --> 01:05:09,740 in 20 per day are not seeking VA healthcare. 1502 01:05:09,740 --> 01:05:12,280 So how are we doing this handoff 1503 01:05:12,280 --> 01:05:15,560 to make sure those individuals continue to get care? 1504 01:05:15,560 --> 01:05:16,393 - Well, first of all, 1505 01:05:16,393 --> 01:05:17,810 we need to meet the patients where they're at. 1506 01:05:17,810 --> 01:05:19,430 So they need to continue the type 1507 01:05:19,430 --> 01:05:21,340 of care that they wanna continue. 1508 01:05:21,340 --> 01:05:24,030 A number of my patients who have severe mental illness 1509 01:05:24,030 --> 01:05:26,220 will continue care at a high level. 1510 01:05:26,220 --> 01:05:28,370 So psychiatrist to psychiatrist. 1511 01:05:28,370 --> 01:05:30,240 And that would include a discharge summary. 1512 01:05:30,240 --> 01:05:32,470 Making sure that our formularies are aligned. 1513 01:05:32,470 --> 01:05:36,140 Which they are, between DoD and VHA. 1514 01:05:36,140 --> 01:05:37,870 Making sure the patient has enough meds 1515 01:05:37,870 --> 01:05:40,070 when he goes to the next place. 1516 01:05:40,070 --> 01:05:41,400 But the folks who... 1517 01:05:42,700 --> 01:05:44,670 The predominance of suicide risk 1518 01:05:44,670 --> 01:05:47,880 in the population is in folks who are less mentally ill. 1519 01:05:47,880 --> 01:05:50,160 And in fact we need to meet those patients where they're at. 1520 01:05:50,160 --> 01:05:52,520 Whether that's in credentialed healthcare, 1521 01:05:52,520 --> 01:05:55,950 or like my colleague, Mr. Fisher, 1522 01:05:55,950 --> 01:05:59,010 in confidential healthcare in Vet Centers or elsewhere, 1523 01:05:59,010 --> 01:06:00,583 or in community based health. 1524 01:06:02,580 --> 01:06:05,640 - Well, Dr. Franklin, how do you receive those individuals 1525 01:06:05,640 --> 01:06:06,770 that need that healthcare, 1526 01:06:06,770 --> 01:06:09,810 need that mental healthcare coming from the DoD? 1527 01:06:09,810 --> 01:06:11,620 - Certainly, there is a program 1528 01:06:11,620 --> 01:06:13,570 in the DoD called inTransition. 1529 01:06:13,570 --> 01:06:15,880 And this is a capability that recognizes 1530 01:06:15,880 --> 01:06:17,610 when people are on active duty status, 1531 01:06:17,610 --> 01:06:19,870 and they have a known mental health problem, 1532 01:06:19,870 --> 01:06:21,650 they fall into this program. 1533 01:06:21,650 --> 01:06:24,590 It's one word, the title of the program inTransition. 1534 01:06:24,590 --> 01:06:27,460 And this is a program that then carries them through 1535 01:06:27,460 --> 01:06:31,640 over to the VA with frequent caring outreach and contact 1536 01:06:31,640 --> 01:06:33,390 where they're getting actual phone calls 1537 01:06:33,390 --> 01:06:35,290 and coached into the VA system. 1538 01:06:35,290 --> 01:06:37,810 Above and beyond this process that Captain Colston 1539 01:06:37,810 --> 01:06:39,630 talked about which is provider to provider 1540 01:06:39,630 --> 01:06:44,040 across DoD to VA, there's also this additional safety net, 1541 01:06:44,040 --> 01:06:46,370 they call it, of this inTransition program. 1542 01:06:46,370 --> 01:06:47,590 But I think what you're getting at 1543 01:06:47,590 --> 01:06:49,020 is this other part of the population 1544 01:06:49,020 --> 01:06:50,460 that ties back to this other question 1545 01:06:50,460 --> 01:06:52,120 that was asked earlier which is, 1546 01:06:52,120 --> 01:06:54,030 when we have a known population 1547 01:06:54,030 --> 01:06:55,270 that doesn't get mental healthcare 1548 01:06:55,270 --> 01:06:57,360 over the course of their whole career, 1549 01:06:57,360 --> 01:06:59,220 and/or doesn't unpack it. 1550 01:06:59,220 --> 01:07:01,020 Doesn't have a known mental health problem 1551 01:07:01,020 --> 01:07:02,440 at the time that they leave. 1552 01:07:02,440 --> 01:07:04,270 They don't fall in inTransition. 1553 01:07:04,270 --> 01:07:06,640 They don't fall clinician to clinician. 1554 01:07:06,640 --> 01:07:09,310 There's no warm handoff because they're not known. 1555 01:07:09,310 --> 01:07:10,700 Then they leave the DoD, 1556 01:07:10,700 --> 01:07:12,900 and then life circumstances happen, 1557 01:07:12,900 --> 01:07:15,660 unemployment, childbirth, divorce, 1558 01:07:15,660 --> 01:07:17,500 good and bad, that are stressful. 1559 01:07:17,500 --> 01:07:20,380 And then the challenge is getting them into care 1560 01:07:20,380 --> 01:07:22,060 at that point if that makes sense. 1561 01:07:22,060 --> 01:07:24,320 And I think that's where we could do better. 1562 01:07:24,320 --> 01:07:26,350 We have work to do in that space I think. 1563 01:07:26,350 --> 01:07:27,250 - All right, yeah. 1564 01:07:28,910 --> 01:07:30,650 One of the worst things I had to do 1565 01:07:30,650 --> 01:07:33,170 in my military service was to go home, 1566 01:07:33,170 --> 01:07:35,960 or not go home, but, to go to a mother 1567 01:07:35,960 --> 01:07:38,883 and tell her her son had committed suicide. 1568 01:07:40,590 --> 01:07:42,700 I feel for these families that are doing this, 1569 01:07:42,700 --> 01:07:44,160 and those individuals that are going through this. 1570 01:07:44,160 --> 01:07:45,630 So we need to figure out 1571 01:07:45,630 --> 01:07:47,030 what the problem is and get to that. 1572 01:07:47,030 --> 01:07:49,130 So thank you very much, my time's expired. 1573 01:07:50,020 --> 01:07:51,160 - Thank you, Mr. Cisneros. 1574 01:07:51,160 --> 01:07:53,503 Mr. Gaetz, you're recognized for five minutes. 1575 01:07:54,720 --> 01:07:55,553 - Thank you, Madam Chair. 1576 01:07:55,553 --> 01:07:59,020 And I wanna thank the Chairs for coordinating this hearing. 1577 01:07:59,020 --> 01:08:00,200 I represent the district 1578 01:08:00,200 --> 01:08:02,137 that has the highest concentration of active duty military 1579 01:08:02,137 --> 01:08:03,440 and one of the highest concentrations 1580 01:08:03,440 --> 01:08:04,440 of veterans in the country. 1581 01:08:04,440 --> 01:08:07,080 And so this is very much a kitchen table issue 1582 01:08:07,080 --> 01:08:08,100 in my district. 1583 01:08:08,100 --> 01:08:09,520 My first question, Dr. Van Winkle, 1584 01:08:09,520 --> 01:08:13,640 is what do we know about the percentage of veterans 1585 01:08:13,640 --> 01:08:16,340 who commit suicide who struggle with opioid addiction? 1586 01:08:19,022 --> 01:08:20,260 - I'd have to take that for the record 1587 01:08:20,260 --> 01:08:22,470 unless Captain Colston has those numbers offhand. 1588 01:08:22,470 --> 01:08:25,060 But I will say that the Drug Demand Reduction Program 1589 01:08:25,060 --> 01:08:27,840 falls to me, so we certainly have ongoing concerns 1590 01:08:27,840 --> 01:08:29,190 about opioid use in the military-- 1591 01:08:29,190 --> 01:08:32,800 - Would anyone on the panel disagree with the conclusion 1592 01:08:32,800 --> 01:08:35,770 that opioid addiction contributes to suicide? 1593 01:08:35,770 --> 01:08:37,310 - I would agree with that, Congressman. 1594 01:08:37,310 --> 01:08:40,220 - You would agree with that. - The prevalence of 1595 01:08:40,220 --> 01:08:44,270 opioid addiction in active duty military service members-- 1596 01:08:44,270 --> 01:08:45,560 - What's our current most effective 1597 01:08:45,560 --> 01:08:47,200 strategy to deal with opioid addiction? 1598 01:08:47,200 --> 01:08:48,730 - Medication assisted therapy. 1599 01:08:48,730 --> 01:08:51,010 Buprenorphine, methadone, or naltrexone. 1600 01:08:51,010 --> 01:08:54,190 - So more pharmaceutical drugs. 1601 01:08:54,190 --> 01:08:57,780 I don't have, I mean, let me ask this question. 1602 01:08:57,780 --> 01:09:01,913 Will access to medical cannabis reduce veteran suicides? 1603 01:09:02,760 --> 01:09:06,350 - In my view, there's far more research to be done. 1604 01:09:06,350 --> 01:09:08,310 So there is insufficient evidence for 1605 01:09:08,310 --> 01:09:10,010 or against that position. 1606 01:09:10,010 --> 01:09:11,810 - Are you unpersuaded by the evidence 1607 01:09:11,810 --> 01:09:13,420 by the National Academy of Sciences 1608 01:09:13,420 --> 01:09:15,750 citing examples in Minnesota and other states 1609 01:09:15,750 --> 01:09:17,580 where access to medical cannabis 1610 01:09:17,580 --> 01:09:20,960 reduces the prescription rates of opioids, 1611 01:09:20,960 --> 01:09:24,910 and the use of schedule I drugs broadly? 1612 01:09:24,910 --> 01:09:27,317 - Well, certainly we're open to all types of research-- 1613 01:09:27,317 --> 01:09:29,420 - Okay, so you said more research needs to be done. 1614 01:09:29,420 --> 01:09:30,890 What is that? 1615 01:09:30,890 --> 01:09:31,723 - Well, first of all, 1616 01:09:31,723 --> 01:09:34,300 there are over 300 psychoactive substances 1617 01:09:34,300 --> 01:09:36,140 in cannabis sativa, so-- 1618 01:09:36,140 --> 01:09:38,750 - How many psychoactive substances are in the medical 1619 01:09:38,750 --> 01:09:41,800 therapies that we're using to replace opioids? 1620 01:09:41,800 --> 01:09:43,978 - There are no cannabis sativa-- 1621 01:09:43,978 --> 01:09:47,000 - No, no, not cannabis sativa, but psychoactive substances? 1622 01:09:47,000 --> 01:09:50,130 - So the three psychoactive substances are methadone 1623 01:09:50,130 --> 01:09:53,050 which is another opioid, a long acting opioid. 1624 01:09:53,050 --> 01:09:56,360 Buprenorphine which is an opioid agonist-antagonist, 1625 01:09:56,360 --> 01:09:59,840 so it's an opioid that essentially you can't overdose on. 1626 01:09:59,840 --> 01:10:02,800 And naltrexone which is an opioid antagonist, 1627 01:10:02,800 --> 01:10:06,660 which in essence takes the drug off of the brain receptors. 1628 01:10:06,660 --> 01:10:09,060 - Right, so that is the current off ramp 1629 01:10:09,060 --> 01:10:11,330 for opioid addiction that we use. 1630 01:10:11,330 --> 01:10:13,500 What evidence do we have that that is a more 1631 01:10:13,500 --> 01:10:16,423 effective off ramp than medical cannabis? 1632 01:10:17,650 --> 01:10:19,210 - I just think those are the three 1633 01:10:19,210 --> 01:10:20,950 evidence based therapies right now 1634 01:10:20,950 --> 01:10:22,940 that meet the medical bar. 1635 01:10:22,940 --> 01:10:25,483 Obviously more research can change that. 1636 01:10:26,670 --> 01:10:29,500 - How would you describe the VA's approach to researching 1637 01:10:29,500 --> 01:10:30,910 the extent to which medical cannabis 1638 01:10:30,910 --> 01:10:33,710 could be an alternative off ramp for opioid addiction 1639 01:10:33,710 --> 01:10:35,810 'cause clearly, what we're doing now isn't working. 1640 01:10:35,810 --> 01:10:37,950 - Well, there's certainly no prohibition 1641 01:10:37,950 --> 01:10:41,110 to any research around medical cannabis. 1642 01:10:41,110 --> 01:10:43,770 And in fact, there are two chemicals, 1643 01:10:43,770 --> 01:10:46,690 or there's a chemical in CBD 1644 01:10:46,690 --> 01:10:50,273 that's used for two pediatric seizure disorders right now. 1645 01:10:53,139 --> 01:10:57,120 - At a local VA, can a physician recommend medical cannabis 1646 01:10:57,120 --> 01:10:59,240 if it's in a state where those recommendations 1647 01:10:59,240 --> 01:11:01,120 are permissible under state law? 1648 01:11:01,120 --> 01:11:04,093 - I defer that question to my colleagues. 1649 01:11:05,810 --> 01:11:07,000 - No, they cannot at this time. 1650 01:11:07,000 --> 01:11:09,330 There's a federal law against it right now. 1651 01:11:09,330 --> 01:11:12,010 - Right, so federal laws prohibit, 1652 01:11:12,010 --> 01:11:13,907 do those same federal laws that you site 1653 01:11:13,907 --> 01:11:16,760 that prohibit prescription, prohibit research? 1654 01:11:16,760 --> 01:11:18,146 - [Dr. Van Winkle] No, they do not. 1655 01:11:18,146 --> 01:11:20,450 - So you're saying the VA is willing 1656 01:11:20,450 --> 01:11:21,970 to engage in this research? 1657 01:11:21,970 --> 01:11:25,460 Willing now to post what federally approved 1658 01:11:25,460 --> 01:11:27,160 clinical trials are available? 1659 01:11:27,160 --> 01:11:28,720 Would the VA be willing to do that? 1660 01:11:28,720 --> 01:11:30,390 - We have two ongoing research studies 1661 01:11:30,390 --> 01:11:31,770 going on right now in this space. 1662 01:11:31,770 --> 01:11:34,320 So I think we are open to research, yes. 1663 01:11:34,320 --> 01:11:36,460 - So the question is, does any existing law 1664 01:11:36,460 --> 01:11:38,770 prohibit the VA from publishing 1665 01:11:38,770 --> 01:11:42,130 what federally approved clinical trials 1666 01:11:42,130 --> 01:11:44,573 are underway or seeking participants? 1667 01:11:46,337 --> 01:11:47,170 - I'm not a lawyer, 1668 01:11:47,170 --> 01:11:48,950 so I don't know about the federal law that may-- 1669 01:11:48,950 --> 01:11:50,600 - [Mr. Gaetz] Is there any law of any kind 1670 01:11:50,600 --> 01:11:52,950 that would prohibit the VA in any way 1671 01:11:52,950 --> 01:11:55,940 from publicizing what federally approved 1672 01:11:55,940 --> 01:11:58,730 clinical trials are available in the cannabis space? 1673 01:11:58,730 --> 01:12:00,143 - I'll probably have to take that for the record. 1674 01:12:00,143 --> 01:12:03,010 I'm just not 100% clear on exact laws. 1675 01:12:03,010 --> 01:12:03,970 - Yeah, I don't think anybody's clear 1676 01:12:03,970 --> 01:12:05,310 which is the source of my frustration. 1677 01:12:05,310 --> 01:12:07,080 Because I think that there are a lot 1678 01:12:07,080 --> 01:12:09,490 of these clinical trials that are seeking veterans. 1679 01:12:09,490 --> 01:12:11,550 The VA, due to a lack of clarity, 1680 01:12:11,550 --> 01:12:14,280 won't publicize that information or make it available. 1681 01:12:14,280 --> 01:12:15,913 And then we're unable to do the research 1682 01:12:15,913 --> 01:12:18,760 that Captain Colston says is necessary 1683 01:12:18,760 --> 01:12:21,180 to advance additional options for veterans 1684 01:12:21,180 --> 01:12:22,520 trying to get off opioids 1685 01:12:22,520 --> 01:12:25,000 and to stop them from killing themselves. 1686 01:12:25,000 --> 01:12:28,700 In my district, there's overwhelming anecdotal evidence 1687 01:12:28,700 --> 01:12:31,460 that when they're given the combat cocktail, 1688 01:12:31,460 --> 01:12:34,010 when they're given heavy barbiturates when they come home, 1689 01:12:34,010 --> 01:12:36,280 they're more likely to trip into addition. 1690 01:12:36,280 --> 01:12:38,760 And if they have other therapies for PTSD 1691 01:12:38,760 --> 01:12:41,020 or to alleviate that addiction, that it's helpful. 1692 01:12:41,020 --> 01:12:44,030 So I'm very interested in that in, Madam Chair, 1693 01:12:44,030 --> 01:12:45,950 I have a unanimous consent request 1694 01:12:45,950 --> 01:12:48,160 that the oped written by our colleague 1695 01:12:48,160 --> 01:12:50,980 Congressman Seth Moulton in the Washington Examiner 1696 01:12:50,980 --> 01:12:53,380 entitled Let's Talk About Cannabis in the VA 1697 01:12:53,380 --> 01:12:55,770 in which he details three bipartisan bills 1698 01:12:55,770 --> 01:12:58,230 that he and I are sponsoring to advance 1699 01:12:58,230 --> 01:12:59,450 the work of the VA in the areas 1700 01:12:59,450 --> 01:13:01,050 of research of medical cannabis. 1701 01:13:02,010 --> 01:13:03,654 - [Chairwoman] Ordered, yes sir. 1702 01:13:03,654 --> 01:13:05,885 - Thank you, Madame Chair, I yield back. 1703 01:13:05,885 --> 01:13:06,940 - [Madam Chair] Thank you, Mr. Gaetz. 1704 01:13:06,940 --> 01:13:09,550 Mr. Lamb, you are recognized. 1705 01:13:09,550 --> 01:13:11,720 - Thank you very much, Madam Chair. 1706 01:13:11,720 --> 01:13:14,670 I do wanna address the opioid topic first. 1707 01:13:14,670 --> 01:13:16,570 And thank you all for your participation. 1708 01:13:16,570 --> 01:13:19,100 Especially Dr. Franklin who we've had the chance to see 1709 01:13:19,100 --> 01:13:21,450 and hear testify me with several times. 1710 01:13:21,450 --> 01:13:23,087 You've brought a lot of energy to this office, 1711 01:13:23,087 --> 01:13:25,780 and this position, so thank you for that. 1712 01:13:25,780 --> 01:13:28,500 And we look forward to working with you going forward. 1713 01:13:28,500 --> 01:13:32,590 On the opioid issue, I would say and Captain Colston, 1714 01:13:32,590 --> 01:13:34,400 would you agree that we actually, 1715 01:13:34,400 --> 01:13:35,890 we do have plenty of evidence 1716 01:13:35,890 --> 01:13:39,220 that these three drugs that you talked about 1717 01:13:39,220 --> 01:13:41,020 that are provided as medically assisted treatment, 1718 01:13:41,020 --> 01:13:43,210 we've plenty of evidence that they work. 1719 01:13:43,210 --> 01:13:45,820 First of all, just the model of how those drugs act 1720 01:13:45,820 --> 01:13:49,770 on the brain compared to the opioids that were being abused, 1721 01:13:49,770 --> 01:13:52,770 is part of why they are used and used so successfully, 1722 01:13:52,770 --> 01:13:54,430 isn't that right? - Yes sir. 1723 01:13:54,430 --> 01:13:57,130 - Okay, and I would actually say that 1724 01:13:57,130 --> 01:13:59,020 from where I sit in western Pennsylvania 1725 01:13:59,020 --> 01:14:01,840 where the opioid crisis has really hit hard, 1726 01:14:01,840 --> 01:14:04,030 the problem is really access. 1727 01:14:04,030 --> 01:14:07,130 It's not that we don't know how to treat these people. 1728 01:14:07,130 --> 01:14:10,730 I have a friend who's a treatment provider who has told me 1729 01:14:10,730 --> 01:14:13,090 if you are able to combine medically assisted treatment 1730 01:14:13,090 --> 01:14:16,240 with some of the more traditional counseling, 1731 01:14:16,240 --> 01:14:18,740 and group based therapies for folks, 1732 01:14:18,740 --> 01:14:20,960 you can move the needle of survival, 1733 01:14:20,960 --> 01:14:23,370 and the ability to quit the addiction, 1734 01:14:23,370 --> 01:14:26,320 maybe from 10% to 25%, or 30%. 1735 01:14:26,320 --> 01:14:28,420 You may not save everyone the first time, 1736 01:14:28,420 --> 01:14:30,060 but you're gonna dramatically increase the odds 1737 01:14:30,060 --> 01:14:32,040 that someone will survive and beat this disease. 1738 01:14:32,040 --> 01:14:34,560 Have you seen something similar? 1739 01:14:34,560 --> 01:14:37,260 - Yes sir, that's absolutely true. 1740 01:14:37,260 --> 01:14:40,030 And we've certainly on the federal level done things 1741 01:14:40,030 --> 01:14:42,760 to make it easier for prescribers 1742 01:14:42,760 --> 01:14:44,780 to get buprenorphine in the hands of patients. 1743 01:14:44,780 --> 01:14:48,670 And I think that's been a successful public health effort. 1744 01:14:48,670 --> 01:14:52,420 Probably one that's equally successful as the ability 1745 01:14:52,420 --> 01:14:55,080 to get naloxone into the hands of first responders. 1746 01:14:55,080 --> 01:14:57,730 And in fact cops and firefighters have saved 1747 01:14:57,730 --> 01:15:00,940 numerous lives in this scourge. 1748 01:15:00,940 --> 01:15:04,440 Had 47,000 opioid overdose deaths in America last year. 1749 01:15:04,440 --> 01:15:07,350 47,000 suicide deaths. 1750 01:15:07,350 --> 01:15:10,170 These are national scourges that 1751 01:15:10,170 --> 01:15:12,040 are on the order of swine flu. 1752 01:15:12,040 --> 01:15:13,430 - No, you're absolutely right. 1753 01:15:13,430 --> 01:15:15,720 And it has been a great success. 1754 01:15:15,720 --> 01:15:16,750 In our part of the world, 1755 01:15:16,750 --> 01:15:18,150 we've had some of the highest death rates 1756 01:15:18,150 --> 01:15:19,490 of anywhere in the country. 1757 01:15:19,490 --> 01:15:21,560 And this year for the first year, 1758 01:15:21,560 --> 01:15:23,570 we're seeing reductions in many of the places 1759 01:15:23,570 --> 01:15:25,350 that were the worst in deaths. 1760 01:15:25,350 --> 01:15:27,580 I would say probably almost completely due 1761 01:15:27,580 --> 01:15:29,370 to the increase in naloxone. 1762 01:15:29,370 --> 01:15:32,270 Again, because the more complicated 1763 01:15:32,270 --> 01:15:35,120 and sustained forms of treatment are not yet available. 1764 01:15:35,120 --> 01:15:37,160 However, the VA provides it. 1765 01:15:37,160 --> 01:15:39,640 And the VA can make this accessible to people 1766 01:15:39,640 --> 01:15:41,790 who otherwise wouldn't get it. 1767 01:15:41,790 --> 01:15:45,800 I served with a Marine who came off of active duty 1768 01:15:45,800 --> 01:15:48,400 addicted to a pain killer because he had been hurt 1769 01:15:48,400 --> 01:15:50,080 in some training right before he left. 1770 01:15:50,080 --> 01:15:51,860 And I don't believe he was medically discharged. 1771 01:15:51,860 --> 01:15:54,360 I think he just sort of got through the injury 1772 01:15:54,360 --> 01:15:57,030 and then left the service with a normal discharge. 1773 01:15:57,030 --> 01:16:00,220 But he still carried with him the addiction to the opiate. 1774 01:16:00,220 --> 01:16:03,840 And he went home and became addicted to heroin. 1775 01:16:03,840 --> 01:16:06,330 He showed up at the VA in Pittsburgh 1776 01:16:06,330 --> 01:16:09,360 after having enough self awareness to realize 1777 01:16:09,360 --> 01:16:11,280 he didn't wanna die that way. 1778 01:16:11,280 --> 01:16:15,530 And at our VA, they gave him 30 days of detox and treatment 1779 01:16:15,530 --> 01:16:17,280 and then moved him over to the other VA 1780 01:16:17,280 --> 01:16:20,820 for another up to six months of treatment ongoing therapy 1781 01:16:20,820 --> 01:16:22,530 and they actually gave him a place to live. 1782 01:16:22,530 --> 01:16:24,060 He stayed there, and it's amazing. 1783 01:16:24,060 --> 01:16:25,220 They had a community. 1784 01:16:25,220 --> 01:16:26,510 They had a little rank structure. 1785 01:16:26,510 --> 01:16:28,900 He was like the Vice President of their group 1786 01:16:28,900 --> 01:16:30,130 of folks that lived there. 1787 01:16:30,130 --> 01:16:32,130 And I learned all this because I just went to the VA 1788 01:16:32,130 --> 01:16:33,640 for a normal tour and ran into him. 1789 01:16:33,640 --> 01:16:36,010 I hadn't seen him in like six years. 1790 01:16:36,010 --> 01:16:38,410 So I always sort of hold up the VA 1791 01:16:38,410 --> 01:16:40,160 as an example of the fact that we do 1792 01:16:40,160 --> 01:16:41,520 actually know how to save people 1793 01:16:41,520 --> 01:16:43,580 if we make the right treatment available. 1794 01:16:43,580 --> 01:16:45,090 It just takes a really long time. 1795 01:16:45,090 --> 01:16:47,070 And it's expensive and difficult. 1796 01:16:47,070 --> 01:16:49,520 And it may take more than one round. 1797 01:16:49,520 --> 01:16:52,830 So the only thing I wanted to ask about that was 1798 01:16:53,920 --> 01:16:56,310 for this guy, I'm not aware of whether 1799 01:16:56,310 --> 01:17:00,150 any information was shared from DoD to the VA 1800 01:17:00,150 --> 01:17:04,010 about the prescription pain killers that he received 1801 01:17:04,010 --> 01:17:04,960 as a risk factor. 1802 01:17:04,960 --> 01:17:07,810 And I know, Dr. Franklin, you mentioned inTransition. 1803 01:17:07,810 --> 01:17:10,350 Which sounded like from what you said had to do with people 1804 01:17:10,350 --> 01:17:12,470 who were actually receiving treatment on active duty 1805 01:17:12,470 --> 01:17:14,540 for a mental health condition. 1806 01:17:14,540 --> 01:17:18,540 Do we have anything right now that would have constituted 1807 01:17:18,540 --> 01:17:21,800 a warning from DoD to VA? 1808 01:17:21,800 --> 01:17:25,410 Here's a guy who received heavy dose of pain killers, 1809 01:17:25,410 --> 01:17:27,580 someone might wanna check once he gets out 1810 01:17:27,580 --> 01:17:29,400 if he's enrolled in VA healthcare yet. 1811 01:17:29,400 --> 01:17:33,910 - So in the last year, we, DoD takes part in PDMP, 1812 01:17:33,910 --> 01:17:35,910 Prescription Drug Monitoring Program. 1813 01:17:35,910 --> 01:17:38,180 So now that flashes for everyone. 1814 01:17:38,180 --> 01:17:40,390 And it's an incredibly powerful tool. 1815 01:17:40,390 --> 01:17:42,020 Especially as you mentioned, 1816 01:17:42,020 --> 01:17:44,040 General Kelly, for Guard and Reserve folks 1817 01:17:44,040 --> 01:17:46,730 who were getting civilian care somewhere, 1818 01:17:46,730 --> 01:17:51,020 now I'm able to look and see what their opiate history is. 1819 01:17:51,020 --> 01:17:53,150 And a lot of times you don't get endorsements. 1820 01:17:53,150 --> 01:17:54,340 You don't get someone who says 1821 01:17:54,340 --> 01:17:56,570 yeah, hey, I'm struggling right now. 1822 01:17:56,570 --> 01:17:59,230 So it's been an incredibly powerful tool. 1823 01:17:59,230 --> 01:18:00,450 And it's one that we've really only 1824 01:18:00,450 --> 01:18:03,080 had online for about nine months. 1825 01:18:03,080 --> 01:18:05,260 But I think will save lives. 1826 01:18:05,260 --> 01:18:07,910 - You, and very quickly, time's expiring, 1827 01:18:07,910 --> 01:18:10,400 Dr. Franklin, do you know, for someone like him, 1828 01:18:10,400 --> 01:18:13,660 if he had never showed up for VA healthcare on his own, 1829 01:18:13,660 --> 01:18:16,180 is there any way right now for VA as an institution 1830 01:18:16,180 --> 01:18:19,130 to know about him and know either for the VA 1831 01:18:19,130 --> 01:18:21,140 or the Vet Center, someone to sort of reach out and say 1832 01:18:21,140 --> 01:18:22,230 hey, you might wanna enroll here 1833 01:18:22,230 --> 01:18:24,450 just to make sure that everything's okay? 1834 01:18:24,450 --> 01:18:26,860 - You perfectly described the nexus of our issue 1835 01:18:26,860 --> 01:18:29,730 we need to get out there and find those people 1836 01:18:29,730 --> 01:18:31,260 and get them into our service delivery. 1837 01:18:31,260 --> 01:18:32,093 Whether that's through 1838 01:18:32,093 --> 01:18:34,400 our suicide prevention outreach people 1839 01:18:34,400 --> 01:18:35,640 that do five outreach events, 1840 01:18:35,640 --> 01:18:39,210 our Vet Center outreach events that get outside the gates, 1841 01:18:39,210 --> 01:18:42,370 our homeless outreach coordinators, our veteran justice, 1842 01:18:42,370 --> 01:18:43,870 I'm not sure if he was involved in the court system, 1843 01:18:43,870 --> 01:18:45,320 but we have justice outreach. 1844 01:18:45,320 --> 01:18:46,580 It's all hands on deck. 1845 01:18:46,580 --> 01:18:47,887 We've gotta like find these people 1846 01:18:47,887 --> 01:18:50,730 and do everything we can to wrap our arms around them. 1847 01:18:50,730 --> 01:18:53,340 - Thank you and Madam Chairwoman, I yield back. 1848 01:18:53,340 --> 01:18:54,470 - Thank you, Mr. Lamb. 1849 01:18:54,470 --> 01:18:56,980 Mr. Barr, you're recognized for five minutes. 1850 01:18:56,980 --> 01:18:58,330 - Thank you, Madam Chairwoman. 1851 01:18:58,330 --> 01:18:59,997 And thank you to Chairwoman Brownley 1852 01:18:59,997 --> 01:19:02,620 and Chairwoman Speier for your leadership. 1853 01:19:02,620 --> 01:19:06,470 And also Ranking Member Dunn, and Ranking Member Kelly. 1854 01:19:06,470 --> 01:19:08,320 Thank you for hosting this joint hearing. 1855 01:19:08,320 --> 01:19:10,260 I think it's excellent to continue shine the light 1856 01:19:10,260 --> 01:19:14,103 on this national tragedy of 20 suicides a day. 1857 01:19:15,165 --> 01:19:17,500 Lemme start with Dr. Van Winkle 1858 01:19:17,500 --> 01:19:18,530 since I haven't had the benefit 1859 01:19:18,530 --> 01:19:19,363 of your testimony as a member 1860 01:19:19,363 --> 01:19:21,820 of the Veteran's Affairs Committee. 1861 01:19:21,820 --> 01:19:24,430 I do want the DoD perspective here. 1862 01:19:24,430 --> 01:19:25,740 As we're nearing 20 years 1863 01:19:25,740 --> 01:19:27,670 of engagement in Iraq and Afghanistan, 1864 01:19:27,670 --> 01:19:29,560 our longest engagement in US history, 1865 01:19:29,560 --> 01:19:31,080 it's my understanding that soldiers, 1866 01:19:31,080 --> 01:19:34,330 particularly those in the Army are deploying longer 1867 01:19:34,330 --> 01:19:37,750 and for multiple deployments. 1868 01:19:37,750 --> 01:19:39,930 As the Director for the Office of Resiliency, 1869 01:19:39,930 --> 01:19:42,500 how is your office taking into account 1870 01:19:42,500 --> 01:19:46,100 the effect of these multiple deployments on service members 1871 01:19:46,100 --> 01:19:48,630 and their families, these long deployments? 1872 01:19:48,630 --> 01:19:50,700 I know it's very, very difficult 1873 01:19:50,700 --> 01:19:54,653 for a lot of the veterans in my district. 1874 01:19:56,140 --> 01:19:57,277 - Thank you for the question. 1875 01:19:57,277 --> 01:20:00,120 And it is certainly something that we're tracking. 1876 01:20:00,120 --> 01:20:02,770 And with our collaborations with the family programs, 1877 01:20:02,770 --> 01:20:05,670 we also track the impact on the families, 1878 01:20:05,670 --> 01:20:07,710 understanding that that's an additional stress 1879 01:20:07,710 --> 01:20:11,210 when the military member is overseas or deployed. 1880 01:20:11,210 --> 01:20:13,913 Within the suicide space as mentioned, 1881 01:20:15,170 --> 01:20:17,310 there's no simple and direct connection 1882 01:20:17,310 --> 01:20:21,220 between suicide and deployment at the aggregate level. 1883 01:20:21,220 --> 01:20:23,870 But what we know is this is an individual stressor 1884 01:20:23,870 --> 01:20:27,470 that for some, when we talk about suicide as a combination 1885 01:20:27,470 --> 01:20:30,100 of individual factors that we're tracking, 1886 01:20:30,100 --> 01:20:32,180 this can certainly be a stressor 1887 01:20:32,180 --> 01:20:34,480 that impacts them negatively. 1888 01:20:34,480 --> 01:20:37,400 And so part of our work is certainly 1889 01:20:37,400 --> 01:20:39,500 within the behavioral health side 1890 01:20:39,500 --> 01:20:42,840 and within our leadership to have those conversations 1891 01:20:42,840 --> 01:20:44,690 about the impact of deployment. 1892 01:20:44,690 --> 01:20:48,067 And Captain Colston can talk a little bit more about 1893 01:20:48,067 --> 01:20:50,993 how the deployment and behavioral health work together. 1894 01:20:53,080 --> 01:20:55,410 - One of the things that I just want to emphasize 1895 01:20:55,410 --> 01:20:57,880 is we really make sure that we embed 1896 01:20:57,880 --> 01:21:00,290 mental healthcare on deployments. 1897 01:21:00,290 --> 01:21:02,160 So at the division level, 1898 01:21:02,160 --> 01:21:05,603 there will be a psychiatrist deploying with the unit. 1899 01:21:06,460 --> 01:21:08,390 And in fact, that's important. 1900 01:21:08,390 --> 01:21:11,960 Because 18 to 25 year olds often struggle with things, 1901 01:21:11,960 --> 01:21:14,780 like not just suicidality, but first break psychosis, 1902 01:21:14,780 --> 01:21:18,620 first break mania, things that are dangerous in folks 1903 01:21:18,620 --> 01:21:20,760 who are there to kill the enemy. 1904 01:21:20,760 --> 01:21:22,760 So it's vitally important that we do that. 1905 01:21:22,760 --> 01:21:23,890 - Well, thank you for that. 1906 01:21:23,890 --> 01:21:26,780 And I appreciate the DoD paying attention. 1907 01:21:26,780 --> 01:21:29,530 Obviously operational tempo could play a role 1908 01:21:29,530 --> 01:21:31,323 in some of the suicide issues. 1909 01:21:32,280 --> 01:21:34,780 Our colleague Brian Mast who of course, 1910 01:21:34,780 --> 01:21:37,700 is a combat veteran, and wounded warrior himself. 1911 01:21:37,700 --> 01:21:41,370 He approached me last Congress with an idea, 1912 01:21:41,370 --> 01:21:46,040 and legislation to require an Oath of Exit 1913 01:21:46,040 --> 01:21:49,643 so that service members would, 1914 01:21:50,950 --> 01:21:53,050 service members obviously who were part of a team, 1915 01:21:53,050 --> 01:21:55,513 part of a unit, a band of brothers, 1916 01:21:57,412 --> 01:22:01,260 who feel a strong sense of loyalty to each other 1917 01:22:01,260 --> 01:22:05,640 would basically take an oath upon a transition 1918 01:22:05,640 --> 01:22:08,800 and discharge to each other. 1919 01:22:08,800 --> 01:22:11,840 That before they would cause harm to themselves, 1920 01:22:11,840 --> 01:22:14,570 they would at least contact one of their former 1921 01:22:17,430 --> 01:22:21,750 brothers in arms and let them know in advance. 1922 01:22:21,750 --> 01:22:23,250 I thought that was a good idea. 1923 01:22:23,250 --> 01:22:25,210 And my understanding is that DoD 1924 01:22:25,210 --> 01:22:29,130 has kind of taken on that idea, is that a good idea? 1925 01:22:29,130 --> 01:22:31,400 Is that something that DoD is considering, 1926 01:22:31,400 --> 01:22:36,400 an Oath of Exit so that men and women service members 1927 01:22:36,790 --> 01:22:41,790 who leave the military are pledging an oath to each other 1928 01:22:41,910 --> 01:22:43,460 that before they take their own lives, 1929 01:22:43,460 --> 01:22:46,670 or before they harm themselves, 1930 01:22:46,670 --> 01:22:50,290 they will contact one of their former soldiers 1931 01:22:50,290 --> 01:22:51,433 or sailors or airmen? 1932 01:22:52,850 --> 01:22:55,190 - Well, I think in regard to all issues around safety 1933 01:22:55,190 --> 01:22:58,370 certainly for those of us that have deployed, 1934 01:22:58,370 --> 01:23:00,370 we met our affiliate of needs with those folks 1935 01:23:00,370 --> 01:23:01,810 that we were in the barracks with, 1936 01:23:01,810 --> 01:23:03,050 that we were out in the field with. 1937 01:23:03,050 --> 01:23:06,460 So, yes, I think in regard to things like safety planning 1938 01:23:06,460 --> 01:23:08,070 which we do for suicidal people, 1939 01:23:08,070 --> 01:23:09,520 that's a critical part of it. 1940 01:23:10,370 --> 01:23:12,590 Telling your brothers and sisters that you're in pain 1941 01:23:12,590 --> 01:23:15,040 is an important part of what we do. 1942 01:23:15,040 --> 01:23:17,610 - I think that's something we ought to pursue. 1943 01:23:17,610 --> 01:23:19,920 Finally, Dr. Franklin, 1944 01:23:19,920 --> 01:23:21,660 you've talked about the inTransition program 1945 01:23:21,660 --> 01:23:24,190 but let me talk specifically about medical records. 1946 01:23:24,190 --> 01:23:27,350 I know we've increased a real effort to have 1947 01:23:27,350 --> 01:23:31,220 that interoperability between medical records. 1948 01:23:31,220 --> 01:23:33,530 But if a service member commits an act of self harm 1949 01:23:33,530 --> 01:23:36,330 or attempts to commit suicide while in the military, 1950 01:23:36,330 --> 01:23:39,840 how is that information or medical documentation of that 1951 01:23:39,840 --> 01:23:41,183 transferred to the VA? 1952 01:23:42,150 --> 01:23:44,310 - As we stand right now, not under the new system 1953 01:23:44,310 --> 01:23:45,740 is what you're asking me. 1954 01:23:45,740 --> 01:23:48,870 That if they've made an attempt of harm to self, 1955 01:23:48,870 --> 01:23:51,750 harm to others, it's in their medical record, 1956 01:23:51,750 --> 01:23:54,210 and it travels with them as the leave the DoD 1957 01:23:54,210 --> 01:23:56,180 over to the VA side through all the methods 1958 01:23:56,180 --> 01:23:57,250 that we've discussed earlier-- 1959 01:23:57,250 --> 01:23:58,563 - Do we have confidence in that? 1960 01:23:58,563 --> 01:24:00,760 That we're catching all of that? 1961 01:24:00,760 --> 01:24:02,320 - I have quite a bit of confidence in it. 1962 01:24:02,320 --> 01:24:04,060 But I'm happy to also do a review 1963 01:24:04,060 --> 01:24:05,220 if that's something that would help. 1964 01:24:05,220 --> 01:24:07,640 Like just to do a random review. 1965 01:24:07,640 --> 01:24:10,220 I can work with our DoD colleagues to scrub that. 1966 01:24:10,220 --> 01:24:11,680 - Well, thanks, my time has expired. 1967 01:24:11,680 --> 01:24:13,410 But obviously it's critically important 1968 01:24:13,410 --> 01:24:17,560 that as a soldier or sailor is passed onto the VA 1969 01:24:17,560 --> 01:24:20,030 that their history of suicidality 1970 01:24:21,055 --> 01:24:23,570 would also be transferred with those medical records. 1971 01:24:23,570 --> 01:24:24,850 - One of the highest risk factors 1972 01:24:24,850 --> 01:24:27,480 for suicide is a prior attempt, so absolutely. 1973 01:24:27,480 --> 01:24:28,965 - [Mr. Barr] I yield back, thank you. 1974 01:24:28,965 --> 01:24:29,880 - Thank you, Mr. Barr. 1975 01:24:29,880 --> 01:24:31,543 Miss Davis, you're recognized. 1976 01:24:32,580 --> 01:24:33,413 - Thank you, Madam Chair. 1977 01:24:33,413 --> 01:24:34,460 And thank you all for being here. 1978 01:24:34,460 --> 01:24:36,370 I'm sorry I missed your testimony 1979 01:24:36,370 --> 01:24:39,650 but I think I have a sense of all 1980 01:24:39,650 --> 01:24:41,550 that you've been trying to do lately. 1981 01:24:41,550 --> 01:24:43,960 And a lot of that has to do with 1982 01:24:43,960 --> 01:24:46,920 how well we connect in terms of the inter-agency, 1983 01:24:46,920 --> 01:24:51,240 intra-agency and what you see on the horizon. 1984 01:24:51,240 --> 01:24:53,720 What is it that you have felt 1985 01:24:53,720 --> 01:24:56,320 you haven't been able to move forward with? 1986 01:24:56,320 --> 01:24:59,950 You've talked about the, your aligning prescriptions, 1987 01:24:59,950 --> 01:25:03,990 and some of the issues about trying to catch individuals 1988 01:25:03,990 --> 01:25:06,260 who might be really at risk. 1989 01:25:06,260 --> 01:25:09,710 I'm just wondering what is it that you feel 1990 01:25:09,710 --> 01:25:11,660 has been a bit of frustration? 1991 01:25:11,660 --> 01:25:13,790 And maybe I can share with you having, 1992 01:25:13,790 --> 01:25:15,480 I believe Dr. Franklin is familiar 1993 01:25:15,480 --> 01:25:17,580 with some friends of mine actually 1994 01:25:17,580 --> 01:25:20,400 who have been very engaged parents 1995 01:25:20,400 --> 01:25:22,420 in trying to be proactive, 1996 01:25:22,420 --> 01:25:25,740 trying to find kind of a key if you will, 1997 01:25:25,740 --> 01:25:30,697 to keeping families, parents particularly engaged 1998 01:25:32,090 --> 01:25:34,620 with the recruitment, with the service, 1999 01:25:34,620 --> 01:25:39,470 with the deployments, and back home again transition, 2000 01:25:39,470 --> 01:25:42,550 so that they're more aware and can be more helpful 2001 01:25:42,550 --> 01:25:46,413 to a loved one who may be a suicidal risk. 2002 01:25:48,040 --> 01:25:49,930 Are we doing more in that area? 2003 01:25:49,930 --> 01:25:54,930 Are we just so prohibitive because of privacy regulations 2004 01:25:55,660 --> 01:25:57,560 that it's really difficult to do that? 2005 01:25:59,360 --> 01:26:01,860 - So I can speak to that latter point. 2006 01:26:01,860 --> 01:26:04,960 We have been working with family members 2007 01:26:04,960 --> 01:26:07,380 on a network of support. 2008 01:26:07,380 --> 01:26:09,000 I can provide you more information 2009 01:26:09,000 --> 01:26:10,200 about where we are on that. 2010 01:26:10,200 --> 01:26:12,140 But we know that one of the protective factors 2011 01:26:12,140 --> 01:26:14,790 is simply the feeling of connectedness, 2012 01:26:14,790 --> 01:26:15,880 often within the unit. 2013 01:26:15,880 --> 01:26:18,570 But also ensuring that family and friends 2014 01:26:18,570 --> 01:26:20,350 understand the military experience 2015 01:26:20,350 --> 01:26:23,210 in a way that they can support the military member. 2016 01:26:23,210 --> 01:26:26,910 So we have been working on the network of support option. 2017 01:26:26,910 --> 01:26:28,560 I can provide, I can take for the record 2018 01:26:28,560 --> 01:26:29,710 where we are with that. 2019 01:26:31,720 --> 01:26:34,023 - Anybody else wanna comment on that? 2020 01:26:35,690 --> 01:26:39,430 - I do continue to make contact the Summers. 2021 01:26:39,430 --> 01:26:41,141 Thank you very much Chairman Davis 2022 01:26:41,141 --> 01:26:45,070 for introducing them to me seven years ago. 2023 01:26:45,070 --> 01:26:46,300 I definitely appreciate it. 2024 01:26:46,300 --> 01:26:49,140 And I probably hear from them once or twice a month. 2025 01:26:49,140 --> 01:26:51,600 And lived experience is very important in making sure 2026 01:26:51,600 --> 01:26:53,770 we learn everything we can from moms and dads 2027 01:26:53,770 --> 01:26:54,820 and brothers and sisters. 2028 01:26:54,820 --> 01:26:57,960 And the DoD and the VA has a joint panel now 2029 01:26:57,960 --> 01:27:00,470 since we have last spoke called the Lived Experience Panel 2030 01:27:00,470 --> 01:27:02,720 where we collectively bring leaders together 2031 01:27:02,720 --> 01:27:05,003 and we pulse parents and survivors 2032 01:27:05,003 --> 01:27:07,430 just to make sure our policies are right. 2033 01:27:07,430 --> 01:27:08,690 Are we doing everything we can? 2034 01:27:08,690 --> 01:27:11,440 Is there some small thing a mom or dad 2035 01:27:11,440 --> 01:27:13,790 could teach us so that we could do better? 2036 01:27:13,790 --> 01:27:14,690 So that's important. 2037 01:27:14,690 --> 01:27:17,160 In terms of the first part of your question 2038 01:27:17,160 --> 01:27:20,910 about what gives, what are your challenges that remain? 2039 01:27:20,910 --> 01:27:23,750 I just offer to you that, we've talked in the panel today 2040 01:27:23,750 --> 01:27:24,967 about how complex suicide is, 2041 01:27:24,967 --> 01:27:27,690 and it does call for bundled approaches. 2042 01:27:27,690 --> 01:27:30,650 And it calls for them at full force over time, 2043 01:27:30,650 --> 01:27:31,860 like full throttle. 2044 01:27:31,860 --> 01:27:34,130 Like we've got to move out with educating 2045 01:27:34,130 --> 01:27:35,700 every single family member in the nation. 2046 01:27:35,700 --> 01:27:36,790 And there are a lot of them. 2047 01:27:36,790 --> 01:27:39,180 Now that I'm on the VA side, there's 20 million veterans. 2048 01:27:39,180 --> 01:27:41,930 And they all have family members. 2049 01:27:41,930 --> 01:27:45,410 And making sure that we have wrapped that into our protocol 2050 01:27:45,410 --> 01:27:47,580 and then just the bundled approaches 2051 01:27:47,580 --> 01:27:52,140 have got to be pushed out over time. 2052 01:27:52,140 --> 01:27:55,960 And I think about that in the context of leadership support. 2053 01:27:55,960 --> 01:27:57,510 So on the DoD side, 2054 01:27:57,510 --> 01:28:01,280 military leaders recognize their role on suicide prevention. 2055 01:28:01,280 --> 01:28:04,860 And on the VA side, hospital leaders recognize their role. 2056 01:28:04,860 --> 01:28:07,990 But I think there's work to be done on other sectors 2057 01:28:07,990 --> 01:28:11,160 in making sure all leaders recognize their role 2058 01:28:11,160 --> 01:28:13,760 in help with this work. - Yeah, thank you. 2059 01:28:13,760 --> 01:28:16,330 And I know that a lot of work has been done 2060 01:28:16,330 --> 01:28:18,950 in identifying the fact that mental health, 2061 01:28:18,950 --> 01:28:21,940 is physical health, is everyone's health. 2062 01:28:21,940 --> 01:28:26,290 And the need to not be intimidated 2063 01:28:26,290 --> 01:28:29,300 by sort of this perception of stigma. 2064 01:28:29,300 --> 01:28:31,660 And yet at the same time I often talk to people 2065 01:28:31,660 --> 01:28:34,247 in the service, and they still raise those questions. 2066 01:28:34,247 --> 01:28:36,560 The families are afraid to identify. 2067 01:28:36,560 --> 01:28:40,850 So I think that we still have more work to do in that area 2068 01:28:40,850 --> 01:28:44,960 as well and I appreciate what you've been trying to do 2069 01:28:44,960 --> 01:28:46,403 along those lines as well. 2070 01:28:47,400 --> 01:28:49,860 Do we know whether or not individuals 2071 01:28:49,860 --> 01:28:53,160 who are able to transition relatively quickly, 2072 01:28:53,160 --> 01:28:56,120 whether it's it's in something that's totally new to them, 2073 01:28:56,120 --> 01:28:58,220 they've had training while they're waiting 2074 01:29:00,010 --> 01:29:02,720 to complete their service, are they doing better 2075 01:29:02,720 --> 01:29:05,330 if they're actually in a job, that they feel that they, 2076 01:29:05,330 --> 01:29:07,570 even if recently have been trained for, 2077 01:29:07,570 --> 01:29:10,250 versus they're still questioning 2078 01:29:10,250 --> 01:29:11,960 what their future looks like? 2079 01:29:11,960 --> 01:29:16,960 How does, I know it's a complex issue, but is that better? 2080 01:29:17,700 --> 01:29:20,680 - Yes, those that are engaged in meaningful employment, 2081 01:29:20,680 --> 01:29:23,420 not just any random job, but meaningful employment 2082 01:29:23,420 --> 01:29:25,320 where they feel like they're part of a mission. 2083 01:29:25,320 --> 01:29:28,380 And this is I think what's in one of our most recent 2084 01:29:28,380 --> 01:29:30,060 findings across the two organization, 2085 01:29:30,060 --> 01:29:31,690 we have a governance structure 2086 01:29:31,690 --> 01:29:32,800 that we spoke about earlier. 2087 01:29:32,800 --> 01:29:34,660 Dr. Van Winkle mentioned the JEC, 2088 01:29:34,660 --> 01:29:36,120 this Joint Executive Council, 2089 01:29:36,120 --> 01:29:37,880 and we've really been, over the last year 2090 01:29:37,880 --> 01:29:39,750 spent a significant amount of time 2091 01:29:39,750 --> 01:29:42,520 tending to the social aspects of transition. 2092 01:29:42,520 --> 01:29:45,080 And so meaningful employment is part of that. 2093 01:29:45,080 --> 01:29:46,700 And just recognizing what it means 2094 01:29:46,700 --> 01:29:49,310 to no longer wear the uniform as a community member. 2095 01:29:49,310 --> 01:29:50,930 - And I guess also I would add quickly, 2096 01:29:50,930 --> 01:29:54,430 'cause the time, and also training of business people 2097 01:29:54,430 --> 01:29:59,020 to be able to identify and work with an individual 2098 01:29:59,020 --> 01:29:59,910 as well as their family. 2099 01:29:59,910 --> 01:30:01,380 - Those leaders, yes. - Thank you very much. 2100 01:30:01,380 --> 01:30:02,810 - [Dr. Franklin] Yes ma'am, I yield. 2101 01:30:02,810 --> 01:30:04,410 - Thank you, Miss Davis. 2102 01:30:04,410 --> 01:30:08,690 Mr. Kelly's requested a few more minutes, so Mr. Kelly. 2103 01:30:08,690 --> 01:30:10,150 - I first thank the Chairwoman. 2104 01:30:10,150 --> 01:30:12,660 But I wanna thank Miss Davis for her efforts. 2105 01:30:12,660 --> 01:30:15,100 Not only in this arena but several arenas 2106 01:30:15,100 --> 01:30:17,360 that are so important in military personnel. 2107 01:30:17,360 --> 01:30:21,270 She is a, such a great leader on this subcommittee 2108 01:30:21,270 --> 01:30:24,453 in trying to get to solutions, that I just wanna thank you. 2109 01:30:25,690 --> 01:30:28,430 Second on the PDMP, as a former district attorney, 2110 01:30:28,430 --> 01:30:30,950 there was a time when the VA did not share 2111 01:30:30,950 --> 01:30:35,400 with other doctors which led to them going and getting it 2112 01:30:35,400 --> 01:30:37,700 two different locations, so I thank you for that. 2113 01:30:37,700 --> 01:30:40,110 And it helps with treatment as well as, 2114 01:30:40,110 --> 01:30:42,173 and so I just thank you for doing that. 2115 01:30:44,060 --> 01:30:46,990 One of the things that I think that is very confusing 2116 01:30:46,990 --> 01:30:50,400 is on Guard and Reserve, and probably guys, 2117 01:30:50,400 --> 01:30:52,420 one term enlistees on active duty 2118 01:30:52,420 --> 01:30:54,270 don't understand what their veteran status is. 2119 01:30:54,270 --> 01:30:59,120 And I know when I demoed in 2005, or 2006. 2120 01:30:59,120 --> 01:31:01,270 They told us, if you don't get a check up every year, 2121 01:31:01,270 --> 01:31:02,680 you lose your VA benefit. 2122 01:31:02,680 --> 01:31:05,500 Although I'd spent a full year in a combat zone, 2123 01:31:05,500 --> 01:31:08,330 and 20 plus years in the military before, 2124 01:31:08,330 --> 01:31:10,540 if that's still the case, we need to change it. 2125 01:31:10,540 --> 01:31:11,970 Because many of these problems 2126 01:31:11,970 --> 01:31:14,210 don't manifest until years after. 2127 01:31:14,210 --> 01:31:16,180 So if we're denying them 2128 01:31:16,180 --> 01:31:19,100 because if they didn't go get a, quite frankly, 2129 01:31:19,100 --> 01:31:21,730 a stupid checkup just to go in every year, 2130 01:31:21,730 --> 01:31:23,160 they've earned their veteran status, 2131 01:31:23,160 --> 01:31:24,340 they shouldn't lose that. 2132 01:31:24,340 --> 01:31:27,380 Is that still the case Dr. Franklin or Mr. Fisher? 2133 01:31:27,380 --> 01:31:30,080 - I have to turn this over Michael Fisher, okay, okay. 2134 01:31:31,040 --> 01:31:32,770 - I can speak to within Vet Centers. 2135 01:31:32,770 --> 01:31:34,720 So Vet Center eligibility is life long. 2136 01:31:34,720 --> 01:31:36,760 And it doesn't matter if you're accessing it today 2137 01:31:36,760 --> 01:31:38,830 or 15 years from now. 2138 01:31:38,830 --> 01:31:41,210 So you can leave, you can come into services, 2139 01:31:41,210 --> 01:31:43,300 you can exit services, you can come back 2140 01:31:43,300 --> 01:31:46,260 and we can pick up wherever you left off. 2141 01:31:46,260 --> 01:31:49,010 Part of our job also is that if we identify 2142 01:31:49,010 --> 01:31:52,150 other things together, other benefit services 2143 01:31:52,150 --> 01:31:54,540 that you as a service member, or former service member 2144 01:31:54,540 --> 01:31:56,900 could benefit from is making those connections. 2145 01:31:56,900 --> 01:31:59,760 That includes going back over to VA Medical Centers, 2146 01:31:59,760 --> 01:32:02,420 getting connected to a Veteran's Service Officer to work out 2147 01:32:02,420 --> 01:32:05,597 claims issues so you can access the medical centers 2148 01:32:05,597 --> 01:32:07,420 and those kind of things. 2149 01:32:07,420 --> 01:32:08,410 - But I think you're absolutely right 2150 01:32:08,410 --> 01:32:10,010 in terms of being onto something. 2151 01:32:10,010 --> 01:32:12,390 If there's confusion on the stat us when they leave, 2152 01:32:12,390 --> 01:32:15,660 it becomes an access to care issue. 2153 01:32:15,660 --> 01:32:18,320 And so if we inside the VA can do a better job 2154 01:32:18,320 --> 01:32:22,570 of an awareness campaign and some educational rollout 2155 01:32:22,570 --> 01:32:24,900 that educates people on the complexities 2156 01:32:24,900 --> 01:32:25,980 of what there title is, 2157 01:32:25,980 --> 01:32:28,580 and that they're access to before they leave 2158 01:32:28,580 --> 01:32:30,130 in partnership with the DoD 2159 01:32:30,130 --> 01:32:32,910 to make that access to care easier 2160 01:32:32,910 --> 01:32:36,120 so that we're all clear, I take that for action. 2161 01:32:36,120 --> 01:32:39,650 - And I would just say, like I said I left in 2006 2162 01:32:39,650 --> 01:32:41,350 and that was the guidance we were given. 2163 01:32:41,350 --> 01:32:45,110 And as a very high ranking officer, as an attorney, 2164 01:32:45,110 --> 01:32:47,640 and a member of Congress, if I don't understand it, 2165 01:32:47,640 --> 01:32:50,030 I'll assure you those, 22 year olds 2166 01:32:50,030 --> 01:32:52,010 that left them probably don't, so let's do a good job. 2167 01:32:52,010 --> 01:32:54,110 And with that, I yield back Madame Chair. 2168 01:32:54,110 --> 01:32:55,020 - Thank you, Mr. Kelly. 2169 01:32:55,020 --> 01:32:56,870 And I think before we adjourn, 2170 01:32:56,870 --> 01:32:58,710 I just had a couple of quick questions 2171 01:32:58,710 --> 01:33:01,880 that I wanted to ask as well. 2172 01:33:01,880 --> 01:33:06,010 Dr. Franklin, in your response to an earlier question, 2173 01:33:06,010 --> 01:33:08,060 you were talking about the various metrics 2174 01:33:08,060 --> 01:33:10,180 that the VA has set up. 2175 01:33:10,180 --> 01:33:14,200 I was just wondering if you had a basic metric for 2176 01:33:16,510 --> 01:33:17,943 a warm handoff? 2177 01:33:19,080 --> 01:33:20,970 I don't quite know how to quantify that, 2178 01:33:20,970 --> 01:33:23,850 but you understand what I'm saying is, 2179 01:33:23,850 --> 01:33:28,730 how are we measuring that in terms of men and women 2180 01:33:28,730 --> 01:33:33,240 leaving the military, warm handoff, you receiving them, 2181 01:33:33,240 --> 01:33:37,300 and then it may be another warm handoff after that 2182 01:33:37,300 --> 01:33:41,680 but it's mainly that transition between military and the VA. 2183 01:33:41,680 --> 01:33:44,780 - Yes, so we get handoffs from other people other than DoD 2184 01:33:44,780 --> 01:33:47,190 but if you are wanting a figure 2185 01:33:47,190 --> 01:33:49,030 on total number of warm handoffs 2186 01:33:49,030 --> 01:33:53,550 that come from the DoD to the VA by type of handoff, 2187 01:33:53,550 --> 01:33:55,300 mental health, primary care, the like, 2188 01:33:55,300 --> 01:33:56,920 I'm sure that we have that in our data set. 2189 01:33:56,920 --> 01:33:58,340 - [Madam Chair] So you would have that all in your-- 2190 01:33:58,340 --> 01:34:00,310 - I believe we do, yes ma'am. 2191 01:34:00,310 --> 01:34:02,530 - [Madam Chair] And so, where do you receive 2192 01:34:02,530 --> 01:34:04,267 other handoffs from? 2193 01:34:04,267 --> 01:34:08,320 - The community members might efer a veteran, VSO's. 2194 01:34:08,320 --> 01:34:10,710 - [Madam Chair] Do you collect that data also? 2195 01:34:10,710 --> 01:34:13,880 - That's a piece I need to sec by referral source. 2196 01:34:13,880 --> 01:34:15,340 Over the years as a mental health clinician 2197 01:34:15,340 --> 01:34:16,650 in the field at the local level, 2198 01:34:16,650 --> 01:34:17,700 I know that we captured it 2199 01:34:17,700 --> 01:34:19,040 but I need to make sure we're capturing 2200 01:34:19,040 --> 01:34:20,930 it at the VACO level, I can check. 2201 01:34:20,930 --> 01:34:24,653 - Great, and Dr. Van Winkle, I just wanted to know, 2202 01:34:26,570 --> 01:34:30,500 so in a deployed setting, 2203 01:34:30,500 --> 01:34:35,040 have any service members been sent home 2204 01:34:35,040 --> 01:34:40,040 or to a military hospital because of a mental illness 2205 01:34:42,510 --> 01:34:44,830 like you would if you had an injury 2206 01:34:44,830 --> 01:34:46,190 and you might be sent to Germany, 2207 01:34:46,190 --> 01:34:49,460 or you might be sent back here to Walter Reed or? 2208 01:34:49,460 --> 01:34:51,430 - So that's a good question. 2209 01:34:51,430 --> 01:34:53,210 And I would have to take if for the record. 2210 01:34:53,210 --> 01:34:55,050 I think that there are certainly a spectrum 2211 01:34:55,050 --> 01:34:56,990 when we talk about mental illness 2212 01:34:56,990 --> 01:34:58,287 in terms of severity of mental illness 2213 01:34:58,287 --> 01:34:59,640 and the impact on the mission 2214 01:34:59,640 --> 01:35:02,160 and on the member themselves. 2215 01:35:02,160 --> 01:35:05,110 Captain Colston, I don't know if you have any information. 2216 01:35:05,110 --> 01:35:06,640 - By all means, we've air-backed folks 2217 01:35:06,640 --> 01:35:07,810 from mental health conditions. 2218 01:35:07,810 --> 01:35:12,070 And the most common condition is actually not suicidality. 2219 01:35:12,070 --> 01:35:15,360 In my experience, it was first break psychosis, 2220 01:35:15,360 --> 01:35:19,060 first break, mainly a lot of 18 to 25 years there 2221 01:35:19,060 --> 01:35:21,930 who had a predisposition for severe mental illness. 2222 01:35:21,930 --> 01:35:25,170 And then getting in a really stressful type of situation 2223 01:35:25,170 --> 01:35:26,513 and it manifests. 2224 01:35:27,540 --> 01:35:29,270 - Thank you, do you have the data manifested that? 2225 01:35:29,270 --> 01:35:30,930 Is that something that you collect? 2226 01:35:30,930 --> 01:35:33,110 - I would imagine that it would be possible 2227 01:35:33,110 --> 01:35:35,740 to do a dive, ma'am, I certainly don't have it on hand. 2228 01:35:35,740 --> 01:35:37,910 I could take that for the record. 2229 01:35:37,910 --> 01:35:40,500 - Very good, well, I wanna thank all the witnesses, 2230 01:35:40,500 --> 01:35:41,890 I have a lot more questions 2231 01:35:41,890 --> 01:35:46,570 but I hope that we can have another meeting like this 2232 01:35:46,570 --> 01:35:50,530 with both the VA and DoD together. 2233 01:35:50,530 --> 01:35:54,010 I know that with the executive orders coming 2234 01:35:54,010 --> 01:35:55,330 from the president's office, 2235 01:35:55,330 --> 01:35:57,110 there's gonna be more collaboration 2236 01:35:57,110 --> 01:36:00,547 and more articulation and I think about that collaboration 2237 01:36:00,547 --> 01:36:03,210 and that first year outside of the military. 2238 01:36:03,210 --> 01:36:07,230 And I'm looking forward to hearing more about that 2239 01:36:07,230 --> 01:36:12,060 as you make that but we all agree in this room 2240 01:36:12,060 --> 01:36:14,530 that this is a real crisis. 2241 01:36:14,530 --> 01:36:19,530 And we must make inroads, we must make progress 2242 01:36:19,960 --> 01:36:24,190 and one suicide a day is one suicide too many. 2243 01:36:24,190 --> 01:36:27,850 And I know both of you sitting here on the dais 2244 01:36:27,850 --> 01:36:31,230 are very dedicated to that and I'm looking forward 2245 01:36:31,230 --> 01:36:33,250 to continuing that work. 2246 01:36:33,250 --> 01:36:38,060 So, again, thank you for providing the testimony today 2247 01:36:38,060 --> 01:36:40,910 and there's no further business, 2248 01:36:40,910 --> 01:36:42,710 this subcommittee will be adjourned.