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Honorable Jeff Miller, Chairman, Committee on Veterans' Affairs

Honorable Jeff Miller, Chairman, Committee on Veterans' Affairs

Thank you, Dan.
    It is a pleasure to be here today with you, the Members of the Subcommittee on Health, representatives from our veterans service organizations, and other interested stakeholders and audience members to discuss my draft bill, the Veterans Integrated Mental Health Care Act of 2013.
    Two weeks ago yesterday, I spent the day in Atlanta, Georgia, with several Members of the Georgia delegation to discuss inpatient and contract mental health program mismanagement issues at the Atlanta Department of Veterans Affairs Medical Center (VAMC)
    This visit occurred after the VA Inspector General (IG) issued two reports, which found that failures in management, leadership, oversight, and care coordination at the Atlanta VAMC contributed to the suicide deaths of two veteran patients and the overdose deaths of two others.
    Alarmingly, the IG found that approximately four-to-five-thousand  veteran patients fell through the cracks and were lost in the system, after the Atlanta VAMC failed to adequately coordinate or monitor the care they received under VA’s contracts with community mental health providers.
    I wish that I could say that the issues in Atlanta are an isolated aberration. Unfortunately, that would be far from the truth.

    Rather, the Atlanta story is just the latest in a tragic series of incidents highlighting serious and systemic deficiencies plaguing the provision of mental health care to at-risk veterans through the VA health care system.

    Since 2007, VA’s mental health care programs, budget, and staff have increased significantly.

     Yet, the numbers of veterans taking their own lives has remained stagnant for the past twelve years - with eighteen to twenty-two veteran suicide deaths per day since 1999, according to VA’s own numbers.

    I could go on but the bottom line is this - the one-size-fits-all path to mental health care that the Department is on is failing the veterans most in need of its services. And, the time to act is now.

    I have been and will certainly continue to be a strong and supportive advocate of the VA taking action to hire staff, and address the continued failures of mental health care provided within its own walls.  
    However, it has become abundantly clear – through the data I have discussed this morning, through Committee oversight, through numerous IG and Government Accountability Office reports, and through the personal accounts of the veteran constituents that call my office and the offices of my colleagues on a daily basis to ask for help – that VA cannot cope with the magnitude of mental health needs our veterans experience in a bureaucratic vacuum with the normal VA business-as-usual approach.
    In order to truly maximize mental health care access for today’s veterans, VA must embrace an approach to care delivery that treats veterans where and how they want, not just where and how VA wants.  Some have said this could undermine VA healthcare as we know it. Nothing could be further from the truth. This isn’t about supplanting the VA healthcare system, it’s about supporting it.
    To the contrary, to truly address and resolve the breakdown in the provision of mental health care services to veteran patients, VA must adopt a proactive, integrated, coordinated care delivery model for mental health care.
    Most importantly, VA must adopt a mental health care delivery model that is truly veteran-centric – one that meets and cares for veteran patients where they are, treats the entirety of their concerns with supportive and timely wraparound services, and recognizes and respects their unique circumstances, goals, and health care needs throughout their lives as veterans.
    That is why I have proposed this draft Veterans Integrated Mental Health Care bill before us.  It would take the first important step to help veterans in need, whether those services are provided in or out of VA facilities.
    Specifically, the draft bill would:  
- require VA to provide mental health care to an eligible veteran who elects to receive such care at a non-VA facility through a care coordination contract with a qualified entity; and,
- require such entity to meet specific performance metrics regarding quality and timeliness of care and exchange relevant clinical information with VA.
    It would ensure that existing mental health care resources – both those found within VA facilities and those provided to veterans through fee basis care – are managed effectively.
    It would also ensure that the care provided to veteran patients in need of mental health services is timely, convenient, and coordinated from the initial point of contact throughout the recovery process.
    I understand that some veterans service organizations (VSOs) have expressed concern about waiting until VA rolls out its own new contract care initiatives.
    And – while I appreciate, understand, and respect these views, I look forward to working closely with them to address their concerns – but the time for waiting is over.
    Last year, the IG found that more than half of the veterans who go to VA seeking mental health care services wait fifty days on average to receive even an initial evaluation.
     This year, the IG found that thousands of Georgia veterans had fallen through giant cracks in VA’s mental health care system and may or may not have received the care they so desperately needed.
    We cannot wait to see what next year brings.
    When a veteran is need of mental health care services, the difference of a day or a week or a month can be the difference between life and death, between contentment and struggle.
    The time to act is now.
    I look forward to working hand-in-hand with Committee Members, our VSO partners, and other stakeholders to strengthen the language in this draft bill and address any issues that may be raised during the Subcommittee’s discussion this morning.
    Thank you once again, Dan, for holding this hearing today and for your hard work and steadfast leadership of the Subcommittee on Health. I appreciate the opportunity to be with you all today.
    With that, I yield back.