health workers. my discouragement is how long it took for the va to pass -- in 2006 an act was passed that was a piece of legislation i introduced to encourage, authorize and insist that you hire those two professionals within the va, and now five and a half years later i'm discouraged how long it took to see that you move in that direction. i encourage you to hire those people and put them to work as rapidly as possible. part of our state is as rural as kansas, in which mental health

professionals are more limited than urban and suburban states. we need to take advantage of the wide array of professional services that are available at every opportunity. and so i'm here to encourage you to -- now that you've made this announcement, let's bring it to fruition, and thank you for reaping the conclusion and getting us to this point. i want to address my questions to major jones. i have candidates with me that have organized a program with the same kind of focus and effort with what you're doing. it's somewhat related to the conversation or questions of senator tester of the stigma or lack of willingness to admit that one needs help, lack of knowledge about what programs are available. how to connect the veteran with

what's there. i wanted to give you the opportunity to educate me and others on what it is you've been able to do to bring that slet ran who is not likely to know of the existence of your program or programs like yours, and secondly what can you -- what can be done to overcome the reluctance of military men and women and veterans to access what is available. >> thank you, sir. 23i6r9 off, i think that the semper fi fund i've been a board member of provides the abilities for these veterans to come. most of the veterans that come back to the caseworkers have some problems or they wouldn't be there, they've had a difficult time making the transition. so when they arrive in western pennsylvania for a week long session, they arrive with a

major degree of skepticism and very tentative, and we try to restore them to what was really the strength of their experience in the marine corps. the team, the cohesion, team building. they basically restore the trust. i would say -- i don't want -- trust in the system, trust in other others. i think my work through the semper fi odyssey because of the mental health officials that have come in and allowed me to speak to other groups, led to a project i'm doing that looks at best practices, so i was a marine for a long time, we never talked much about mental health issues until recently. as a vietnam platoon commander

we never talked about it, but now there's programs in the marine corps and army too, operational stress control and readiness, it's a great program, but it's not easy to overcome the stigma. and the program really rests on the strength of the nco. no major general is going to ride into a marine corps squad or platoon or company and build immediate trust, it's got to come from the nco. what we have to do so overcome the skepticism is difficult but it's happening. especially the units deployed four and five times. they're seeing the power of what a squad leader can do to identify problems when they're still in the category of combat stress injuries. i think that's the strength of the marine corps's program.

i think the problem with the army program is that it's very well built. the application is not focused on the young nco as is the marine corps program. i don't say it because i'm a marine, i just sense that the nco identifying in iraq or afghanistan that there's a problem. you can start the dialogue right there, and you can start the reconciliation process right there, and you don't have to wait six months after he returns and he has a problem -- we try to restore and very successfully restore, because all these veterans come in and volunteer their services. we had a marine whose brother was killed in vietnam. we had an orthopedic surgeon

come in as a team leader from wyoming, it doesn't take a fi beta cappa to tell, these people are giving themselves for me. i would say by wednesday of a seven-day program these people start realizing, these people care about me. then you're on the road to identification. that's when you find the demons. the company commander was killed, he feels guilty, irrationally but true, he's never shared that with a clinici clinician. he's never divulged to his clinician that he killed a marine accidentally because their sectors aligned with each other. so i think that we have no foolproof system, but the power of the corps, the power of the army, clearly as a team,

cohesion. if you can restore that to what degree you can restore that, then you're on the road to a good program. there's no shortage of people that come and chronicle their experience with a clinician. and they're not damning the clinician at all, but the clinician simply does not understand the individual adamantly enough to build that bond of trust. >> thank you for your service to our country. and thank you all for your interest and well being of our nation's servicemen and women. thank you. >> thank you very much. dr. dave, let me turn to you. as you well know, it's hard enough to get veterans into the va system to receive mental health care, once a veteran does take a step to reach out for health, we need to knock down every potential barrier to care. clearly the report your team produced shows a huge gap between the time that the va

says it takes to get mental health care and the reality of how long it takes them to get seen at facilities across their country. va has concurred with all of your recommendations, but i think it's clear we all have some real concerns. some of these issues have been problems for years. so can you address a question of what you think it would take to get the va to get this right this time. >> i think to begin with, the veteran population is zurlsed across the country and the va is not evenly dispersed across the country. those veterans that go to fixed facilities to receive their care, the va is probably trying to address the current plan for 1600 people, i haven't seen the details of the plan, so i don't know. i think the first issue is to

realize that you have a problem where you have facilities and where you don't have facilities. i think the second problem is, as has been stated here, there simply are not enough mental health providers to hire off the street. there's like 1200 members of psychiatric from our medical school. there's a limited pool and a great deal of demand for mental health providers. they said because of the downturn in the economy and other factors that the nonva, nonmilitary demand had gone up in their experience 10%, 20% in the last couple years. when i looked at mental health access in montana, it was an

interesting review for me, the va had linked up with the community mental health centers. i may be out of date since we did it a couple years ago, there was an organization of community mental health centers, allowing them to go to the mental health centers, usually staffed by psychologists and not psychiatrists. they were able to improve the access time to get folks to talk to people in their neighborhood in their city to get some care. i think in order to make that care cohesive as mr. tolentino said, you have to be able to get medical records back and forth, so there's a coordination of care, and so i think the all hands on deck idea is one that i wholly endorse, and one where if i look at some of the cases

we've looked at in the past, it was not infrequent for veterans to show up at a community mental health center in their town. and because they were veterans, they were then sent to the va, and there was not a link. they were not accepted, there was no payment mechanism or authority. soy think that would be a useful step. secondly, i think you really do have to sit down. and as bad as metrics are, i think you just have to sit down and model what you're going to do and figure out what demand is, try to lay out a business case for what you're doing. >> is that in place at the va today? >>. >> i don't believe they have for the level of mental health they should have. >> do you want to comment on that? >> no, i would like to say,

though, the original question where you said, what's needed to fix this? i really believe va needs to focus on the data integrity of the information they are collecting along with the new set of metrics. i think they need to hold the medical facility directors accountable to ensure that data, integrity. if we've seen scheduling practices that resulted in gaming the system to make performance metrics look better at the end of the day over the past seven years, they need a culture change. to get that culture change, i think they really need to hold the facility directors accountable for how well the data is actually being captured. the auditors that did the work in the field at the sites for this review, had general observations that the focus was always on the outliers, who was not getting care outside of the

14-day window. but there really was very limited focus on how well the schedulers were capturing that information. that is the information that starts to identify demand. it starts to tell you what type of services you're going to need. and whether you need to address emergent care or strategically address care over the long term. you have to have reliable information, coupled with, i think a positive step to increasing the staffing, that is clearly very important. >> thank you very much. senator brown? >> thank you very much. i want to get back to the bonus issue. this year, budget $12.9 million. next year $16.2 billion an increase, obviously. and the va gave out in $2011194

million to senior executive service employees. do you think that's appropriate? >> well, sir, we have -- at va, under the secretary's leadership, we have done an extensive review of performance bonuses, and have reduced those in the number of ratings and the dollar amount that's been imt plimted. >> so the number was higher at one point? >> it was. we had taken this very much to heart. and let me offer, that the integrity of our performance measures and the integritity of our scheduling system. the fidelity with which we implement these and adhere to them that are veteran centric is extremely important to the department. we take very seriously the

comments that have been made by the i.g. and we will be rigorously following up. we have been emphasizing the integrity of the system, it's obvious some of what we put in in my opinion, in performance measures, particularly as it relates to the desire date, may get us into a discussion where it leads to this kind of confusion, what sometimes happens is that a scheduler will say, i want to schedule you for when you next want to come in. the veteran might say, when are you next available? i'll be happy to take whatever's there, that's a trick bag we need to get out of by going back in our view -- >> sir, i understand that, but my question is focusing on bonuses now, i understand there are holes and we need to fix them. the chair woman brought up it has been an issue since the

mid-2000s. i get it's not perfect, you're going to work on it. what's the average salary for these people that are getting these bonuses? >> sir, can we take that for -- >> what is the salary, how do you justify 194 million tax dollars to go to pay bonuses of people that this should be part of their job? i want to make sure i understand it. if not, i'll stand corrected. what do you think about the opinion that tieing these bonuses to quality rather than quantity? what do you think about that possibility? >> senator, my opinion with the bonuses is that i think you already mentioned it, it's bonuses for doing your job. you're doing your job up to par, you're rewarded for that. from what i was always taught from my 14 years in the military, your bonuses, your

rewards for going above and beyond. and clearly i'm not seeing that. in the treatment of evidence and the care that they need. so my opinion is -- >> do you think that money could be used somewhere better? >> beg pardon? >> do you think that $194 million could be used somewhere better? >> i do. >> in general, thank you once again, i enjoyed the testimony from senator moran, why do you think the veterans are reluctant to share their experiences with a clinician, and you're finding that during -- your situation the semper fi odyssey, and during that week, you found that so many folks have actually opened up? why do you think that -- is it a trust issue, is it just -- what is it? >> yes, it's a trust issue. the issue, the combat -- obviously there's operational stress -- >> can i add one thing to that? >> what do you think the va could do to establish the bond

that you have? >> i think the issue is a lot -- it is a trust issue. a lack of trust. it's the fact that quite honestly, many clinicians do not understand the nuances of combat stress. some of the tools that have been built now are much like a traumatic event. combat stress is very different and very personal. it's something that people have to have a feeling of trust with someone else to share those experiences. the longer the person waits for the reconciliation process, the more difficult the problem may be. the answer to what i think they can do, i think we need to provide more opportunities like we're doing at semper fi odyssey for some of these people in the mental health community. i don't think that 1900 more people or 3400 more people are going to solve the problem, unless you're hiring a person

that really can in fact connect to the individual that will inspire him or her to share their perspective. >> thank you. thank you all very much. >> dr. scohn, at this committee's mental health committee meeting, you said you were not aware of not fully reporting waiting times. you heard the testimony about the manchester va regularly using loopholes to meet their mental health measures at the expense of veterans. now that you've listened to his testimony, i want to ask you the same question that i asked you in november. do you believe that va facilities are gaming the system and not fully reporting wait times? >> senator, i would say that we have zero tolerance for that,

and we are going to continue our audits and reviews to ensure with additional training of scheduling practices, that this is not occurring. this is certainly not a practice that can be condoned. >> well, you heard mr. torentino, he talked about the manchester va increasing their mental health work load numbers in order to get additional resources, despite not having enough staff to support that growth. the quality over quantity that i believe you stated. and the result is, veterans not getting the care they need. i'm really shocked that the va allowed providers to be put in that kind of dilemma where they have to chose following directions from their leadership or following the ethics of their profession. what are you going to do to ensure that the quality of care is not being sacrificed as you continue to meet these timeliness standards. >> i think it's a multifold

approach going-forward that we are underway and have been implementing here. first, we need to ensure with the staffing model that we will continue to perfect, that we have sufficient staffing on board to serve the veterans needs. we also need to look as dr. day said earlier at the productivity event. there's a productivity directive that is being developed to ensure that care is being rendered in a productive way. second, we need to make sure that we have the measures in place to ensure that the veterans are receiving timely care in accordance with their condition. and if i might just go back to an earlier discussion with senator brown, as we were discussing those veterans who are most critically at need who are urgently in need of crisis, i feel so strongly that we should be sure to respond to

those, but certainly in the case where we would not have an in patient psychiatric bed available we would feed that out to the private community. that is something that should happen in order to ensure the veteran is cared for, but it's fundamentally important that we get disability for this, and in the conversation with senator brown, what i was trying to emphasize is that we must have visibility and we must respond to those who are most in crisis. and if that requires that we fee out, because we don't have a bed available or something we would do that, we do do that. but we would only do that after making sure we don't have the capacity. because candidly, part of the risk is the handoff to the private sector, and it's important we get visibility. we bring those veterans in, and we take care of them.

>> let me go back to the scheduling issue. >> yes. >> because that is a critically important piece of this. back in 2005 and again in 2007, problems were reported with scheduling, in terms of wait times. despite having heard about this for seven years now, here we are today. why is it so difficult to address these problems and should we be more optimistic it's going to happen this time? >> well, vha has established the business needs, madam chairman for scheduling, including a vision of a modern scheduling package that would among other things provide patients the ability to make their own employments. >> and the implementation thing. >> we have published in rfi, december of 2011, would like to take for the record when we will

be implementing, we are underway if this new initiative. >> do you believe that's going to happen. >> i don't have enough information to comment, ma'am. i'd have to check and see where they are with this. i would just say that it -- this has been an issue for a number of years and it hasn't been solved. i'm not aware of the specifics of what they're talking about. >> okay, i have several other questions i'm going to submit for the record. i want to say, i want to thank all of you for being here today and sharing your views, critically access to va health care in a timely fashion is absolutely essential. especially as we have a growing number of men and women who are returning from a war, where this is a signature issue, and a signature wound that we are very cognizant of, we need to be prepared for, and this committee is focused on this, wants answers and follow-up, and not

just this to be another hearing, but real action is taken. so mr. schoenhard, i appreciate the va stepping up to this today, i appreciate them accepting the i.g. report, i really appreciate the i.g. for all the work you did. a large number of your resource focused on this, there were other witnesses, thank you very much for being here today, i want to make it clear, this is not something we're going to have a hearing on, and leave and go do something else tomorrow, this has to be taken care of, we owe it to these men and women, i don't want to continue to hear that anyone's gaming the system, i want to know that the action plan that's being put in place to make sure that the hiring you have announced is actually taking place. if there are barriers to that, we want to know about it, and i want to know how you decided

which visns are going to get the practitioners you have outlined and i want to know from on the ground there is a real connection to the va here at central office and this is not just another hearing here in washington, d.c., and the action on the ground continues to be the anecdotes that this committee and i have heard and too many committee members have been continuing to hear, this is very critical, i think we've made some progress, but boy do we have a lot of work ahead of us. and i think the nation expects that of us, i intend to stand up to it, and i expect all of you to stand up to it as well. i want to take a second and congratulate miss halladay to her recent promotion as assistant inspector general. we look forward to working with you. with that, this hearing is adjou adjourned. thank you. next on c-span3, a memorial service at the capital for

congressman donald payne. the senate commerce committee looks at how technology is changing the media landscape. and a hearing on efforts to combat the lord's resistance army in central africa. born in a north korean work camp, it's the only world shin had ever known. he's the only one to ever escape from camp 14. >> his first memory at the age of around 4 was going with his mom to a place near where he grew up in the camp to watch somebody get shot. shootings, public executions in the camp were held every few weeks, and they were a way with of punishing people who violated camp rules and of terrorizing the 20,000 to 40,000 people who lived in the camp to obey the rule rules from then on. >> sunday author blaine harden

on shin's journey out of north korea and learning about society and civilization. and may, look for our q & a interview with robert caro. the passage of power, volume four in the years of lyndon johnson. his multiyear biography of the 36th president 37. congressman donald payne died last month at the age of 7. his colleagues honored him with a memorial at the capital. he represented new jersey's tenth congressional district for over two decades. this is just over an hour. ladies and gentlemen, please rise for the presentation of colors by the united states capital police ceremonial unit.