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Witness Testimony of Captian A. Kathryn Power, M.Ed., USNR (Ret.), Substance Abuse and Mental Health Services Administration, Director, Center for Mental Health Services, U.S. Department of Health and Human Services

Mr. Chairman, Mr. Ranking Member, and Members of the Committee, good morning. I am Kathryn Power, Director of the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA). I am pleased to offer testimony this morning on behalf of Dr. Eric Broderick, Assistant Surgeon General and Acting Administrator of SAMHSA, an agency of the U.S. Department of Health and Human Services (HHS).

Thank you for the opportunity today to describe how SAMHSA is working to prevent suicides among our Nation’s veterans through the Veterans Suicide Prevention Hotline.  It is also a privilege to be here along with my colleagues from the Department of Veterans Affairs (VA), Dr. Jan Kemp, the VA’s National Suicide Prevention Coordinator and Dr. Antonette Zeiss, Deputy Chief Consultant, Patient Care Services Officer for Mental Health. SAMHSA and VA have developed a strong partnership, reflected in our current Intra-Agency Agreement, to work together to help prevent suicides by veterans. Just last month, SAMHSA and VA, along with the Department of Defense, sponsored a three-day conference on meeting the mental and behavioral health needs of our returning veterans. The conference included a focus on working together to prevent suicide among America’s veterans.

Suicide is a major public health problem for our nation. Suicide is a leading cause of death across the lifespan, among veterans and non-veterans alike. To reduce suicide nationally requires that our efforts include a sustained focus on preventing suicide among America’s veterans, to whom all of us owe so much.

My testimony will focus on the National Suicide Prevention Lifeline, the rationale behind the VA/SAMHSA partnership, and our plans for the future.

SAMHSA provides national leadership for suicide prevention, consistent with the National Strategy for Suicide Prevention. We have three major suicide prevention initiatives within the Center for Mental Health Services.

One of these initiatives is the Garrett Lee Smith Youth Suicide Prevention grant program. As of October 1, 2008, more than 50 states, tribes, and tribal organizations, as well as more than 50 colleges and universities, will be receiving funding for youth suicide prevention through this program.

A second initiative is the Suicide Prevention Resource Center, a national resource and technical assistance center that advances the field by working with states, territories, tribes, and grantees and by developing and disseminating suicide prevention resources.

The third major initiative is the National Suicide Prevention Lifeline, the program that has been the centerpiece of our partnership with the Department of Veterans Affairs to establish a Veterans Suicide Prevention Hotline.

The National Suicide Prevention Lifeline is a network of 133 crisis centers across the United States that receives calls from the national, toll-free suicide prevention hotline number, 800-273-TALK. The network is administered through a grant from SAMHSA to Link2Health Solutions, an affiliate of the Mental Health Association of New York City. Calls to 800-273-TALK are automatically routed to the closest of 133 crisis centers across the country.  Those crisis centers are independently operated and funded (both publicly and privately). They all serve their local communities in 47 states, and operate their own local suicide prevention hotline numbers. They agree to accept local, state, or regional calls from the National Suicide Prevention Lifeline and receive a small stipend for doing so. In the three states that do not currently have a participating crisis center, the calls are answered by a crisis center in a neighboring state.  Every month, nearly 44,000 people have their calls answered through the National Suicide Prevention Lifeline, an average of 1,439 people every day.

When a caller dials 800-273-TALK, the call is routed to the nearest crisis center, based on the caller’s area code.  The crisis worker will listen to the person, assess the nature and severity of the crisis, and link or refer the caller to services, including Emergency Medical Services when necessary.  If the nearest center is unable to pick up, the call automatically is routed to the next nearest center.  All calls are free and confidential and are answered 24 hours a day, 7 days a week.

By utilizing a national network of crisis centers with trained staff linked through a single national, toll-free suicide prevention number, the capacity to effectively respond to all callers, even when a particular crisis center is overwhelmed with calls, is maximized. This also provides protection in the event a crisis center’s ability to function is adversely impacted, for example, by a natural disaster or a blackout.

Further, by utilizing the national number 800-273-TALK, national public awareness campaigns and materials can supplement local crisis centers’ efforts to help as many people as possible learn about and utilize the National Suicide Prevention Lifeline. In fact, SAMHSA has consistently found that when major national efforts are made to publicize the number, the volume of callers increases and this increased call volume is maintained over time.

Early in 2007, through the vehicle of the Federal Working Group on Suicide Prevention, SAMHSA and VA began exploring strategies for a potential collaboration in providing Veterans Suicide Prevention Hotline services.

It quickly became apparent that using the National Suicide Prevention Lifeline as a front end for a Veterans Suicide Prevention Hotline would offer numerous, very important advantages. We knew that on the very first day of operation, by utilizing a number that had already been heavily promoted for several years as the national suicide prevention hotline number, more than 1,000 callers in crisis would hear the following message when they dialed 1-800-273-TALK: “If you are a U.S. military veteran or if you are calling about a veteran, please press ‘one’ now.” Callers who press “one” are routed to the VA call center in Canandaigua, NY, staffed by VA professionals. On the very first day of operation, 73 callers pressed “one.”

As both SAMHSA and VA have promoted the 800-273-TALK number, the number of callers pressing “one” has continued to increase. Further, every veteran who calls 273-TALK has a choice. They can press “one” and be connected to the VA center, or they can choose not to press “one,” in which case they are connected to their local crisis center. The network also provides backup so that if all the counselors at Canandaigua are busy, the caller is automatically routed to one of five high capacity crisis centers, specially trained by VA in working with veterans. This also provides protection to the veterans hotline in case the center at Canandaigua is adversely impacted, for example, by a natural disaster or a blackout.

We also realized that through this partnership, veterans who call the National Suicide Prevention Lifeline, would be able to receive follow up services arranged by VA’s Suicide Prevention Coordinators. This is the most extensive system for providing follow up care to suicidal hotline callers that exists anywhere.

With the support of VA, the Lifeline has also created a web-based “Knowledge Bank” on veterans issues, available for use by every crisis center in the network when they talk to local veterans who do not press “one” or veterans who call a crisis center through its local hotline number. This guarantees that every crisis worker in the network will have veterans information at his or her fingertips. If, during the call, the veteran decides that he wants to talk with a VA professional or receive care through a VA facility, the crisis counselor can do what is called a “warm” transfer: without disconnecting from the veteran, the counselor is able to call Canandaigua, introduce the caller to the VA counselor, and hang up, leaving the caller and VA connected.

In the future, we plan to continue and expand our efforts to work with the VA and to utilize the network of crisis centers to reach out to as many veterans as possible. We have been encouraging local crisis centers and our Garrett Lee Smith grantees to meet with their VA Suicide Prevention Coordinators for planning and training in veterans issues, and to refer veterans to Canandaigua, as appropriate.

In addition, SAMHSA and the VA have begun to examine how communications technologies popular among young people, such as social networking sites, chat, and text messaging, can best be utilized to promote suicide prevention.

SAMHSA is also currently in the process of awarding grants to six local crisis centers to assess and assist their important work of following up with suicidal Lifeline callers. This initiative is based on SAMHSA-funded evaluations that demonstrated the need for this type of assistance to prevent suicide. One of the requirements for these grants is that the crisis centers work with veterans as a priority population and coordinate with both the hotline in Canandaigua and with their local VA Suicide Prevention Coordinators. SAMHSA plans to continue its support of the Lifeline, including ongoing evaluation efforts so that we can continue to assess and enhance the services that are provided.

I will defer to Dr. Kemp to provide you with more specific information on the call volume statistics for the Veterans Hotline. We are pleased that we have been able to work together with the Department of Veterans Affairs to help deliver the critically important messages that suicide is preventable, and that help is available. All Americans, veterans as well as the general public, have access to the National Suicide Prevention Lifeline during times of crisis, and we are committed to sustaining this vital, national resource.

Mr. Chairman and Members of the Committee, thank you for the opportunity to appear today.  I will be pleased to answer any questions you may have.