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Hearing Transcript on The Truth about Veterans’ Suicides.

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THE TRUTH ABOUT VETERANS' SUICIDES

 



 HEARING

BEFORE  THE

COMMITTEE ON VETERANS' AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

SECOND SESSION


MAY 6, 2008


SERIAL No. 110-86


Printed for the use of the Committee on Veterans' Affairs

 

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COMMITTEE ON VETERANS' AFFAIRS

BOB FILNER, California, Chairman

 

CORRINE BROWN, Florida
VIC SNYDER, Arkansas
MICHAEL H. MICHAUD, Maine
STEPHANIE HERSETH SANDLIN, South Dakota
HARRY E. MITCHELL, Arizona
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
SHELLEY BERKLEY, Nevada
JOHN T. SALAZAR, Colorado
CIRO D. RODRIGUEZ, Texas
JOE DONNELLY, Indiana
JERRY MCNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
CLIFF STEARNS, Florida
JERRY MORAN, Kansas
HENRY E. BROWN, JR., South Carolina
JEFF MILLER, Florida
JOHN BOOZMAN, Arkansas
GINNY BROWN-WAITE, Florida
MICHAEL R. TURNER, Ohio
BRIAN P. BILBRAY, California
DOUG LAMBORN, Colorado
GUS M. BILIRAKIS, Florida
VERN BUCHANAN, Florida
VACANT

 

 

 

Malcom A. Shorter, Staff Director


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.

 

       

C O N T E N T S
May 6, 2008


The Truth About Veterans' Suicides

OPENING STATEMENTS

Chairman Bob Filner
    Prepared statement of Chairman Filner
Hon. Steve Buyer, Ranking Republican Member
    Prepared statement of Congressman Buyer
Hon. John J. Hall
Hon. Phil Hare
Hon. Ciro D. Rodriguez
Hon. Harry E. Mitchell
    Prepared statement of Congressman Mitchell
Hon. James P. Moran
    Prepared statement of Congressman Moran
Hon. John T. Salazar
Hon. Jerry McNerney
Hon. Corrine Brown
Hon. Stephanie Herseth Sandlin, prepared statement of
Hon. Shelley Berkley, prepared statement of
Hon. Jeff Miller,  prepared statement of 
Hon. Ginny Brown-Waite,  prepared statement of
Hon. Timothy J. Walz, a prepared statement of


WITNESSES

U.S. Department of Veterans Affairs:
Hon. James B. Peake, M.D., Secretary
    Prepared statement of Secretary Peake
Michael Shepherd, M.D., Senior Physician, Office of Healthcare Inspections, Office of Inspector General
    Prepared statement of Dr. Shepherd


Maris, Ronald William, Ph.D., Distinguished Professor Emeritus, Past Director of Suicide Center, Adjunct Professor of Psychiatry, and Adjunct Professor of Family Medicine, University of South Carolina, School of Medicine, Columbia, SC
    Prepared statement of Dr. Maris
Rathbun, Stephen L., Ph.D., Interim Head and Associate Professor of Biostatistics, Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA
    Prepared statement of Dr. Rathbun
Rudd, M. David, Ph.D., ABPP, Professor and Chair, Department of Psychology, Texas Tech University, Lubbock, TX
    Prepared statement of Dr. Rudd


MATERIAL SUBMITTED FOR THE RECORD

Material Submitted for the Record:

Video Transcriptions:

Transcription of CBS News Video entitled, "Suicide Epidemic Among Veterans," aired November 13, 2007

Transcription of CBS News Video, entitled, "VA Hid Suicide Risk, Internal E-Mails Show," aired April 21, 2008

Reports:

CRS Report for Congress entitled, "Suicide Prevention Among Veterans," May 5, 2008, Order Code RL34471, by Ramya Sundararaman, Sidath Viranga Panangala, and Sarah A. Lister, Domestic Social Policy Division, Congressional Research Service

Background Materials:

U.S. Department of Veterans Affairs Pamphlet, entitled "Suicide Prevention, Men and Women Veterans, Knowing the Warning Signs of Suicide, dated September 2007

U.S. Department of Veterans Affairs Pamphlet for VA Employees, entitled "Suicide Risk Assessment Guide," Issued by the U.S. Department of Veterans Affairs, Employee Education System

Letters:

Hon. Michael J. Kussman, M.D., M.S. MACP, Under Secretary for Health, U.S. Department of Veterans Affairs, sample of outreach letter sent to veterans, informing veterans of the National Suicide Prevention toll-free hotline number, 1-800-273-TALK (8255), and pocket-sized card with VA Suicide Crisis Hotline phone number/information, as well as a Crisis Response Plan

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Rick Kaplan, Executive Producer, CBS Evening News With Katie Couric, letter dated December 21, 2007, and response letter dated May 16, 2008, from Linda Mason, Senior Vice President, Standards and Special Projects, CBS News

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, letter dated December 21, 2007, and response letter dated February 5, 2008, requesting additional data on suicide rates among veterans

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Hon. Robert M. Gates, Secretary, U.S. Department of Defense, letter dated December 21, 2007, requesting the number of active-duty suicides for each year from 1995 to 2006; Hon. Robert M. Gates, Secretary, U.S. Department of Defense to Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, providing preliminary response designating David Chu, Under Secretary of Defense for Personnel and Readiness, to address the matter, letter dated January 17, 2008; Follow-up request letters from Chairman Filner, dated May 6 and 21, 2008, requesting DoD to provide response to original letter dated December 21, 2007;  Response letter from Secretary Gates, designating David Chu, Under Secretary of Defense for Personnel and Readiness, to address the matter, letter dated June 3, 2008; and Follow-up request letter from Chairman Filner, dated June 5, 2008, requesting DoD to provide response to original letter dated December 21, 2007[AS OF SEPTEMBER 25, 2008, THE U.S. DEPARTMENT OF DEFENSE HAS REFUSED TO RESPOND TO THE COMMITTEE'S REQUEST FOR INFORMATION REGARDING THE NUMBER OF ACTIVE-DUTY SUICIDES FOR EACH YEAR FROM 1995 TO 2006.]

Materials Due from the U.S. Department of Veterans Affairs Requested During the Hearing:

Hon. Michael J. Kussman, M.D., MS, MACP, Under Secretary for Health, U.S. Department of Veterans Affairs, to Hon. James B. Peake, Secretary, U.S. Department of Veterans Affairs, Memorandum dated May 5, 2008, Regarding Blue Ribbon Work Group on Suicide Prevention in the Veteran Population

Table entitled, "Rates and Risk of Suicide and Other Suicidal Behaviors Among U.S. Veterans," Updated April 30, 2008, Prepared by Joseph Francis, M.D., MPH, Acting Deputy Chief Quality and Performance Officer, Office of Quality and Performance, U.S. Department of Veterans Affairs

"The Comprehensive Veterans Health Administration Mental Health Strategic Plan," (A Comprehensive VHA Strategic Plan of Mental Health Services), dated July 2004.

Table entitled, "Crosswalking between the U.S. National Strategy for Suicide Prevention, the VHA Comprehensive Mental Health Strategic Plan and VHA's Suicide Prevention Actions"

Information Provided by the U.S. Department of Veterans Affairs From Discussion with Secretary Peake during Post-Hearing Meeting

Post-Hearing Questions and Responses for the Record:

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, letter dated May 21, 2008, and VA Responses

Attachments to Chairman Filner's Post-Hearing Questions and Responses for the Record Retained in the Committee files include the following:  The Medical Inspector Final Report #2008-D-654, entitled "Quality of Care Review, Veterans Affairs Medical Center (VAMC) Dallas, Texas, Veterans Integrated Service Network 17," dated May 20, 2008; the Course Script entitled, "VA National Rules of Behavior," Developed by the U.S. Department of Veterans Affairs, Office of Information and Technology, Cyber Security Service; and Presentation entitled, "VHA Privacy Policy Training, FY 2008."

Hon. Stephanie Herseth Sandlin, Committee on Veterans' Affairs, as forwarded by Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, and VA Responses

Hon. John J. Hall, Committee on Veterans' Affairs, as forwarded by Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, and VA Responses

Hon. Shelley  Berkley, Committee on Veterans' Affairs, as forwarded by Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, and VA Responses

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Michael Shepherd, M.D., Physician, Office of Healthcare Inspections, Office of Inspector General, U.S. Department of Veterans Affairs, letter dated May 21, 2008, forwarding questions from Hon. Stephanie Herseth Sandlin, and response letter dated July 2, 2008


THE TRUTH ABOUT VETERANS' SUICIDES


Tuesday, May 6, 2008
U. S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.

The Committee met, pursuant to notice, at 10:03 a.m., in Room 334, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.

Present:  Representatives Filner, Brown of Florida, Snyder, Michaud, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Salazar, Rodriguez, McNerney, Space, Walz, Buyer, Stearns, Moran of Kansas, Brown of South Carolina, Miller, Boozman, Brown-Waite, Turner, Lamborn, and Buchanan.

Also Present:  Representatives Kennedy and Moran of Virginia..

OPENING STATEMENT OF CHAIRMAN FILNER

The CHAIRMAN.  Good morning.  This meeting of the Committee on Veterans' Affairs of the House of Representatives is now called to order. 

I ask unanimous consent that two of our colleagues, Mr. Kennedy and Mr. Moran, be allowed to sit with us at the dais.  They have a longstanding interest in the issues that we will be discussing today.  Any objection? 

Mr. BUYER. I have no objection.  We should follow protocols of the Committee.

The CHAIRMAN.  Thank you, Mr. Buyer.

The hearing today is entitled, "The Truth about Veterans' Suicides."  I hope we can get to that truth. 

A few months ago, on December 12, 2007, this Committee held a hearing that we entitled:  "Stopping Suicides:  Mental Health Challenges within the U.S. Department of Veterans Affairs (VA)."  Nearly five months later, we are holding another hearing on this tragic issue and what the VA is doing.  But it is brought to us because of data within the VA that seems to dispute what we were told in a hearing in December. 

Much of this was occasioned because last year, in November, CBS News aired a story called "Suicide Epidemic Among Veterans," and recently, another story called "VA Hid Suicide Risk, Internal E-Mails Show." 

I want to just make sure everybody understands what we are dealing with, and I would like to play two brief segments of those newscasts on our new video system. 

[Videos played.]

Suicide Epidemic Among Veterans

November 2007

 

VA Hid Suicide Risk,
Internal E-Mails Show
April 2008

 

 

The CHAIRMAN.  Mr. Buyer raised an interesting point now of how we are going to refer to this in the record—a tape.  We have not exactly figured it out yet.  We may have a transcript or referral to a Web site.  But before the transcript of this hearing is done, we will work with you to figure out a way to do this.

Mr. BUYER. Members, this is relatively new.  Often we ask unanimous consent to place letters in the record.  This is a first, that we actually watch a news program. 

I am willing to work with the Chairman to do something new.  Either we refer to a Web site, whereby individuals could pull that down from a record, actually view the video, because that was how it was viewed in the Committee; or do we transcribe what was just put in there and put that in the record? 

We are going to work with the Chairman to figure out how we handle this. 

The CHAIRMAN.  This is a 21st century problem.

Mr. BUYER. We will work through it. 

Sorry, Mr. Secretary.  Housekeeping. 

[A transcription of both the November 2007 and April 2008 CBS News videos appear in the Appendix.  In addition, the videos may be viewed  at http://veteransaffairs.edgeboss.net/wmedia/veteransaffairs/videos/cbs_suicide_part_1.wvx (November 2007) and  http://veteransaffairs.edgeboss.net/wmedia/veteransaffairs/videos/cbs_suicide_part_2.wvx (April 2008).]

The CHAIRMAN.  I think we all know that the first step in addressing a problem is to understand its full scope and extent.  In the case of the VA and the epidemic of veteran suicides, either the VA has not adequately attempted to determine the scope of the problem, which I think is an indictment of the competence of the VA; or the VA knows the extent of the problem, but has attempted to obfuscate and minimize the problem to veterans, Congress, and the American people.  This is an indictment, I think you would all agree, of the leadership of the entire Department. 

In December, Dr. Katz' testimony before this Committee stressed a low rate of veteran suicides, stating that: "From the beginning of the war through the end of 2005, there were 144 known suicides amongst these new veterans."  In responding to the figures that CBS News researched, Dr. Katz stated that: "Their number for veteran suicides is not, in fact, an accurate reflection of the rates of suicide." 

Either Dr. Katz knew that the CBS News figures were indeed an accurate reflection of the rates of suicides at that hearing or he had a sudden epiphany just three days later. 

In an internal e-mail dated December 15, 2007, Dr. Kussman, Under Secretary for Health in the Department, referred to a newspaper article and wrote that: "Eighteen veterans kill themselves every day, and this is confirmed by the VA's own statistics.  Is that true?  Sounds awful, but if one is considering 24 million veterans." 

That same day, Dr. Katz responds, "There are about 18 suicides a day among America's 25 million veterans.  This follows from CDC (Centers for Disease Control and Prevention) findings that 20 percent of suicides are among veterans, and it is supported by CBS numbers." 

Just this past February, Dr. Katz sends another e-mail that starts with, "S-h-h.  Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities.  Is this something we should carefully address ourselves in some sort of release before someone stumbles on it?" 

There was silence from the VA. 

As you saw on the viedo, the chief investigative reporter for CBS News, Armen Keteyian, characterized the VA's internal e-mails as a "paper trail of denial and deceit, a disservice to all veterans and their families that has rightfully been exposed." 

In April of this year, a Dallas Morning News editorial describing a "recent spike in suicides among the psychiatric patients treated at the Dallas VA hospital," stated that "descriptions of how four veterans committed suicide in four months, prompting the psychiatric ward to close, suggests that patients went to conspicuous and time-consuming lengths to end their own lives.  There seemed to be ample time for staffers to stop them, had they been doing their jobs better."

The RAND Corporation, in a recently published study entitled, "Invisible Wounds of War," found that since October of 2001, approximately 1.6 million U.S. troops have been deployed, and more than a quarter of them have mental health conditions. 

I think it is higher than that.  The study estimated that approximately 300,000 of those deployed suffer from post traumatic stress disorder (PTSD) or major depression.  Among those with PTSD or major depression, only half had seen a mental health provider or physician to seek help in the past 12 months, and among those who sought help, just over half received "minimally adequate treatment." 

We saw a recent New York Times article that said up to one-third of those diagnosed with PTSD of recent veterans had committed felonies, of which 200 had been homicides, mainly members of their own families. 

Something is going on in America.  The study that RAND did found minimally adequate exposure to psychotherapy as consisting of at least eight visits with a mental health professional, such as a psychiatrist, psychologist, or counselor in the past 12 months, with visits averaging at least 30 minutes. 

I would like to know, how does the VA mental healthcare treatment stack up against this definition of minimally adequate care? 

The RAND study also found that the VA faces challenges in providing access to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, many of whom have difficulty securing appointments, particularly in facilities that have been resourced primarily to meet the new demands of older veterans.  Better projections of the amount and type of demand among new veterans are needed to ensure the VA has the appropriate resources to meet the potential demand.  "New approaches of outreach would make facilities more acceptable to OEF/OIF veterans," so says the RAND study. 

I think many of us believe that the VA health care system has been pushed to the edge in dealing with mental health care needs of our veterans.  I believe we are witnessing either an inability to address this problem or a purposeful attempt to minimize the problems faced by veterans and the VA, and sweep this epidemic of suicides under the rug.

This morning we are going to attempt to get a better idea of the scope of this epidemic and what the VA is doing to respond to it.  What specific steps has the VA taken since December, steps not previously planned, to get a better idea of the scope of what problem; and what has it done to begin to address the problem? 

Finally, I think we must seek real accountability from the VA. 

Mr. Secretary, we are looking to you to provide that.

[The statement of Chairman Filner appears in the Appendix.]

The CHAIRMAN.  Let me just say, for the record, that was my prepared, controlled statement.  My uncontrolled statement goes something like this, Mr. Secretary: 

We should all be angry at what has gone on here, at what looks like posturing before this Committee by not telling us the truth and talking about how to deal with statistics without informing this Committee.  Our oversight function has to work, and can only work, with mutual respect for each other.  We both, presumably, want to do the best job we can for veterans.  We have to have mutual respect for each other, and the facts; and, I believe your staff exhibited neither. 

If the testimony that Dr. Katz gave was wrong, being questioned three days after we went through a back-and-forth that was very difficult to do for both of us, why weren't we notified?  Why didn't you say, "we found new statistics and we're checking them out?"  You never told us anything after your chief doctor in charge of mental health testified differently. 

What we see is a pattern, Mr. Secretary, a pattern that we have seen going back to the days of atomic testing, through the Agent Orange controversies of Vietnam, depleted uranium, and more recently, Persian Gulf War Illness, PTSD, traumatic brain injury (TBI), suicides, and homelessness.   The same pattern that really reveals a culture of a bureaucracy. 

The pattern is deny, deny, deny.  Then, when facts seemingly come to disagree with a denial, you cover up, cover up, cover up.  When the cover-up falls apart, you admit a little bit of a problem and underplay it:  It's only a few people, only 1,000 veterans got exposed to that gas; Agent Orange didn't affect very many; atomic testing, well, nobody knew what was going on. 

Then, finally, maybe you admit it's a problem and then, way after the fact, try to come to grips with it. 

We have seen it again and again and again.  It is not just dealing with numbers, as your whole testimony does, Mr. Secretary.  You are talking about numbers as if that is all it is.  It is a bureaucratic situation. 

This is not a bureaucratic situation with just numbers.  This is a matter of life and death for the veterans that we are responsible for. 

I think there is criminal negligence in the way this was handled.  If we do not admit, if we do not assume there are problems, if we do not know what the problem is, then the problem will continue, and people will die.  If that is not criminal negligence, I don't know what is. 

Mr. Secretary, we had a discussion right after you were confirmed.  I came up to see you to congratulate you on your new role as Secretary.  I asked you a question.  I said, Are you going to just be a caretaker for the last year of this administration, or are you going to do something real and have a legacy?  I said, I hope it is the latter, and I will help you do that. 

I will tell you how you deal with this issue will determine how we see your role.  There is clear evidence of a bureaucratic cover-up here. 

One of the people in the e-mails is Dr. Kussman and I don't even see him here.  I guess he had a previous engagement.  He ought to be here.  I also don't see the public relations guy that was one of the people in the other e-mail.  They should be here to talk about what happened. 

I want to know, since I don't see it in your testimony and I see only vague references to the e-mail, how are you going to ensure accountability?  Are you going to ask for the resignations of Dr. Kussman, Dr. Katz, and anyone else who participated in the cover-up of the data? 

I want to know if you are going to really take your role seriously and if there is going to be accountability for what has gone on here.  This is not just an abstract discussion, this is not just a hearing to say, "We got you."  This is about our veterans and whether they have a life ahead of them or not. 

I will tell you I have talked to the Members of this Committee and they are pretty angry with what is going on.  I think you need a better answer than your prepared statement, which just goes into bureaucratic details. 

Now, we will have opening statements. 

Mr. Buyer, you are recognized. 

OPENING STATEMENT OF HON. STEVE BUYER

Mr. BUYER. Thank you, Mr. Chairman.  I think those of us who have friends or family members that have committed suicide, number one, are haunted by that experience because we then look at that individual, and we reflect upon what could we have done to have prevented it.  What did we miss?  What were those risk factors? 

And sometimes they are noticeable.  Sometimes when they are a friend and they are closest to you, you might be providing counsel to them, you think it is a moment of just being a good friend.  Then, when they commit a foolish act and take their own life, you are tortured for the rest of your life. 

So this is a pretty powerful issue.  Especially, it cuts across the sections of our population, when you think of suicide being the 11th leading cause of death in our society.  So it is just not within the veteran population, it is within our population as a whole.  When we don't have a national surveillance system, it is very difficult for us to even gain a better understanding. 

But we do have defined abilities to come up with the proper cohorts not only within U.S. Department of Defense (DoD), but also in the VA, so we can better understand, and identify those risk factors.

I think, Mr. Secretary, by looking at how many Members have come here today, it sends a signal to you that the loss of a single veteran is a tragedy to us.  I am sure that every Member of this Committee, in earnest, seeks to help you to identify contributing factors and to do anything we possibly can to prevent servicemembers or veterans from taking their own lives. 

We recognize that many of the veterans that do take their own lives, in fact, are inpatients and in psychiatric care.  So even though we can provide in a controlled environment and we do everything we can, half of them that are inpatients are committing suicide. 

So it is one of those things where, even in a controlled environment, we can come up with identifying factors and still can't prevent someone from committing what we view as a very foolish act. 

So the challenge that you have is real. 

I want to thank the Chairman for continuing these hearings to discuss this important issue and to help those at risk.  A number of questions were raised during our hearing last December regarding the validity of data on the number of veteran suicides.  Such information is vital to understanding the scope of the problem, as well as identifying risk factors and providing better prevention and treatment protocols. 

Chairman Filner joined me in a letter I wrote to you, Mr. Secretary—and to DoD and CBS News—requesting their respective data on how it was formulated.  For the record, CBS News failed to respond to Mr. Filner's and my letter.  DoD only acknowledged the letter, and we are still waiting on their reply. 

Mr. Secretary, you were the only one to respond to Mr. Filner's and my letter.  That letter included information and worksheets on two separate studies that the VA is conducting.  So I appreciate the timeliness with which you responded to this Committee's concerns. 

These studies may provide some useful information, but they are limited to data on suicide rates among veterans in the VA healthcare system.  VA must have a better method for the systematic collection and tracking of veteran suicide data.  It is also important to find ways to reduce the stigma associated with mental healthcare and encourage more servicemembers to seek treatment when it is needed. 

During our last hearing, I asked the VA to be proactive and to reach out to soldiers and their families during premobilization, and to start with the 76th Indiana Brigade Combat Team as it prepared to deploy.  Mr. Filner and I agreed that we would proceed with that. 

I want to thank you, Mr. Secretary.  I am very pleased that the VA came, as requested, and participated in such an outreach. 

I also recognize that you are operating outside the lines of your jurisdiction.  But you didn't say that.  You didn't say, "That is outside my jurisdiction; I am now dancing on DoD turf."  You said, "I am going to embrace the counsel of the Committee and we are going to see if we can follow this group.  We will identify ourselves with the family members.  They are the ones who are the closest to being able to identify individual risk factors or if there is a change in my husband, my brother, my loved one, that we could see."

I stood with 3,400 Indiana soldiers, with Joe Donnelly at the RCA Dome on January 2, for the formal send-off ceremony.  Along with about 20,000 friends and family members was VA staff from the Indianapolis VA Medical Center, the regional office, and the Vet Center.  The VA reported about 1,700 families received information regarding VA benefits and services, including mental health services, Mr. Chairman, and information on post traumatic stress disorder and suicide prevention. 

The VA also followed up with subsequent briefings while the brigade was at Fort Stewart, Georgia, for training.  As the brigade marched off to war, I believe they left with a clear impression that the VA was available to provide support and assistance to their families during their deployment, and that you will be there when they return from Iraq. 

There was very positive feedback regarding the VA's presence at these events; so I want to thank you, Mr. Secretary, for working with the Committee to be proactive and to do something outside the norm. 

Mr. Secretary, you have taken decisive action to meet these increased needs.  This month, for example, the VA contacted nearly 570,000 recent combat veterans about VA medical care and benefits.  These veterans were either injured in Iraq or Afghanistan or discharged from active duty but had yet been contacted by the VA.  So I want to thank you for your outreach.  It is something that Mr. Filner had also been expressing, and had expressed that to you. 

So, Mr. Chairman, I think we need to acknowledge when the Secretary acts on something that you ask for, we need to compliment him for it.  The Secretary has also directed the creation of an independent working group to assess VA's suicide prevention programs. 

I want to thank Secretary Peake and other witnesses for their participation today, and I look forward to their testimony.  In the end, I hope this hearing will drive home the message to our Nation's men and women who serve, and to their families, that if you need help, care is available and treatment works, and there is a road to recovery. 

I yield back. 

[The statement of Congressman Buyer appears in the Appendix.]

The CHAIRMAN.  Before the Secretary testifies, are there opening remarks of any Members?  I will call Members in the order that we have. 

Mr. Hall?

OPENING STATEMENT OF HON. JOHN J. HALL

Mr. HALL.  Thank you, Mr. Chairman. 

Just briefly, I would say that if we can prevent any single suicide among our veterans, it is worth going to great lengths to do that.  I would ask you—I know you are wearing two conflicting—and, sometimes—hats that are at cross-purposes with the "Honorable Secretary" before your name and the initials "M.D." after it, and most of my questions will be addressed toward the M.D. part of it. 

It strikes me that minimally adequate treatment, as described in our documents we have before us, of at least eight visits in one year to a counselor, psychiatrist, or psychologist; and we understand from testimony before this Committee that that is not necessarily the same psychiatrist, psychologist or counselor.  It is hard for an individual servicemember or veteran to strike up enough of a rapport with a doctor or counselor who is treating them, if they are seeing somebody different every time they go in and they have to kind of start from scratch.  We have heard that that is a problem. 

Thirty minutes, anybody in this room who has been to therapy for any kind of marital counseling or depression or whatever can tell you that 30 minutes is just about enough to get started and say goodbye and book the next visit.  So I would at least say that the definition of "minimally adequate treatment" is not adequate. 

I would also say that with the rates of bankruptcy and divorce that we are seeing, which are records, we are told are records among our veterans, that those two things—each of them alone, not to mention bankruptcy and divorce taken together—are enough to drive people, servicemembers or regular civilians, to suicide.  There are many stories during the Great Depression of people jumping off of buildings because their material wealth was gone, and they saw no hope. 

So some of this is rocket science in the mental health world; some of it is really just nuts and bolts and simple common sense in taking care of our veterans. 

I think that we should be as adaptable.  Just as our military adapts their strategy in combat, we have had to change the course.  For instance, in the war in Iraq we have had to change our strategy several times, and the insurgents have changed their strategy several times in response.  They make a bigger bomb, we make a more armored vehicle, et cetera.  We need to do the same thing, I think, on the VA side and constantly be ready to change our strategy. 

Lastly, we had a pair of parents before, I forget whether it was the full Committee or Subcommittee on Disability Assistance and Memorial Affairs, but two parents who were courageous enough to come in, whose son had taken his own life.  They asked us for universal screening for PTSD for all veterans so they don't have to self-identify.  

I think that that is maybe one of the answers, because men or women who are taught to be tough and are taught to handle situations, and who also want to just get back to their families and not be held over for extra questioning and not have something on their record that might be a stigma in the future for employment or for being able to be in law enforcement or advance themselves in the Guard or Reserve or what have you. 

Their son, this couple's son, had not shown a sign that they, the parents, saw that would tip them off that he was so distressed that he was going to take his own life.  So if parents, people that are close to an individual, don't see the change, and can't see it, I think we need the professionals to be right on top of the case.  That would probably call for universal screening at some point after separation. 

With that, I look forward to your testimony.  Thank you very much. 

I yield back, Mr. Chairman. 

The CHAIRMAN.  Mr. Miller?  Mr. Brown?  Ms. Brown-Waite?  Mr. Turner? 

Mr. Hare?

OPENING STATEMENT OF HON. PHIL HARE

Mr. HARE.  Thank you, Mr. Chairman. 

Thank you, Mr. Secretary, for appearing before the Committee today.  It is nice to see you again. 

While I appreciate the amount of time and the effort and thought the VA has put into veteran suicide prevention, which I honestly believe has saved some lives, I have to say I was shocked and very disturbed after reading the e-mails. 

But this isn't about numbers or formulas or programming.  This is about people; this is about families, wives, husbands, sons, daughters.  This is about honoring those who serve this country. 

A few weeks ago I sat and talked with Mike and Kim Bowman of Illinois, whose son, Tim, committed suicide.  Tim was an incredible young man who bravely served in Iraq and came home a changed man, suffering from PTSD.  His parents did their best to try to help him, but they didn't know what signs to look for and how to reach out to help him.  They are rightly angry and frustrated that, from their perspective, the VA didn't do more to reach out to help their son. 

I believe the first step in solving any problem is admitting that you have one.  If the VA, for some reason, isn't being honest about the number of veterans committing suicide, then that is stopping us or preventing us from giving you the resources that you need to prevent them. 

I have said many times at hearings, and I will continue to say as long as I serve on this Committee, the question isn't, "Can we afford to give the necessary funds out to help our veterans?"  The question should be—the statement should be, "We simply can't afford not to give you the funds we need."  But we have to know how severe the problem is in order to be able to help you on that. 

I think, to be honest, this is more than a problem; I think it is an epidemic among veterans if these numbers are remotely close, to what is happening and I believe they are. 

But we are all here today for the same reason, to find solutions to stopping veteran suicides so that no family like the Bowmans have to go through this.  The RAND report found that 300,000 military servicemembers who have returned from Iraq and Afghanistan report symptoms of PTSD or major depression, but only slightly more than half have sought treatment for their conditions. 

Let me just echo the sentiments of my friend from New York, Mr. Hall, when he said that screening all the veterans when they come back is something that we need to do.  It is something that I think—clearly, they may not know that they have the problem, their families don't know; then we need to monitor them for some period of time down the road to make sure that if there is a problem, we can bring them in and be able to help them. 

With mental health disorder being a significant precursor to suicidal thoughts, it is clear to me that the VA has to do more to proactively reach out to veterans. 

As you know, Mr. Secretary, when we met—you know I come from a rural district, and I am also interested—one of my questions to you during the question period is going to be, How do we reach out to those rural veterans that come back where there may not be a VA hospital close to them?  How do we get them in quickly and timely in order to prevent what happened to Mr. Bowman? 

So I thank you for coming today. 

I would yield back my time.  Thank you, Mr. Chairman. 

The CHAIRMAN.  Thank you.

Mr. Rodriguez?

OPENING STATEMENT OF HON. CIRO D. RODRIGUEZ

Mr. RODRIGUEZ.  Thank you, Mr. Chairman. 

Let me, first of all, thank you, Mr. Secretary, for being here today.  And let me just add that some of us have extremely high expectations for you—and I know that you are uniquely situated because you served not only in our military as a soldier, but also in the DoD—in terms of service there and the VA, and the difficulty that we have had as a Committee in the past to try to get both the DoD and the VA to work together. 

With this situation, also I think that we are talking right now about veterans committing suicide, but we have had a lot of active-duty soldiers also committing suicide.  Nothing is worse than a soldier committing suicide in terms of how badly they and their families are treated when they come home, even by other veterans.  They are treated as if they were cowards and those kind of things.  Those are the numbers that we also need to seek out and get the right information for us to be able to do the right thing.  I think you can be helpful there. 

Let me just add to what Chairman Bob Filner has said, we are coming from a perspective, when I got on this Committee some 12 years ago, I heard about Project 112, Project SHAD, where the DoD was denying that it even existed.  Later on, as time went on—and 20 years have passed since the inception of those projects—we identified some 35 projects that were out there, that we did experimental things with our soldiers.  Then we found it was not 30, it was 40; then it went to 50.  I think the latest numbers were something like 60, where we experimented with our own soldiers. 

But it took us prying and pushing and tugging to be able to get that information, when we really need to work together to see how we can help address some of these situations—and hopefully that is what we will do—to move quickly to try to meet the needs of our soldiers and our families out there. 

I want to also lay down the groundwork for that in terms of how important it is, what do we do from now?  We know we have a serious situation in the VA.  And I know we have a serious situation in the DoD also, which I know you don't oversee, but that is also another area that we need to deal with. 

We have situations where—I just did an interview in San Antonio regarding a VA patient that died; the accusations are basically that he was killed because of presumed negligence on the part of the doctors—and the importance of peer review in the military, I mean in the VA, as it deals with doctors' recommendations and those kinds of things. 

So there are other areas that are very serious, and I am hoping that we can make some inroads in those areas.  As we move forward on this testimony, I am hoping that we can come up with some recommendations, and if you have recommendations for us as to what you need to get it done. 

And, I know that for the longest time we didn't provide the resources that were needed, and we have a responsibility there.  But we also ask that we be given the information and the data that is needed for us to be able to do that, and hopefully we can respond to some of those needs. 

Thank you very much.  Thank you for being here, Mr. Secretary.

[The following was subsequently received from the VA:]

  1. Update on Dallas (not requested during hearing)
  2. Noted patient died in San Antonio may be related to negligence-importance of peer review-provide updates.

Response: The Office of Medical Inspector (OMI) conducted a site visit to the Dallas VA Medical Center (VAMC) on April 16 through April 17, 2008. Its findings were presented to the Dallas VAMC leadership at the conclusion of the site visit and to the Veterans Health Administration (VHA) leadership on the OMI's return. The OMI identified a number of environmental issues that needed to be addressed. The Dallas VAMC reports that action to address environmental issues such as removal of metal holders for linen hampers, geriatric chairs in the showers, and replacement of unit doors that did not lock automatically were completed by April 30, 2008.

The OMI recommendations currently under assessment or in progress include increasing the amount of therapeutic patient activity, replacing the suicide risk assessment tool, and changing the current continuity of care model to an inpatient model of care. The Dallas VAMC is addressing these issues.

On April 22, 2008, a team from VA's Office of Mental Health Services visited the facility to evaluate the safety of its mental health program. It identified additional environmental, organizational, and programmatic issues that can improve the delivery of mental healthcare. Actions on many of these environmental issues, such as additional housekeeping staff, painting and repairs, installation of new doors, and moving cameras and monitors have been completed or will be in the near future. In addition to the actions noted, the Dallas VAMC is reassessing the mixing of acuities on the Mental Health unit.

The report has not been cleared by OMI and is in the pre-decisional stage. It is anticipated that it will be ready by the end of May.

San Antonio - An external Peer Review was completed in the second quarter FY 2008. South Texas is in the process of reviewing the results and developing professional practice evaluations.

The CHAIRMAN.  Thank you. 

Mr. Mitchell?

OPENING STATEMENT OF HON. HARRY E. MITCHELL

Mr. MITCHELL.  Thank you, Mr. Chairman. 

In November, CBS News brought some shocking and critically important information to light.  Not just that those who served in the military were more than twice as likely to take their own life in 2005 than Americans who never served, or that veterans aged 20 to 24 were killing themselves when they returned home at rates between two-and-a-half to four times higher than nonveterans the same age, but that the Department of Veterans Affairs wasn't keeping track of veteran suicides nationwide. 

In December we had a hearing to find out why. 

Mr. Chairman, I don't know if there is anyone here who attended that hearing who will ever forget it.  Mr. Hare mentioned that we heard from Mike and Kim Bowman, whose 23-year-old son, Tim, survived a year of duty in Iraq, only to come home and take his own life.  Mr. Bowman warned us that our troops were coming home to an underfunded, understaffed, underequipped VA mental health system that imposes so many challenges that many are just giving up. 

So when Dr. Katz insisted at that hearing, repeatedly, that the VA had all the necessary resources to reach all veterans at risk for suicide and make special treatment available to them, I was skeptical.  How could Dr. Katz be so sure that there weren't any requests for additional resources sitting somewhere within the vast VA system that have gone unfulfilled?  Was he absolutely certain that there were no pending requests for an additional mental health counselor, for extra gas money to enable a VA employee to drive somewhere to contact an outreach? 

As Chairman of the Subcommittee on Oversight and Investigations, I felt I had a responsibility to make sure, so I asked the VA to double-check.  I asked them to take a look at their records and send us any documents relating to any request for additional resources that had gone unfulfilled or underfilled.  My thought was, if we could find out what the VA needs are to address this problem, we could get to work and make sure they got it. 

More than 4 months later, however, all I have gotten are excuses, complaints, and most recently, a suggestion that I, "Go file a Freedom of Information Act request."  That is not just an insult to me, it is an insult to this Committee and to our veterans. 

I have tried to be reasonable.  I have tried to work with Secretary Peake's office.  But, Mr. Chairman, my patience is at an end. 

I have given the Department until Friday to finally produce the documents I requested.  If they do not, Mr. Chairman, I want you to know that I will be asking you to pursue a subpoena. 

I yield back. 

[The statement of Congressman Mitchell appears in the Appendix.]

The CHAIRMAN.  Thank you, Mr. Mitchell. 

Mr. Moran, we thank you for your interest.  You have been interested in this issue and have been a leader for many years, and we thank you. 

OPENING STATEMENT OF HON. JIM MORAN

Mr. MORAN OF VIRGINIA.  Thank you very much, Mr. Chairman and Ranking Member Buyer and my friends and colleagues. 

I want to mention, incidentally, with regard to the recommendation for individual screening, in the Defense Appropriations bill, when we put $900 million in for PTSD and traumatic brain injury, we did require that everyone get an individual face-to-face screening by the Pentagon.  But the problem is, that is when all they can think about is getting home to their families, and it is oftentimes only after they get home that evidence of emotional problems, whether it comes out in domestic abuse or inability to hold on to a job and so on, manifests itself. 

The fact that 20 percent of our veterans from Iraq and Afghanistan show signs and symptoms of PTSD, depression, and anxiety is a compelling statistic.  But even more so is the fact that that number increases to 50 percent for soldiers with multiple tours and inadequate time between deployments; and in fact, that is becoming more and more the case. 

One of the measures that I would suggest that this Committee might consider is to create a stand-alone, 24-hour, national, toll-free hotline to assist our veterans in times of intense crisis.  The key is that this hotline would be staffed by veterans trained to appropriately and responsibly answer calls from other veterans. 

I understand that the Department of Veterans Affairs has developed a veterans option off of the National Suicide Hotline.  While I applaud your effort to address this problem, I believe that there are about three deficiencies in this approach.  First, oftentimes a veteran doesn't want to talk to a doctor; he or she wants to talk to someone who has got a real-life perspective on what is going on in their mind—cultural competency, if you will.  That is a term that has been used to express that a fellow veteran can provide a real difference in crisis counseling because they can better relate. 

Secondly, soldiers with mental illnesses face social stigma that is identified with seeking care through the VA.  Research from the Air Force's Suicide Prevention efforts suggests that fear of the system, of an unfriendly mental health establishment, and of potential job-related consequences do keep many active-duty soldiers and recent veterans from seeking the care that they need. 

Thirdly, the VHA is already overburdened by a great many healthcare responsibilities; and as a result, I think it is ever more difficult to provide a topnotch hotline effort.  Stretched budgets, staffing shortages, they may not be able to meet the challenges of so many returning veterans when our Nation redeploys from Iraq in the future. 

A nonprofit organization dedicated to suicide prevention might be better able to provide focus, stability, and commitment that the VA is particularly challenged in being able to achieve. 

So to conclude, our vets deserve as much support when they return from combat as they receive while in battle, and I know that this Committee is acutely aware of that fact.  But too many of our veterans are struggling to make the difficult adjustment back to society, and they desperately need someone that they can talk to, that they can relate to, someone that has walked a mile in their shoes.  So that is why I have offered legislation that would do that. 

I very respectfully suggest that this Committee consider that legislation.  I certainly applaud this Committee for your efforts on behalf of veterans. 

Mr. BUYER. Would the gentleman yield?

Mr. MORAN OF VIRGINIA.  I would be happy to.

Mr. BUYER. Mr. Moran, I want to thank you for your leadership over the years.  Your care and sincerity, it is real and very evident to me, having known you over the years.  So I want to thank you for your leadership. 

We debated your bill; and I like the idea of having veterans, but not all veterans are trained in mental health.  I know that is your aspiration.  But you have a good idea, and we want to work through that. 

We did have a conversation, Mr. Chairman, and I want to caution my friends in the fourth branch of government who may be covering this hearing, please do not refer to suicide as an epidemic without saying that treatment is available.  Because if you say or you put on the air that suicide is an epidemic in America, you are exacerbating the problem and you could actually be moving people to suicide.  So, please, if you write that, say that treatment and care are available. 

Thank you for your leadership.

Mr. MORAN OF VIRGINIA.  Thank you, Mr. Buyer. 

If I could quickly respond, what we are suggesting is that a nonprofit organization that would be available for veterans, that would spread the word within the network of veterans and give them training simply to be able to react to people on the other side of the line.  They don't need to be trained in mental health counseling, just be able to know how to listen and to talk and to calm down someone that is in a time of crisis.  That is what we are talking about. 

It is just that sometimes when you have very large institutions, it is difficult to accomplish what a nonprofit group that is particularly committed and understanding of the problem sometimes is able to provide with a lot less money.  That is all I am suggesting. 

I thank you for your comments, Mr. Buyer. 

And thank you very much, Mr. Chairman, for giving me this opportunity.

[The statement of Congressman Moran appears in the Appendix.]

The CHAIRMAN.  Thank you, Mr. Moran.  We will be looking again at that legislation. 

Mr. Salazar, any opening remarks?

OPENING STATEMENT OF HON. JOHN T. SALAZAR

Mr. SALAZAR.  Mr. Chairman, I want to thank you for having this important hearing.  I agree with my colleagues, but the one thing that I think we have to be very, very adamant about is finding out whether there was a cover-up by the VA to push these things under the carpet or was it something that they need additional tools for.  We are here to help.  That is what we are here for. 

So with that, thank you, Mr. Chairman.

The CHAIRMAN.  Ms. Berkley?

Ms. BERKLEY.  I would like to submit my opening statement for the record, if I may, so we can get to the witnesses.

[The statement of Ms. Berkley appears in the Appendix.]

The CHAIRMAN.  So ordered.  I would ask unanimous consent that all Members can submit their statements for the record.  Hearing no objection, so ordered.

The CHAIRMAN.  Mr. McNerney, any quick opening? 

OPENING STATEMENT OF HON. JERRY MCNERNEY

Mr. MCNERNEY.  Thank you, Mr. Chairman.  It is clear that all Members of the Committee are sincere in wanting to find the bottom of this. 

There is nothing that is more tragic than suicide.  As Mr. Buyer pointed out, it is a situation that haunts the family and friends for years and years, especially when young men and women who have served our country and have looked to this country to help them when they have needs and, it appears, that that may not have been followed through. 

So it is our solemn responsibility to get to the bottom of this and to find ways to move forward that will prevent this in the future. 

Thank you. 

The CHAIRMAN.  Ms. Brown?

OPENING STATEMENT OF HON. CORRINE BROWN

Ms. BROWN OF FLORIDA.  Thank you, Mr. Chairman, and I want to thank you for holding this hearing today. 

First of