Apr112013
Hearing Transcript on Examining the Progress of Suicide Prevention Outreach Efforts at the U.S. Department of Veterans Affairs.
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EXAMINING THE PROGRESS OF SUICIDE PREVENTION OUTREACH EFFORTS AT THE U.S. DEPARTMENT OF VETERANS AFFAIRS
HEARING BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION JULY 14, 2010 SERIAL No. 111-91 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
July 14, 2010
Examining the Progress of Suicide Prevention Outreach Efforts at the U.S. Department of Veterans Affairs
OPENING STATEMENTS
Chairman Harry E. Mitchell
Prepared statement of Chairman Mitchell
Hon. David P. Roe, Ranking Republican Member
Prepared statement of Congressman Roe
Hon. Timothy J. Walz
Hon. John H. Adler
Hon. Rush D. Holt
WITNESSES
U.S. Department of Defense, Colonel Robert W. Saum, USA, Director, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
Prepared statement of Colonel Saum
U.S. Department of Veterans Affairs, Robert Jesse, M.D., Ph.D., Principal Deputy Under Secretary for Health, Veterans Health Administration
Prepared statement of Dr. Jesse
American Legion, Jacob B. Gadd, Deputy Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. Gadd
Bean, Linda, Milltown, NJ
Prepared statement of Ms. Bean
Cintron, Warrant Officer Melvin, USA (Ret.), Manassas, VA
Prepared statement of Warrant Officer Cintron
Iraq and Afghanistan Veterans of America, Timothy S. Embree, Legislative Associate
Prepared statement of Mr. Embree
Vietnam Veterans of America, Thomas J. Berger, Ph.D., Executive Director, Veterans Health Council
Prepared statement of Dr. Berger
SUBMISSIONS FOR THE RECORD
American Foundation for Suicide Prevention, Paula Clayton, M.D., Medical Director, statement
Coleman, Penny, Rosendale, NY, Author, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War, statement
Oregon Partnership, Portland, OR, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
EXAMINING THE PROGRESS OF SUICIDE PREVENTION OUTREACH EFFORTS AT THE U.S. DEPARTMENT OF VETERANS AFFAIRS
Wednesday, July 14, 2010
U. S. House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:00 a.m., in Room 334, Cannon House Office Building, Hon. Harry E. Mitchell [Chairman of the Subcommittee] presiding.
Present: Representatives Mitchell, Walz, Adler, Hall, and Roe.
Also present: Representative Holt.
OPENING STATEMENT OF CHAIRMAN MITCHELL
Mr. MITCHELL. Good morning and welcome to the hearing on Examining the Progress of Suicide Prevention Outreach Efforts at the U.S. Department of Veterans Affairs (VA) for July 14, 2010.
The Committee on Veterans' Affairs' Subcommittee on Oversight and Investigations will now come to order. I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and that statements may be entered into the record. I also ask unanimous consent that the statements of Dr. Paula Clayton of the American Foundation for Suicide Prevention and Penny Coleman from New York be entered into the record. Hearing no objection, so ordered.
I appreciate everyone being here today and for your interest and concerns on the progress of suicide prevention outreach efforts.
Before we begin, I want to acknowledge a positive step that the VA has taken recently to help veterans suffering from post-traumatic stress disorder, or PTSD. The VA recently announced it is easing the evidentiary hurdle that veterans must clear to receive treatment for PTSD. This is a step in the right direction. I am glad they are doing it. However, to be truly effective in reaching all veterans who need help, not just those who are already showing up at the VA and asking for it, the VA also needs an effective outreach strategy.
We have 23 million veterans in this country, only 8 million of which are enrolled to receive care at the VA. The VA has an obligation to the 15 million who are not enrolled for care, not just the 8 million who are already enrolled. If these other veterans have PTSD or are at risk for suicide, the VA has an obligation to reach out to them as well and let them know where they can turn for help.
Last year upwards of 30,000 people took their lives by suicide in the United States. Twenty percent of these deaths were veterans. Each day, an estimated 18 veterans commit suicide. By the time this hearing concludes between one and two veterans will have killed themselves. These statistics are startling.
As you know, many of our newest generation of veterans, as well as those who served previously, bear wounds that cannot be seen and are hard to diagnose. Proactively bringing the VA to them as opposed to waiting for veterans to find the VA is a critical part of delivering the care they have earned in exchange for their brave service. No veteran should ever feel that they are alone.
As Chairman of this Subcommittee, I have repeatedly called upon the VA to increase outreach to veterans who need mental health services and are at risk of suicide, and Members on both sides of the aisle have urged the same.
In 2008, the VA finally reversed its longstanding self-imposed ban on television advertising and launched a nationwide public awareness campaign to inform veterans and their families about where they can turn for help. As part of this campaign, the VA produced a public service announcement featuring Gary Sinise and distributed it to 222 stations around the country, aired it more than 17,000 times. The VA also placed printed ads on buses and subway trains.
According to the VA's own statistics, the effort proved successful. As of April 2010, the VA had reported nearly 7,000 rescues of actively suicidal veterans which were attributed to seeing ads, PSAs (public service announcements), or promotional products. Additionally, referrals to VA mental health services increased.
However, despite the success late last year, the public service announcements stopped airing. I don't understand this. If anything, it seems to me we need to be increasing outreach to veterans at risk for suicide, not stopping it. It is my understanding that VA is planning to produce a new public service announcement, which will be ready by the end of this year.
However, the question remains, why did the VA stop running the first public service announcements while they worked on the second one? How does this help veterans to go dark for more than a year?
While I commend the additional expansion in outreach that has grown in the way of brochures and other useful steps, I do not think the VA should suspend, even temporarily, outreach efforts like the public service announcements that have proven so successful. It is also imperative for the VA to utilize and adapt to technology, including the use of Facebook and Twitter, to reach the latest generation of veterans. Doing so I believe will help transform VA into a 21st Century organization and, most importantly, save lives.
Today, the Subcommittee is assessing the suicide prevention outreach program on national implementation and achievements. We have a wide range of testimony that will be presented today, and I look forward to hearing all that will be said on this vitally important issue. We appreciate our panelists' dedication to the formulation of a more comprehensive and targeted suicide prevention outreach program. These struggling veterans deserve our help. We must continue to work on breaking the stigma associated with asking for help. We cannot wait for veterans to go to the VA. The VA needs to go to them. Additionally, we must work in a bipartisan way to ensure the VA delivers the resources our veterans have earned.
Before I recognize the Ranking Republican Member for his remarks, I would like to swear in our witnesses. I ask that all witnesses stand and raise their right hand, from all three panels.
[Witnesses sworn.]
Mr. MITCHELL. I now recognize Dr. Roe for opening remarks.
[The prepared statement of Chairman Mitchell appears in the Appendix.]
OPENING STATEMENT OF HON. DAVID P. ROE
Mr. ROE. Thank you, Mr. Chairman. I appreciate your calling this hearing today to review what the VA has done in the area of outreach to veterans in our communities who are feeling vulnerable and uncertain of their future.
I cannot imagine what goes through the mind of someone seeking to end their life, but we must do anything we can to ease their pain and to help them through this crisis that they find themselves in so that they can move forward and heal the wounds from which they are suffering.
Public Law 110-110 was signed on November 5, 2007, by President Bush. This law, as part of the comprehensive program of suicide prevention among veterans, provided that the Secretary may develop a program for a toll-free hotline for veterans available and staffed by appropriately trained mental health personnel at all times and also designated that the Secretary would provide outreach programs for veterans and their families.
As part of this outreach, the VA contracted with the PlowShare Group, Inc., to distribute, promote, and monitor a public service announcement featuring actor Gary Sinise, who played Lieutenant Dan in the movie Forrest Gump and also performs with the Lieutenant Dan Band. This moving PSA, which can still be found on YouTube, encourages veterans to contact the toll-free national suicide hotline in an emotional crisis.
According to PlowShare, their work on this campaign was successful as they were able to generate nearly $4 million in donated media and the suicide hotline saw an increase in activity during the campaign, as the Chairman mentioned.
The VA also piloted outreach advertising right here in the metro area of Washington, DC, driving around the city and on the metro bus system, and signs could be seen in various locations promoting the hotline to veterans.
What I look forward to learning in the hearing today is the following: Have we seen a reduction in the number of veteran suicides since the inception of PSAs, whether the plan is there to continue the PSAs now that the contract for the previous PSA has expired, and how has the national suicide hotline helped in the reduction of veteran suicides, and where do we go from here?
I am pleased that the witnesses from our veteran community are here today as well as the VA so that we can hear from everyone how useful the previous PSAs were and what other kinds of outreach efforts need to be made to reach not just our older veteran population, but our new veterans coming out of Iraq and Afghanistan, and how the VA is using new media to get information out to our new set of veterans who may not be aware of all the services that the Department provides. We need to review and evaluate the successes of outreach efforts on an ongoing basis and see where they can be improved and enhanced as well as how frequently they are being broadcast to the general public.
And again, Mr. Chairman, I thank you for holding this hearing and I yield back my time.
[The prepared statement of Congressman Roe appears in the Appendix.]
Mr. MITCHELL. Mr. Walz?
OPENING STATEMENT OF HON. TIMOTHY J. WALZ
Mr. WALZ. Well thank you, Chairman and Ranking Member Roe, and I appreciate your continued commitment to providing the oversight and responsibility that this Subcommittee has. I thank all of you for being here today. But I know no one in this room needs to be reminded, but I said here looking at the picture of Sergeant Coleman Bean and his mother who is going to speak to us in just a moment, this is the face of why we are here. There is no higher calling that we do here in the protection of these warriors that are willing to go and protect our freedoms, and I think that obligation and that responsibility is very apparent on everyone here that this is a zero sum game. One Coleman Bean is too many, and we need to get this right.
I am very encouraged to see we have in this room, and it is something many of you have heard me talk about often, we have U.S. Department of Defense (DoD) here, we have VA here, we have veterans service organizations (VSOs) here, we have the private sector here, we have the Congressional oversight here. We are starting to understand that this is a very complex project. It is going to have to be multidisciplinary across all these agencies, we have to get seamless transition right. We have to bring to bear on this problem all the resources this Nation can have. It is moral responsibility, and it is a national security responsibility.
A mother lost this beautiful young man. We as a society lost one of our best and brightest. The world is weaker and worse for this, and we can do something about it.
So I am encouraged that we are here. I am, like many of you, searching for ways we can do this better, but the commitment amongst all of you here, I know, is unwavering. And I am personally very appreciative of it. And when we get to that zero sum, that has to be our goal. We may never get there, but we have an obligation to try. So thank you, Mr. Chairman, and I yield back I look forward to hearing from our witnesses.
Mr. MITCHELL. Thank you. Mr. Adler?
OPENING STATEMENT OF HON. JOHN H. ADLER
Mr. ADLER. Thank you, Mr. Chairman. I share your comments, those of Dr. Roe and Sergeant Walz. I want to particularly direct my attention with gratitude to Linda Bean of New Jersey, my State. It would have been enough just to let your son serve in the military and serve two tours in Iraq, serve our country valiantly, heroically, and to have lost him is a loss you can't ever get back. You could then go away and not talk out, but instead, Ms. Bean, you choose to keep your son's memory alive by helping other people, by reaching out to other folks returning from Afghanistan, from Iraq and from missions around the world to keep us safe here at home, and that is an ongoing patriotism consistent with your love for your own son and his own patriotism. So I am grateful to you, to all the experts, the DoD, VSOs, private sectors, as Sergeant Walz said, but particularly Ms. Bean you take the time to share with us your own experience, Coleman's experience so that we can learn from it and avoid recurrences.
Thank you. I yield back.
Mr. MITCHELL. At this time I would like to welcome panel one to the witness table.
And joining us on our first panel is retired Warrant Officer Mel Citron, a Gulf War and Operation Iraqi Freedom (OIF) veteran from Woodbridge, Virginia, and Mrs. Linda Bean, a mother of an OIF veteran from Milltown, New Jersey. If both of you would please come and sit at the table.
I ask that all witnesses stay within 5 minutes of their opening remarks. Your complete statements will be made part of the public record.
Mr. Citron, you are recognized for 5 minutes.
STATEMENTS OF WARRANT OFFICER MELVIN CINTRON, USA (RET.), MANASSAS, VA (GULF WAR VETERAN AND OIF VETERAN); AND LINDA BEAN, MILLTOWN, NJ (MOTHER OF OIF VETERAN)
STATEMENT OF WARRANT OFFICER MELVIN CINTRON, USA (RET.)
Mr. CINTRON. Thank you. Mr. Chairman, distinguished Members of the Committee on Veterans' Affairs. My name is Melvin Cintron. I was a flight medic conducting forward area medical evacuation in support of U.S. and enemy wounded personnel, civilian, military and enemy prisoners of war.
I am also a veteran of Iraq Freedom War on Terrorism. I am extremely proud of my service to our country. I have been submitted for Combat Air Medal in Desert Storm and the Army Bronze Star Medal, which I did receive for my services in this last tour as an aviation maintenance officer.
I have no regrets for answering the call and would proudly do so again, despite the fact that it came at a great cost to me and my family financially, physically, socially and mentally.
However, I am often ashamed to enter the VA for help, having seen so many of my fellow soldiers that have paid an even much higher price for their service. I am here today in hopes that my testimony will help improve the support for them.
I would like to make clear that I personally know that the VA has many caring and committed professionals. My testimony is reflective of the system, not of the dedicated and committed personnel of the Veterans Administration.
When I entered the VA medical center, I see a poster saying, it takes the courage of a warrior to ask for help. But the poster should read, it takes the courage of a warrior to ask for help from the VA.
There are numerous examples of failures our veterans encounter when seeking help from the VA. But this Committee is seeking specific input on the VA's suicide prevention efforts and hotline.
Make no mistake, I consider myself extremely blessed. I have the ability to provide for my loved ones, two arms to hug my children, full sight to see my family, two legs which led me here to testify, not for my own need, but as stated, in hopes that in some way I can contribute to providing better support for others who may not be as blessed.
Their need for timely help from the VA should never be compromised. I feel strongly that the VA suicide prevention efforts and hotline are not working since it is too much of a last alternative with little else in between before getting there.
Have you heard the recording when veterans call the VA? Either you don't have enough of a problem and you can wait, sometimes for weeks for an appointment, or you're suicidal.
Distinguished ladies and gentlemen, I believe that there is a large void that exists between the no problem type strategy and the suicidal stigma strategy. Not having that void filled with intermediate prevention tools and mitigation strategies will only continue to fuel the need for the forensic type strategy of concentrating only on the suicidal hotline. I could easily be wrong, but I believe that by the time a veteran is desperate enough to call the suicide hotline, it may already be too late.
In my 19 years since coming back from Desert Storm, and my 5 years coming back from Iraq, I have met many veterans who have broken down while talking to me about their experiences, experiences they held for a long time. I have asked them, why don't you go to the VA for help, knowing the answer. I have advised them to call the VA, but they don't, because they are not suicidal and do not want to risk that label for fear of the effect on their jobs, their family, or social circles.
I have interacted with the VA regularly for many years, and I am aware of the suicide prevention hotline. However, I do not know of a readily or easily accessible intermediate or nonsuicide hotline. I apologize for my ignorance if such a system does exist. But if it does, and so many don't know of it, then the system obviously needs better marketing, promotion, and outreach, or at least as much as is done with the suicide hotline.
Instead of just suicide hotline, we should provide support long before a veteran considers suicide. Veterans need and deserve a system of continuing support, a dignified program that addresses basic needs of a soldier to talk without the stigma or label of being considered a suicidal risk.
Please help our veterans ask for help in dignity, not in fear, apprehension or labeling. Thank you very much.
[The prepared statement of Warrant Officer Cintron appears in the Appendix.]
Mr. MITCHELL. Thank you. At the time I would like to introduce Congressman Holt. You are recognized to introduce Ms. Bean.
OPENING STATEMENT OF HON. RUSH D. HOLT
Mr. HOLT. Chairman Mitchell, Ranking Member Roe, and Members of the Subcommittee, thank you very much for holding this hearing and for allowing me the courtesy and giving me the honor of introducing my remarkable constituent, Linda Bean of East Brunswick, New Jersey. Linda and her husband Greg are accomplished communications professionals who have lived in central New Jersey for many years. For nearly 2 years now, Linda and Greg have waged a battle openly and courageously to prevent other military families from suffering the kind of loss that they endured when their son, Coleman, tragically took his own life in September 2008 after serving two grueling tours in Iraq. This is Linda's story to tell, and I ask you to give her your full attention.
I was astounded to learn that servicemembers who are in the Individual Ready Reserve (IRR), as Coleman was, do not receive the kind of suicide outreach protection they need and deserve. As the Bean family and I discovered, our current suicide prevention efforts simply do not encompass these reservists and a number of others.
I have sent a letter to Secretaries Gates and Shinseki asking that to the extent possible under law they implement the kind of Individual Ready Reserve suicide prevention program that I have advocated and which is included in the House version of the Fiscal Year 2011 National Defense Authorization Act. The very least we can do for the veterans of Iraq and Afghanistan who are still in the Reserve rolls but not in units is ensure that someone from the DoD or VA checks in with them periodically over the course of a year. If we can afford to send them to war, we can certainly afford a few regular phone calls to make sure that they are doing okay, that they are readjusting to civilian life and, if necessary, that they get the help quickly that they need when they need it, not after it is too late.
I ask for the Subcommittee's support in this effort and I now ask you to turn your attention to someone who can speak far more eloquently than I can about the need for action, Linda Bean.
Mr. MITCHELL. Thank you, Mr. Holt. Ms. Bean, you are recognized for 5 minutes.
Ms. BEAN. Mr. Chairman and Members of the Subcommittee, thank you for allowing me to appear before you today. Representative Holt, thank you for all your support to my family and for me and for your leadership on this issue.
I testify today because my son, Sergeant Coleman Bean, 25, a veteran of two tours of duty in Iraq, shot and killed himself on September 6, 2008.
I am so grateful for this opportunity.
Coleman was an amazing man, and he was a proud soldier. I owe a duty to my son, and I owe a debt to the men with whom Coleman served.
It is my hope that the observations drawn from a shared experience of loss will be useful to you as you oversee the development and the implementation of suicide prevention strategies for the VA.
First, I would encourage you to accept some facts. Men and women come home from service to towns and cities and families that are far removed from a VA hospital or a Vet Center. Many veterans who are at risk for suicide would never call themselves suicidal. And some veterans, as I think you well know, either will not or cannot use VA services.
I believe it is crucial for the VA to assume immediately, identify and publicize civilian counseling alternatives, including the Soldier's Project, GiveAnHour and the National Veterans Foundation; partner with civilian organizations to assure that all vets have the immediate access to the widest possible range of mental health care; and encourage media outlets in your district to publicize local information on mental health resources for veterans.
Second, I believe it is critical to implement a simple, straightforward public information campaign that is geared specifically to veterans' families and their friends. It may fall to a grandmother or a best friend or a favorite neighbor to seek out help for a veteran who is in trouble. Make information on available services easy to find, easy to understand, and publish that information broadly. The suicide hotline number, as you have already heard, is not enough.
Finally, I would encourage you to help veterans help each other. The VA is confronting PTSD and suicide with new programs and new research, and that is all good and important work. But that has not always been the case. And there are plenty of veterans who will tell you that they have had to scrap and fight for every service they have received from the VA.
In addition to the official patient advocacy complaint resolution program, please establish a separate body, one made up of your most feisty and tenacious veterans, to help ensure that no one gives up because it was too hard or because it took too long to get the service that they needed.
My son joined the Army when he was 18 on September 5, 2001. The terrifying tragedy of September 11 confirmed for my son the rightness of that commitment. When he came home on his first leave, he took a pair of socks, lovingly folded by his mother, and he unfolded them and refolded them to Army specifications. It was his intention, he said, to be a perfect soldier.
In the days following Coleman's death, our family had the humbling experience of meeting with the men with whom Coleman had served. They traveled from all over the country to be with us and to be with each other, and it was clear to us then that many of these men were carrying their own devastating burdens.
In the days after Coleman's service, I spent hours on the telephone trying to identify for some of these young men services that would assist them as well, and I reached out first to the VA hospitals in the States where those young men lived. I have to tell you my inquiries netted some mixed results.
A VA representative in Texas was horrified when I described for him my fear for our young veterans. And he said, Ms. Bean, just tell me where he is, I will get in my car, I will go there right now. Just tell me where he is and I will go to him.
By contrast, a man in Maryland told me, if they don't walk through the door, we can't help them.
Now, I know that is not correct. Of course we can help them. And it is our duty to figure out how, not theirs.
Thank you.
[The prepared statement of Ms. Bean appears in the Appendix.]
Mr. MITCHELL. Thank you. Ms. Bean, I am very sorry for your loss.
Ms. BEAN. Thank you.
Mr. MITCHELL. And I want to thank you for your son's service.
Ms. BEAN. Thank you Mr. Chairman.
Mr. MITCHELL. In your testimony you described how you would like to see the VA identify and describe, identify and publicize civilian counseling alternatives.
How do you think the VA should go about this?
Ms. BEAN. There are a number of established organizations, most of them have developed since 2003, that use the services of civilian therapists in local communities to help augment whatever services the VA has available. The services are confidential, they are free of charge, they help veterans and they help the families, and I suspect if the VA posted a notice saying we would be interested in hearing what you do they would come to the VA. I am not sure the VA is going to have to look that hard to find community-based organizations that want to help soldiers.
In our own State of New Jersey, there is a hotline for veterans staffed by veterans that developed out of the events of September 11, a similar program, Cop to Cop. I know that there are vet to vet programs in a number of States and if somebody wanted to throw out the welcome mat and say tell us what you do, I know those people would come to you. But if you need a list of resources, Mr. Chairman, I have a list and I would be happy to provide that to your office.
Mr. MITCHELL. Thank you. Also from your testimony it is clear that you continue to be in contact with other veterans and their families as they try to navigate the government bureaucracy in search for help.
Can you tell the VA on how to make information easier and more accessible to veterans and their families?
Ms. BEAN. Veterans who are already in the system know how to navigate the VA Web site and they understand the jargon and they know how to get from point A to point B. But it isn't always the veteran who is going to be looking for the services. So somewhere within that dense content on both the DoD and the VA Web sites, there needs to be, and I think I said, a welcome mat. There needs to be a notice that says, if you know a veteran in trouble, if you have questions, if you think someone is suffering PTSD, click here, and make those resources easy to read and easy to understand.
It is daunting to go through the VA Web site in search of help.
Mr. MITCHELL. Mr. Cintron, in your testimony you say that the VA's suicide prevention hotline and suicide prevention efforts aren't working.
Can you please elaborate on why you think that?
Mr. CINTRON. Yes, sir. I believe, Mr. Chairman, that—and I am an aviation safety professional. I have a responsibility for safety. The things that we try to do is never go to an accident site but rather prevent the accident from happening. But the suicide hotline the way it is, and you are either don't have a problem serious enough to consider and you can wait and make a appointment 3, 4 weeks down the road, or you are suicidal. There is no intervention in between. There is no prevention. There is no strategy there to say how do we keep our soldiers and our veterans from getting to that stage.
I am very glad that the hotline is there. Please don't misunderstand. I think it is needed. However, by not having something in the program that allows somebody to just talk or just keep them from going to the next level, because they don't have an outlet, that now they will get there, and by the time they reach the suicide hotline it is too late. We could have prevented them from even getting there.
The numbers that you stated today are stunning to me, both in the soldiers that we are losing, the veterans that we are losing, and in the good way, the ones that we are preventing. But I say we could prevent so many more if there was a prevention strategy of keeping them from getting to a suicide hotline.
One of the things that I would like to say, Mr. Chairman, is that programs such as are out there for our folks to interact with, are critical. But it also has to be part of the military's program. And I will share this example with you. When I came out of Iraq the second time around, we were in Fort Dix being outprocessed. As we are being given all our out briefings, a sergeant steps up and says who here needs to talk to somebody for anything you have seen or done? And nobody raised their hand. Nobody said here. He said okay, if you want to do it confidentially, we will have a board, a tablet that you can sign up on. The day before we left Fort Dix, same sergeant stood in an auditorium with that board and read those names and said, do you still need to talk to somebody?
I was one of those soldiers. I did not need to talk to somebody at that time.
So there has to be an interlacing, collaborative effort to also get the services involved in having peer-to-peer training in identifying, you know we have the buddy system, we have the life saver program for a soldier that doesn't have to be a trained medic to be able to provide that first aid lifesaving technique. They have that. We can have the same thing, but we are talking about saving a soldier's mind and saving their life.
Mr. MITCHELL. Thank you.
Dr. Roe?
Mr. ROE. Thank you all for being here, and Ms. Bean, especially you. I have a unique perspective being a veteran and being a physician to have worked with these types of issues during my medical career and I can't tell you how courageous it is and how much I appreciate you being here and sharing your testimony.
Ms. BEAN. Thank you.
Mr. ROE. I think you and actors like Gary Sinise who have stepped up and done an incredible job have more credibility than anyone, and I want you to comment certainly on some of the PSAs. It brings back to me breast cancer awareness, how we used public service announcements to raise awareness among women, and I think that has done a great deal in decreasing the incidence of breast cancer. And I think the VA, if we talked about suicide or talked about suicide ideation, that somehow we would increase the incidence. I think it does just the opposite.
And I wanted to hear your comments and both of you, Mr. Cintron also, on how you believe that just making people aware and then having some place to go, and I could not agree more with you, having that in between is very important because I as a physician had patients who said, you couldn't determine from even sitting down in a fairly long conversation whether they really were suicidal. And it is not easy. This is a very difficult diagnosis to make.
So I will be quiet. I want to hear what Ms. Bean has to say about that.
Ms. BEAN. I think that there are families like mine who have experienced the homecoming of a much loved child who is now out of harm's way and you are so grateful that they are back with you that you may overlook the fact that they are drinking too much or that they are irritated or that they insist on being isolated. And you are not empowered, as a mother or a sister or a wife, to go to the VA and say, my veteran is in trouble.
I don't even know that I would have known how to do that.
I think, in the way that Mr. Cintron described, we need to make sure that people understand there are places to go before you hit the suicide hotline. There are veterans who are not, who may in the end be alone in a room with a gun to their heads but the day before would not describe themselves to you as suicidal.
So I guess I would go back to my very strong feeling that as part of that, in addition to the messaging, we need to make sure that there are community-based programs that are easily accessible, and we need to make sure that the information that the VA has is geared to families and friends in a friendly and accessible way, made easily available so people can find it, and that the VA is willing to say, look, if you won't come here, that is okay, we will help you find help somewhere else.
Is that what you were looking, the answer?
Mr. ROE. The public service announcements, I think you and the public service announcement in New Jersey would be an incredible statement for people.
Ms. BEAN. I guess if you are saying, are there other kinds of public service announcements that would be workable.
Mr. ROE. Yes.
Ms. BEAN. I think it would be the public service announcement that said, you know, you're home, you're drinking too much, you're fighting with your wife, you can't get along with your boss, you need help.
That is a message that resonates with people who are in that position. The message that says you are home and you are suicidal, not so much.
Mr. ROE. I agree. I agree.
Mr. Cintron?
Mr. CINTRON. Yes, sir. I agree. I think there has to be peer counseling both on the family side and on the soldier side. I once read in a magazine that had a copy, had a picture of a wall that was used as a firing squad wall, and in it, it said, you have never lived until you have almost died. For those who fight for it, life has a flavor to protect it we will never know. For the veterans, it also has a price for that flavor. They cannot just go to a family member and talk about what that family member would never know. They cannot just go and talk to anyone.
So even that, in itself, is something that also needs to be addressed so that they feel that a mother is not nagging when they say, hey, I think you're drinking too much or a wife isn't nagging. So those are awareness things that also need to be out there.
I think there are so many good outreach programs that can be done. You have groups here that you must interact with and reach those folks that can be reached. The other thing that I would ask is that consider the unreached soldier, the person that doesn't go to the VA, the person that doesn't go to AVA, the person that doesn't think they need help. And all it takes is a simple outreach from someone saying, hey, let's talk about what you did.
Mr. ROE. I think your comment, Mr. Chairman, and then I will yield back, your comment about when you had the sergeant stand up is at least a move further than when I ETSed 36 years ago when nobody did and I am a Vietnam era veteran and served overseas, and we are doing better, and I think we have to do a lot better. But I know that then there was no outreach or anything, and that has steadily improved because of people like yourself being willing to stand up and saying something needs to be done. I thank you for doing that, and I yield back my time.
Mr. MITCHELL. Thank you.
Mr. Walz?
Mr. WALZ. Thank you and, Ms. Bean, again I echo the comments of my colleagues and thank you again for being here, Mr. Cintron, and thank you both. You are making a difference and you are continuing your service. And I truly appreciate that.
I would also mention what Dr. Roe said, it may be a little bit of a move forward, but as a senior NCO myself I am just appalled by that. I think it goes to a deeper cultural issue. It is mental health parity in this Nation and how we view mental health issues. I think the good news is, and I would like to say a deep heartfelt thank you to my colleague from New York, Mr. Hall, on Monday when we got the notice from the VA on the issue of PTSD in trying to make this easier for folks, this is a huge step forward on the issue we are talking about today. I think we are starting to attack this from multiple perspectives. Monday was a very gratifying day for me because of that ruling coming down and I was in Hennepin County in Minneapolis where we established our State's first vets' court, which we all know is a way we start to see these things, a progression, exactly what you are all talking about is stop it before we get to that point, stop it before it escalates from driving on the wrong side of the road, drinking and driving, domestic violence down the road to these types of things. So I appreciate obviously because of your experience and unfortunately in your case, Ms. Bean, your personal experience. You are incredibly insightful on what needs to happen and I think we are starting to see that happen. I want to hit on one thing with you, Ms. Bean, and I know Mr. Holt just left but he mentioned and you explained a little of your concern with the IRR, and dropping back, I understand your son was on active service his first tour, then he was called back through the IRR on the second one. I am concerned with this as a former National Guardsman and coming from a State where we have put a lot of time and thought in the beyond the yellow ribbon campaign on when these folks come back, of how we capture them in that seamless transition in that care. What did you see in your experience where there was a drop-off, both of you, as you see this, is it fair for me to say that it is, and Ms. Bean, you mentioned it about your view in Texas versus Maryland, those types of things. Do you think we are not capturing it as a whole and that it is spotty across the country as you come back on how that care is?
I would like each you to take a stab at that because we have talked about this, of nationalizing this beyond the yellow ribbon campaign, to make sure that no matter where you go into service or how you go in either active service or IRR, you are still going to have that support net. So if you have a comment on that of how that affected you.
Ms. BEAN. Coleman's first tour of duty was with the 173rd, and when they returned from Iraq to Vicenza, Italy, they had mental health musters on a regular basis. They were on a base. They were together. They had each other. They had shared the same sort of experiences, and they had that opportunity to talk things through.
He was home for I think almost 18 months, recalled to duty through the Individual Ready Reserve, and he was assigned to a unit of the Maryland National Guard. When they came back out of Iraq, the Maryland National Guard went home to Frederick, Maryland. Coleman came home to New Jersey. I know that they had regular musters in Frederick, mental health musters, health musters, weapons checks, all the kinds of things that you would do to keep a unit running. Mental health was a part of that. Coleman participated in none of that.
And I know that when the men from that National Guard unit came to Coleman's service and we talked later, they were heartbroken. They didn't know. And they didn't know how they could have known how to reach out. There wasn't, for them, for the leadership of that unit, there wasn't a way for that leadership to reach these men who served under their flag but lived in a different State.
And I would say to you, Mr. Walz, it is very, very hard to get numbers of soldiers in that circumstance. I don't think we have a clear number of how many IRR soldiers or how many individual augmentees may be at risk for suicide. But I think the numbers are big. And I think it is a shame that if a man from Wyoming serves with the National Guard from California, he should get the same help those boys get.
Mr. WALZ. You are absolutely right.
Mr. Chairman, I would suggest and I think Ms. Bean has hit on something that has troubled me for quite some time is how we disaggregate that data and find that out. We see this also with active forces coming back in ones and twos to our States. I have to be honest that I see that in Minnesota. You are far better off to go with a National Guard unit from Minnesota and be part of that community than you are not to. And I bet, I am willing to, anecdotal, but I bet if we disaggregate that I bet you we are seeing better prevention measures amongst that and that would be something that would be very interesting to know.
Mr. Cintron, before my time is up, any comments?
Mr. CINTRON. Yes, sir. I am your poster child also because I was in the IRR, and after 6 years of not being in uniform I got a letter in the mail saying that I have been called up. I served my country proudly. And I was put in with a National Guard unit from Maryland and New Hampshire and sent to Iraq as an IRR soldier.
When I came back, I didn't have any of that support that they had. Nobody reached out or said, hey, you are part of this unit, you did this, you did that, no, nobody did.
Mr. WALZ. Did you get a call from a first sergeant or anything?
Mr. CINTRON. No, I did not, sir. No, I did not, and so if you are part, at least my personal experience, being the IRR, having been called back, having served, you are done, we are done with you, you are not part of the unit. So you don't get this, you are not part of that unit.
I will even share you with an issue coming back, one of the programs was, which I think would have been an excellent program if it continued, was that when the soldiers came back you could actually go with your family to a retreat, to a retreat, you could go with your family. After 19 months and countless phone calls because I was not attached to a unit, and I could not get a first sergeant to approve this or a commander to approve that because I am not attached to a unit, my wife, who is extremely patient, we gave up after 19 months of the bureaucracy because we were not part of a unit.
Mr. WALZ. I know I have gone over my time but I want to hit on this. This is something I brought up back home often on this. They will not cut you travel orders, they will not pay for you to come back. These soldiers would come back if we were paying for them to come back, get them a hotel room, let then attend the 30, 60, 90, 120-day out processings on these retreats. This has been an ongoing problem.
I think it comes back to, and I will leave it at this, very frustrating on this. People like these two folks here and others have been talking about this for a long time. We know this is an issue and now we just need to address it. So I thank you both.
Mr. MITCHELL. Thank you.
Mr. Adler?
Mr. ADLER. Mr. Chairman, thank you. I want to followup on what Mr. Walz was saying. I am very grateful for the two of you to make this so real for me. I think that the panelists and at least for me to give me some takeaways so that I can go do things starting today.
Mr. Cintron, you mentioned Fort Dix. I have the privilege of representing Fort Dix. I plan to call the base commander today, not to find out who the sergeant was a few years ago who was a little insensitive with respect to you and some other folks, but maybe to alert her so she can alert the various folks, people who are deploying and returning that show sensitivity for individual needs and on a discreet, confidential basis because folks aren't going to raise their hands in a big crowd and say I need help with something.
Ms. Bean, thank you for being a New Jersey person. We have fantastic yellow ribbon clubs throughout New Jersey, certainly at least in my area. Every soldier, sailor, Marine, Coast Guardsman, Navy person who returns from overseas from anywhere has a welcome home party. That is great. But maybe some of these organizations could also followup people afterwards 30 days, 60 days, 90 days, if somehow they are falling through the cracks governmentally, there are lots of very caring people who really want to celebrate the human being, not just somebody that wore a uniform and went overseas but the actual human being that did this mission for America. And I think some of those folks would be very willing to schedule followups so it is not just one parade and then forgotten but actually treating each person holistically, even episodically, the way Tim said first sergeants might want to call. There are volunteers who would be just as committed in terms of helping individuals.
So I thank you for at least giving me ideas of what I can do in New Jersey to help avoid Coleman Bean's situation for the next tier that comes back from overseas.
And I thank both of you.
Mr. MITCHELL. Mr. Hall?
Mr. HALL. Thank you, Chairman Mitchell and Ranking Member Roe, and thank you to our witnesses for graciously appearing and testifying before us today.
I will submit a statement for the record.
[No statement was submitted.]
But I would just like to ask Ms. Bean, first of all to thank you for your strength and clarity, appearing and speaking before us. I know how difficult that is but I think I can imagine how difficult that must be to speak about your son and I commend you for being willing to put that aside to help other veterans and their families. It has been obvious to many of us that when a person joins the military they should also be automatically enrolled in the VA and members of the Armed Forces and their families should have access to information or education about assimilating back into civilian life, into their families, into their communities before, during and after deployment.
One of the problems, as I see it, is that the Veterans' Affairs Committee has one piece of jurisdiction, the Armed Services Committee has another one, on the Executive side the DoD has one piece and then the VA has another piece, and there is not that overlap and that seamless transition that we have talked about in so many ways, not just medical records, but mental health followup.
So perhaps, Ms. Bean, you can start a little bit about what kind of information or resources were available to you and to your son before he took his life and what kind of outreach was there. And you have told us a little about what you would like to see available, but was there anything of substance?
Ms. BEAN. We have a strong VA system in New Jersey. When Coleman came home from his second tour of duty, VA services were certainly available to him. Mental health care is at a premium, and it is difficult to get an appointment in a timely fashion.
I don't know when or how Coleman called the VA to seek out mental health assistance, but it is something that we learned of only after Coleman had died.
I didn't know, and this is a gap in my own understanding as much as anything else, I didn't know what else was available. I didn't go looking for something else to be available. And it wasn't until Coleman had died that I learned that there were many other programs that could have been available.
I keep going back to the idea that our local newspapers run Little League box scores, we run the Butterball Turkey hotline on Thanksgiving, we put out notices about bowling leagues. I think our local newspapers and radio stations could run a little box of resources; if you are a vet, if you are a soldier, if you are family, you can go to these places for help, and that list could include the VA hospitals and the Vet Centers, but it needs to go beyond that to include civilian resources, localized civilian resources.
And I am not sure I am answering your question.
Mr. HALL. That is helpful. Thank you.
Mr. Cintron, would you discuss the kinds of prevention that might help a veteran from reaching the point where they take their own life? We have heard about how Coleman and other veterans had not exhibited or used the word "suicide" and had not exhibited those tendencies until it is too late. And so what kind of outreach would you suggest could reach a veteran before they get to that point?
Mr. CINTRON. I think there are a few outreach efforts that can be done. But the first effort has to be to have the people to reach out to, and that can reach out to the folks, and they have to have some minimal training, not a lot. All it takes oftentimes, and like I said, I have encountered many veterans and for some reason they start talking to me and share their experience, and it is like, wow, you don't know that weight that was on me. And it just lingers with them and all they wanted to do was get it out at least once with someone that can understand, not to judge, but just to listen to them. That is what is needed.
Those outreaches, I think when you get with some of the groups that are available to us, if there is a combined effort with the groups, find the synergy with them and with the governmental organization, so that we all own part of the solution. It is not just the VA solution, it is not just the DoD solution, it is not just the solution of any individual program. It is a combined solution. We all own part of it.
So the outreach would be obviously training and identifying personnel who are willing to take a call at anybody. I give my phone to friends and to veterans that I meet and I say hey, if you ever have an issue give me a call, and I have actually received calls in the middle of the night. Man, I can't sleep tonight, I was just thinking about this, and we talked through, and we are done. But having that available, that outreach, the ability to call somebody, and it doesn't have to be somebody that they really know but somebody that knows what it is they are going through.
Mr. HALL. Thank you. I know I am over my time, but I would just mention that this Committee has—the full Veterans' Affairs Committee on the House side has voted to give funding not just for PSAs, as Ranking Member Roe mentioned, but for paid advertising and Iraq and Afghanistan Veterans of America (IAVA), who we will hear from shortly, partnered with the Ad Council in one effort to put together an ad that is more powerful than the average PSA. Public service announcements run in the middle of the night usually because that is when the time is cheapest and the TV station will give it up to do their public service, whereas what we really need I believe is advertising during the Super Bowl, during American Idol, during the highest rated shows during prime time where the half hour—I mean the 30-second spot or the 1-minute spot costs the most money. But we are willing to do that, to advertise be all that you can be or the few, the proud, the Marines, you know the lightning bolt coming down into the sword. So if we want to attract and recruit people to go into the armed services and go fight for our country we will spend the money for prime time advertising, but when it comes time to help them find the resources they need to stay healthy after they come home, we want to do it on the cheap and just do it at 3:00 in the morning on a PSA, and I think that needs to change to something we in Congress should fund so that the outreach is just as strong afterwards as it is before they were recruited.
I yield back.
Mr. MITCHELL. Thank you.
And again, Ms. Bean, I am very sorry for your loss and I want to thank you for your son's service and for you being here today.
Mr. Cintron, same with you, thank you for your service and I think you have both done a terrific job today to help further try to solve this big problem. So thank you very much.
Mr. CINTRON. Thank you, Mr. Chairman and Members of the Committee.
Mr. MITCHELL. At this time, I would like to welcome Panel two to the witness table.
For our second panel we will hear from Tim Embree, Legislative Associate for the Iraq and Afghanistan Veterans of America; Jacob Gadd, Deputy Director for Veterans Af
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