about this. these are 2008 data. i'm sure you all know this by now. suicide is the tenth leading cause of death of all americans. that is way too much, and unfortunately, while these are 2008 data, so that we can compare them across disease types, the 2009 data are getting worse. and we anticipate in terms of what the trajectory looks like, 2010 isn't getting any better. the tough reality about suicide for us is that it's not just deaths from suicide. that is incredibly critical. because the deaths from suicide in our country exceed the deaths from hiv/aids. and the deaths from traffic fatalities. these are issues that all of us as a public health matter look at carefully and pay a lot of attention to and provide a lot of resources for. suicide deaths exceed that. unfortunately, whether for kids or for adults, certainly people in the military and their families, the people who have

serious thoughts of suicide and the people who make a plan about suicide and the people who actually attempt suicide, these numbers are astronomical. they are much more, and they represent a lot of distress going on behind the mortality rates. we are very concerned about all of those issues. 90% of the people who die by suicide, i'm sure you all know by now, have a mental disorder. many times unidentified. the suicide rate among people with major depression is eight times that of people without. and an estimated 20% of individuals who die by suicide were veterans. those numbers are not precise, but that is way too many suicides and it's way too many veterans dying from that cause. we also know that suicide is very connected to substance abuse. 30% of the people who die by suicide have a blood alcohol level above the legal limit. and just for those tested, so not everyone who dies by suicide

is, but for those tested, 10% of them involved substances such as amphetamines, cocaine, opioids, and marijuana. so these are increasingly concerns of dealing with these issues. for young people, this is an age group that has bigger issues and less willingness to do something about it or reach out and of course for help, and that is true for the age group about 18 to 25, or up to -- between 15 and 24 suicide is actually the third leading cause of death, so to the extent that military recruits and others are in that age group, this is a high priority issue, for families as well. the other thing we're looking at is how the health care system deals with people who might be depressed or have anxiety disorders or ptsd or other kinds of issues that may proceed suicide. we know a lot of individuals who go to an in-patient unit for

suicide attempts, when they leave, they continue to be at even higher risk for suicide and the connections are not well done. so one of the things that we are really trying to think about is how do we get at people who have attempted suicide once or more times and then are leaving our care systems without good connections to post care. we also know that there's missed opportunities. there are a lot of people who go to their primary care physicians. 77% of individuals who die by suicide have seen their primary care doc within the last year. 45% of them have visited their primary care doc within the last month. and 18% of elderly patients, in which there's a very high rate of suicide, visited their primary care doc on the very same day as the suicide and yet no mention or very little was -- seldom was the question of suicide-related issues raised. so we have lots of opportunities.

and the national suicide prevention, the national action alliance for suicide prevention was launched a couple of years ago by secretary sebelius and gates. and the idea was to champion suicide as a national public health priority and to make suicide a nonevent. we think it is a preventable public health issue that we can address nationwide. one of the things that this national action alliance, which is a public/private partnership, is working on is the national strategy for suicide prevention. it was done in 2001 by the surgeon general then and it's being updated. we are working hard to get it out by this fall. you may know that the public/private partnership for this suicide action alliance is the honorable john mchugh, secretary of the army, and also senator gordon smith who is currently the national association of broadcaster ceo. so we have a very strong private/public partnership.

the national suicide strategy has got four strategic directions. we're trying to look at both healthy and empowering individuals, families, communities. getting the word out. getting awareness raised. getting people to understand this is a preventable issue. trying to look at community and clinical preventative services and treatment and support services. we're also looking at surveillance, research and education, and we have a number of federal agencies and departments including the military agencies working with us. one of the task forces, and there are many, one of the special population task forces focuses on military families. that means not just current personnel and not just veterans but also their family members, as well as the national guard and other parts of the military. we are collaborating a lot with the veterans administration. we're pleased with the collaboration. as janet said, we're doing a lot of work on sharing resources so the veterans administration has actually adopted sama's addressing suicidal thoughts and

behaviors in substance abuse treatment and likewise they then helped us to create a training video that's used by both va and community providers. samsa also assisted the veterans administration and updating the suicide prevention gatekeeper training for use in communities and we're also participating in a group to develop dod and va joint clinical practice guidelines to prevent suicide. in the behavioral health field, the militarmilitary's actually part of the world that's done very cutting-edge work in behavioral health that we have been able to use over the decades in communities. so we're very pleased with that. we also have work going on with tri care, working to try to expand behavioral health provider capacity and do some pilots there. so there's a lot of work going on between samsa and the military parts of the federal government. we have a strong commitment to

military families as one of our strategic initiatives. i'm very pleased with the interrelationship that we have on these issues. there's much more i could say, but my joy and job is to introduce the secretary, and i think i see her down there. and i think, secretary, we got the memo about the colors today. so this is a good thing. i do want to introduce my boss. i've worked for lots of governors and mayors and political leaders in my career, and none of them are more committed or clear, energetic, and focused on all the right things than secretary sebelius. she is part of the historic affordable care act, she's implementing reforms that ended in of the insurance industry's worst abuses and going to help 34 million uninsured americans get health coverage. she's working with all of us, doctors, nurses, hospital leaders, employers and patients to slow the growth in health care costs through better care and better health.

she actually has called on all of us at hhs to collaborate at the federal level and with states, with tribes, with communities, with federal partners to make america healthier and to be the most efficient and effective government agencies that we can be. she's an extremely strong supporter of behavioral health as part of this health care effort and leads the charge on the messages that prevention works, treatment is effective, and people recover. please join me in welcoming secretary sebelius. [ applause ] >> good morning, everyone. i am really pleased to have a chance to be part of this very important conference, and i want to start by recognizing one of our great health leaders, pam hyde, who leads this incredibly important agency on substance

abuse and mental health services, and as pam said, our strategy, among other things, is to not only look at the cutting edge research and best practices but actually to collaborate and leverage assets across the federal government. i've been really pleased at the level of cooperation and collaboration with two of the military partners, secretary shinseki, and i know that janet kemp is here with the office of mental health and that has been a terrific effort on all kinds of fronts. this being among them, but we're working on veterans homelessness and a whole series of activities. and also secretary leon panetta who will follow me because he has a deep and personal interest

in this area. i don't think there's any more important work than taking care of those who have stood up to protect our nation. our men and women in uniform put their lives on the line for us each and every day, and we need to be there for them when they return. now, what we know about the snapshot of soldiers today is that they carry an especially heavy burden and have over the last decade. there have been longer deployments, more frequent redeployments, shorter breaks in between. the stress has been more constant. not only on the active duty military, but certainly on their families. and tragically, as a consequence, we've seen suicide rates continue to rise among service members and veterans. so the defense department and the veterans administration have taken this crisis on and made it a top priority.

but the responsibility of meeting the mental health needs of our service members, veterans and their families, lies with the entire country. and the people who fight and defend our freedom need help. we all have an obligation to make sure they get it. and that's why, in 2010, i joined then-secretary robert gates and secretary of the army john mchugh to launch the national action alliance for suicide revenge. our aim was to make suicide prevention a national priority especially for vets. in our department that's meant life saving services and supports more accessible and responsive to people in crisis. for example, we operate the national suicide prevention lifeline number. a national network of crisis call centers for those experiencing a suicidal crisis or in serious emotional distress.

last fall, the lifeline received its 3 millionth call. and knowing we had this large and effective network already in place, the va reached out to us several years ago, and we formed a partnership. today, service members, veterans and their families who call the lifeline can press number 1 to be connected to a va call center that provides specialized rcriss services. the veterans crisis line, or military crisis line, as it's known within the services, is also available in a number of european countries. and in just the first five months of this year, over 85,000 lifeline calls were answered by the veterans crisis line. more than 550 calls a day. our department is alhas also organized a series of policy academies that bring together community leaders, guard and reserve members and veterans

officials from several different states to team up and share best practices. one great example is a program known as operation emersion. an initiative that brought community-based health care providers to a national guard base where they live like soldiers for a few days. they eat mres, run drills, do pt. and in between, they meet with soldiers of every rank and their families to hear about military culture, life on the frontline, and what it's like to be back home. now, that has given health care providers an in-depth understanding of what service members and their families are actually going through and helps them provide better care. operation emersion started in tennessee, but when organizers brought it to one of our policy academies as a best practice, it sparked a lot of interest. so we flew representatives from other states to tennessee where

they experienced operation emersion for themselves. and now a number of them have replicated this program in their own communities. so one of the things that we're trying to do and will continue to do is find best practices and help them come up to scale throughout the country. our ultimate goal is to work in support of states, together with the department of defense and the veterans administration, to create a system where there's no wrong door for any service member, veteran or family seeking help. where no matter where they go for help, they get the care they need. and to do that requires some real work. educating community-based doctors and nurses about how to ask patients if they've served or seen combat. how to screen for ptsd. how to best refer patients to the va and to tri care. we want to give state officials

the technical support to create accessible integrated databases they can use to connect service members and veterans to local services. from childcare and employment, to local chaplains and peer support networks. and we're helping state and local agencies collect and share data so we can get services in communities where they need it most. mapping out what exists and trying to fill those gaps. the thing that ties all of these efforts together is a commitment to care for the whole person. we want to make sure that people stop making distinctions between behavioral health and physical he health. i know that all of you feel the same way. i'm a former governor. i was governor of kansas. my general at the time was major general todd bunting. he was the attorney general of the kansas army and air national

guard and he took very seriously the effort to address the mental health needs of returning national guard men and women. he used to talk to me about how when a soldier is going into the field, how he would take his bradley tank and run a check on the vehicle. things like checking the treads, making sure that the guns are operational, making sure that they have all the correct ammo. and that we would never send that machine into the field unless it checked out. unless everything was right. but we actually weren't taking the same care with servicemen and women who were in that tank and guiding that machine. so in this administration we're committed to ensuring we meet the full needs of our service members and veterans. and that means taking care of the whole person. their physical health and their mental health. i note it's exactly the

important lifesaving work that so many of you do every day, and we want to help give you the support to keep doing it and doing it well, and i want to thank you for sharing your experience and your expertise at this conference here this week. our men and women in uniform, veterans and their families, have given so much to defend this nation. by giving them the support they need to stay healthy and get help when they need it, we honor their service and fulfill our shared responsibility. and at the department of health and human service, we regard this as a priority initiative and look forward to our ongoing partnership. thank you very much. [ applause ] the supreme court issued a number of decisions in several

cases today though it did not announce its ruling on the president's health care law. that decision is expected thursday on the court's last day of this term. today the court struck down arizona's illegal immigration law. justices are allowing one part of that to go forward. the requirement that police check the status of someone they suspect is in the country illegally. and in another ruling today, the justices overturned a montana law limiting corporate campaign spending. a busy week ahead in congress. the house convenes tomorrow to consider spending for agriculture, transportation, and housing programs. and also a vote on holding attorney general eric holder in contempt of congress. republicans want the attorney general to turn over more documents related to the fast and furious gun tracking operation. live coverage from the house floor on c-span. and over in the senate, lawmakers gavel in today at 2:00 eastern with two bills on the agenda. the flood insurance program and user fees the fda collects from

drug companies and medical device makers. you can watch that on c-span2. and there's a july 1st deadline hanging over congress. without congressional action, student loan rates will double on the 1st and money runs out for the nation's highway and mass transit programs. and here's a look at president obama's schedule this week. today the president travels to boston and portsmouth, new hampshire, for campaign events. he continues on the campaign trail tomorrow visiting atlanta and miami. the president is back in washington on wednesday when he'll meet with the crown prince of abu dhabi and later in the day he'll host a picnic for members of congress at the white house. sunday, award winning author and historian david pietrusza is our guest on book tv's "in-depth." his passion for u.s. presidents and great american pastime, baseball, has resulted in a dozen books including "1920: the

year of the six presidents." "1960: lbj vs. jfk vs. fixing e 1919 world series. join us live with your calls, emails and tweets. sunday at noon eastern on book tv's in depth on c-span2. we welcome you to missouri governor's mansion. >> the girs government was brown. here we have a photograph of him, his wife and his child. what is interesting about him is the fact that his granddaughter margaret wise brown wrote the book "good night moon", which is a favorite of many school children not om here in missouri, but all over the united states. >> july 7th and 8th, book tv and american history tv explore the heritage and literary culture of missouri state capital, jefferson city with c-span's

local content vehicles and american history tv inside the governor's mansion. >> there was a governor stewart, a bachelor governor the story says he rode his horse up the front steps of mansion and the dining room and proceeded to feed his horse oats in this plate warmer part of the side board. the comment was he should probably not be feeding his horse in the governor's mansion. his comment to them was, i have had to feed more people in this home with probably less manners than my horse has. >> watch for book tv and american history tv in jefferson city, missouri, july 7th and 8th on c-span2 and 3. >> every year the veteran's affairs department performs amputations on 6,000 veterans and treats more than 40,000 veteran who is have lost limbs. a house subcommittee looked at the department's program providing prosthetic limbs for veterans. this hearing is three hours.

good morning. the subcommittee will now come to order. good morning and welcome to today's subcommittee on health hearing optimizing care for veterans are prosthetics. our nation's commitment to restoring the capabilities of disabled veterans struggling with devastating combat wounds results in the loss of limb began with the civil war. restoring these veterans to fullness was a core impetus behind the creation of the department of veteran affairs. and then now it continues to play a vital role in the department's mission. prosthetic technology and v.a. care have come a long way from the civil war era. wooden peg legs and simple hooks. following world war ii 1945, veterans dissatisfied with the quality of v.a. property thetic

care stormed the capital in protest. congress responded by providing the v.a. with increased flexibility for prosthetic operations and launching new research into mobility and assistive devices. with these reforms v.a. led the way in prosthetic care and research. guide by dedicated professionals both inside and outside the department who worked tirelessly to provide veterans with the quality care they earned and they so much deserve. as a result, the model of v.a. care today for today's veterans includes leading edge artificial limbs and improved services to help them regain mobility and achieve maximum independence. still, the magnitude of the heartbreaking injuries sustained by service members and veterans returning home from military service from iraq and afghanistan find the v.a. struggling to keep pace with the rising demands of younger and

more active veterans with amputatio amputations. prosthetic care is unlike any other care provided by the department. prosthetic devices particularly prosthetic limbs quite literally become a part of their owner. requiring the integration of body, mind and machine. the goal is not just to teach amputees to walk or use an artificial arm or hand, but to provide multidisciplinary continuing care to maintain long-term and lifetime functions and quality of life. which is why i am troubled by the department's proposed changes to prosthetic procurement policies and procedures. the forthcoming reforms will among other things take prosthetic purchasing authority from prosthetic providers and transfer them to the contracting officers. this is alarming to me as we will hear soon it is also alarming to many of today's

witnesses. i would like to read a quote from captain prudhomme a wounded warrior himself who states in his testimony that we see no prospect that this planned change in prosthetic procurement holds any promise for improving sfrss to the warrior. instead almost certainly threatens greater delay in v.a.'s ability to provide severely wounded warriors needed prosthetic devices. and heightens the risk that a fiscal judgment will override a clinical one. i think that the members of this committee agree along with many of you in the audience this morning that we cannot allow this to happen and this morning we will look to the department for assurance that it won't happen. it is nothing short of inspiring to see how far modern technology and most importantly the spirit, courage and resolve of our veterans themselves has come in restoring mobility, dignity and

hope to our nation's heroes. and they are our heroes. and this nation owes them this debt of gratitude to make sure our veterans have exactly what they need to survive, to thrive and to have a quality of life. it is rye tal that we set v.a. prosthetic care on a course that matches the can you recollect v courage and bravery of the men and women who serve our nation in uniform. again, i thank all of you for joining us this morning. i now recognize our ranking member for any remarks me might have. >> thank you very much, madam chair. i would like to thank everyone for attending this very important hearing we're having today. the purpose of today's hearing is to look closely at v.a.'s prosthetic aid services and to examine number win demand for prosthetic services, number two, quality of care and access issues, three, the impact of ongoing procurement reforms and four, if current acquisition in

management policies are sufficient. as the three office of inspector general reports have shown, there are numerous concerns including the frequency of overpayment in the nearly a quarter of a transaction totaling over $2.2 million in fiscal year 2010. the absence of negotiations, price guidance abds other controls in the limited information to access if current prosthetic limb fabrication and acquisition practices are effective. i've said it on this committee before, but what seems to be a case that there is little accountability in management and once again procurement procedures and policies were not in place or not followed in managing nearly $2 billion worth of prosthetics and sensor aids.

the v.a. in the last year's budget's mission claims that $355 million in savings in fiscal year 2012 and 2013 due to acquisitions improvements. but if the v.a. can't follow its own policies and procedures, how much faith can we have in the claim of acquisition savings in i hope the v.a. can help us understand today what accountability we should expect to make certain that the v.a. does not continue to overpay for prosthetics in the future that tax payers and veterans receive the best value for their devices and for management to ensure that the prosthetics and sensor aid services is fully meeting veterans needs. finally, it has come to my attention that v.a. has proposed changes in the procurement of prosthetics and that there is a

high degree of concern among some of our witnesses today as to the effectiveness of these changes. i look forward to hearing from the v.a. on these issues as well. and i'd like to thank all of the panelists for coming today and want to thank those of our panelists who are veterans for your service for this great nation of ours. i am committed to working with all of you to ensure that our wounded veterans those who have served honorably and made such great sacrifices are able to go about their lives more comfortable with these devices and with the best support and services from the v.a. possible. so i want to thank you once again for coming today. i want to thank you very much madam chair for having this very important hearing. i yield back. >> thank you. i'd like to now invite our first panel to the table. joining us this morning are john register