for the service of your sons and sergeant, in your case your own service. my heart goes out to you for your losses as a veteran myself. the question i have is, i mean, do you think, certainly sergeant in your case and then for the parents in the cases of your sons, was va overmedicating them in lieu of giving them therapy? >> thank you for that question. this is an issue we battle with on a daily basis as we provide support and service to veterans and active duty members.

part of what i do through the ministry i'm in is providing support groups through the chaplain's channels. so ideal with this very closely on both sides. medication is no longer being used as a tool to subdue the symptoms while we work on the deeper issues. >> no. what does the va do? >> the va specifically utilizes medication to control it and keep them, suppress the symptoms without working on the deeper issues. >> thank you. please. >> brian was never put on any medication. only for his back when he had that problem. >> okay. >> yes. clay was on quite a bit of medication. as i said, he felt like a guinea pig, constantly being begin something different. >> do you think they chose medications in lieu of therapy? >> sure. >> one-on-one therapy? >> yes.

the only one-on-one therapy that he spoke of that seemed to be effective at a certain point in l.a. he went to a vet center and had a counselor there that he really liked and felt he finally found somebody he to talk with. >> okay. >> from daniel's point of view, i think part of his problem was that he also had gulf war syndrome which manifested with so many physical symptoms. so, yes, he had a 24 inch by 24 inch drawer full of pill bottles, but i think it was because he was having such incredible interactions between the different drugs he was taking for pts and the gulf war syndrome. >> and daniel was not being seen by a va psychiatrist six months after he was home, just because he never got the post card that he was supposed to get to assign

him another provider. >> how much of the stress of the factors leading to suicide do you think might have been related to the fact that -- i can tell you having been to iraq, first iraq war then the second, that when you come home there is a huge, i guess maybe separation anxiety that you develop these interdependent bonds in this team around you and all of a sudden it is gone. it is just gone. people fall into very dark and deep depressions sometimes. i think it's easier for those that come back and they have a long period of active duty with the same people that they served with. i wonder if you might comment.

we'll start with this side of the table. >> this is a problem certainly with national guard. daniel was a member of california national guard with the military intelligence. they are routinely separated from their main unit and assigned to other units. daniel went to iraq with an mp unit out of texas. so he was already not with the unit he trained with. he went to iraq. when he came back, his wife had moved to arizona to be with her parents. he's california national guard deployed through texas and ended up in arizona. so he had no support group whatsoever close by. it would have been phone call and e-mail. >> this is a news magazine issue. reserves and national guard, it's a huge issue. not to take away, of course, from regular service members and all branches of the service, but it's a much bigger issue for

those who do not have the opportunity to come back to a defined facility and spend time, like you said, with the people they were deployed with. >> great question. the bonds that these men and women form in combat are just incredible. so it's very difficult for them to leave service and come back to their communities. lay probably stayed in, he struggled about going home to texas or staying in california. i think one of the reasons he stayed there for a while was because his close friends, marines were staying there and continuing in his life. one of the tragedies with clay was he moved back to texas and he really wanted to consider going into working for the fire department, paramedic, that sort of thing, and was having some struggles with that. after he died, he found out that, i think, three of his

group were actually in the greater houston area. one of them in particular had gone through all the steps. he was like a year ahead of him going through the fire department. it would have helped just the knowledge those people are there would have helped. there is a big break leaving service and going back to the community. >> when brian went first he was with first caf. that was deployment that was supposed to be 12 months and they extended it to 15. he was very, very tight with all those brothers and they are still very, very connected online and text and everything. when he was in college then for the year, then when he was called back the second time, his unit was already home for the year. so he was put with louisiana national guard. he had no idea those were completely new people.

so you can imagine then when you are already damaged and you wake up screaming three times a night and have anxiety and panic attacks, you know, it's very difficult. i think he did bond with the people. he was very social, but it wasn't the same type of bond he had with the first group. >> i think it's been stated well. to highlight on that, the battle buddy system is so culturally engrained in the military community. you really become a family unit with those around you that you serve with. separating from that, and especially our wounded as they are shuffled from their units to a warrior transition battalion, they are separated from that unit. they transition out and lose connection and begin to isolate themselves after that loss. that's a very difficult thing. i think that's why a program such as the va's peer mentor and

navigator program are so essential. we should look at that and look at the way it's being implemented and improve upon that. service members and veterans connect best with other veterans. especially those who have shared experiences and can help navigate through the experience es they experience through this system. >> thank you. >> mr. o'rourke for five minutes. >> thank you, mr. chairman. i would like to join my colleagues thanking you and telling you what you have shared with us today is so powerful. sergeant, your story, the story of brian and clay and daniel, i hope will force us and the administration and this country to treat this issue with the respect that it deserves, with the attention it deserves, and to get the results that our veterans deserve. and beyond the power of the

stories, which are just -- it's hard to put into words the effect they are having on me and i think my colleagues on this committee. you've also come to the table with solutions and proposals to improve the system. i love the idea that we think about the va restricting its responsibilities to becoming a center of excellence for war-related injuries. i haven't thought about that before. i don't know what the effect would be. i would love to hear from other veterans and veteran service organizations. i love that you are thinking about a big idea to transform a system that is obviously not working today, but hasn't worked for a very long time from everything that i've learned so far. this idea of an interdisciplinary approach to taking care of veterans when they return, i'd like to know more about that. i think it makes a lot of sense begin your earlier testimony. the buddy-to-buddy system you brought up. identifying a support network

when these service members are still enlisted are all excellent ideas. i'd like to ask you is, i've received so much value from this testimony today than i ever have from a representative of the va, including the reasons why we should be focused on this, the ideas and suggestions on how to fix it. i'd like to ask you if there was some formal process to involve you in fixing the va, would you like to participate? secondly, if you have any other ideas because there have been so many good ones that have come through so far that we haven't raised today, i would love to give you an opportunity to share that. maybe we can start with dr. somers and work down. >> we want to be part of whatever efforts. we submitted as part of our testimony 15 pages of problems and potential solutions.

there are a lot of really good people who can be very beneficial to try to help the syst system. we just don't have the time to get into specifics right now. to answer your question, for sure we would like to be involved, if at all possible. >> thank you. >> absolutely. we would be happy to do whatever we can to help. i want to kind of shift the focus a little bit off of us as parents who lost sons and lost childr children. words can't describe that, but i sit here and look at sergeant rensler and listen to his story, and we are surrounded by veterans behind us, a lot of them from the iva group. if there is any blessing or silver lining in clay's death,

we have become friends with so many of these young veterans that have enriched our lives. i don't know where i'd be without them. i mean that sincerely. they just have enriched our lives so much. so whatever we can do. we can't do anything to bring back clay or brian or daniel, but what we can do is do something, whatever it is, to make life better for all these veterans behind us and all of them all across the country, all veterans. not just iraq, afghanistan, but all of them. we shouldn't have to be reminded of that, and yet we seem to have to be reminded that we need to do a better job. so we are happy to do whatever we can to help. >> thank you. >> any time, any place, we're available. part of the process for us to heal, and i think for everybody at this table is to have the

opportunity to go beyond our personal losses and to address the veteran community as a whole, and to do whatever we can to take care of those fine men and women. so the opportunity to be in this community here and to be able to talk and to be able to be heard by people who hopefully have, i believe certainly have the heart and hopefully have the ability to make some things happen. the va is very, very complicated. it's a huge animal. i know there are a lot of things that need to be dealt with. there's a lot of really good stuff it does. there are some big problems. i think if we can just focus on the individuals, just focus on them as people in need, as patients on their care. what do they need today? and then build the system,

modify the system, do whatever based on that. i think that will take us a long way. the focus needs to be these veterans. >> thank you. >> totally. >> my time has expired. miss portwine and sergeant rensler, would you indicate if you would like to be involved perhaps in a more formal way to include your ideas? >> it would be an honor for me to help make a change for the veterans. it would be like paying it forward. >> thank you. >> any time, any place. i not only bring my battlefield perspective, but all the veterans i work with. i can only offer that much. >> thank you. >> mr. cooke, you are recognized for five minutes. >> thank you, mr. chair. i want to thank the group for being here. i know this is really, really tough.

sergeant, for your input, this is tough to listen to and it's even tougher for you guys. the comment about the parents not knowing, i'm not surprised. a lot of people, the worst thing in the world, after my second purple heart, i didn't want my parents to know what was going on. this is going to be the problem that i think all of you are sharing, that common denominator. you know, everybody that goes through these experiences will have huge psychological problems, but who are they going to share it with? are they going to share with a psychiatrist or a psychologist that doesn't understand the military culture, the veteran culture? they are not going to open up. you need that connection. i think the sergeant made a great point.

your comments about the wounded warrior program where they have that, the actual battalion where when somebody's got a problem, they go into that system there. i just want to get your feelings. maybe i'm going down the wrong road because i think they need somebody that has a problem, they need an ombudsman, somebody that's going to look out for their interests. that if they have a particular hospital, that they can go to the administrator. they can go to anybody and say, hey, wait a minute. this is an immediate situation. this is general quarters and we need to have a meeting right now or somebody is going to die on your watch. can you comment a little bit more on that? it's pretty much what you were talking about, buddy-to-buddy,

the same things over and over and over again, but to cut through the red tape right then and there with individuals that understand severity of the problem. >> yes, sir. this is a crucial element is to have somebody to come alongside of these severely injured, cut through that red tape and get treatment now. this is something we experienced first hand. i've experienced. i shared with some of the folks from wounded warrior project recently. we did a crisis intervention on attempted suicide. we got him in a position of stability and i found out he never accessed care at the va facility. he went down and he was denied treatment and told he would be able to be seen in three months after telling somebody he had attempted suicide the night before. i went down there and met with that veteran and we walked in and i said this is an

unacceptable answer. we got the department head to come out and say i will take him today. we have a program we can start him in next week. that saved that veteran's life that day, but there are thousands more a day that are getting the no and not getting the extra answer because they don't have somebody to advocate for them. i'm not saying that to toot my own horn. ifa advocating for these veterans, we would get better care. >> i just got back from camp lejeune. i saw some of the folks, including my platoon sergeant, he was my platoon sergeant 47 years ago. we talked about the infantry unit. you never forget the marines you lost. 13 may, 1967. horrible, horrible day. you never forget their names, the occasion. just like you are never going to forget this. what you have to do is try to

make the system better. right now i think it's broken in terms of not capturing those individuals and those thoughts, the morale is just down to the point where they are going to do something bad. if we don't correct it now, it's our fault. comment? >> it's a systems issue within the va. and our feeling is everybody who works in the va should have only one purpose in mind and that's to advocate for the veteran. it's the person who sits in the corporate office to the person who cleans and empties the waste baskets at night. that's the only, only thought they should ever have. >> doctor, that concept of the ombudsman or for lack of a better term, somebody that is ultimately responsible or somebody that is that advocate for that person in trouble. >> we agree there needs to be an ombudsman. we know about the navigator

program. that's a great program. we know that they are doing a much better job of that out in san diego. it's not only the ombudsman. it's not only the navigator. it's every single person. >> it should be an sop. >> standard operating procedure for every hospital. i yield back. >> thank you, colonel. ms. brown for five minutes. >> thank you, mr. chairman. let me thank each and every one of you. i recently did work with marines and they would be very proud of you, your sons. thank you very much for your service. you know, i have to say we are talking about the va, but this is not just the va. it's dod. this hearing should be va/dod because it's dod that send people over and over and over

again to combat. it's not transitional as far as when they come back, so it's a bigger problem. to sit here and say it's the va, that's just not true. it's just not true. we need to deal with the problem. the fact is we've been fighting a wall with reservists. and we've sent them over and over again. and they didn't have the support that they need. i've gone out when they're deployed. they don't have all of the other, that the other military branches have. we're not doing the wars the way we need to. and the system is fragmented. so as we develop a comprehensive system, let's get everybody in the room. let's deal with the system the way we need to deal with it. now, you mentioned the

formulary. we insist they negotiate the prices of the drugs to keep the costs down. what is wrong with the way we're doing that? because in the regular market, it is illegal for the secretary to negotiate the price of the drugs. which i think is dumb. >> there is no problem negotiating the price of the drugs. the problem is the drugs aren't the same so that, for example, lexopro, you would want the dod formulary as opposed to the va formulary, no doubt about it. i know first hand you can basically get anything you need with relatively little hassle. >> but i thought the va was the one that was doing a lot of the research, not the dod.

>> research has nothing to do with anything. the only thing that has to do with it is the actual drug you are being prescribed by your provider. you can do research. that was one of daniel's issues. there is a problem doing research because of the fear of the fda and dea and schedule one medications and things like that. that's a totally different issue. the problem is the formularies aren't the same. i've got patients, not only veterans being discharged, but retired military who are being seen at a dod hospital and at a va medical center and they are eligible to be seen in both, and they are under medication restrictions because the formularies are different. we need to make it a single formulary. bottom line. >> okay. >> excuse me. in addition to that, it's like if a person is doing really well on a drug, they should be able

to stay on that drug. >> the doctor can override that. >> just because you can get it for 10 cents cheaper, it can have major effects on their body. >> absolutely, but the doctor can override that. >> what gina is saying is different. it's still a generic, but as i said before, it's a different formulation of the generic. >> right. >> especially as was said. that's what's so important to have these groups of the multispeciality groups, the interdisciplinary committees that are going to communicate among themselves. >> i think that is something we can work on. miss portwine, i think you made a very important point. your son, you realized was having serious problems, yet he was redeployed. >> yes. >> he wasn't given the medication.

it should have been a time-out at that point. >> well, even on the form you can see it said "no go." that was crossed through and somebody stamped, the coordinator that sends the people put "go." >> but that's dod. >> that tells me they had hesitation sending him to begin with. >> that's dod. >> yes, ma'am. >> thank you very much. i'm saying it's a lot of work that needs to go on. it's not just va. thank you again for your service. >> thank you very much. >> thank you, mr. chairman. thank you to the panel for being here. i can assure you that this is how things change in this country is when brave men and women step forward and say to a concerned body like this of republicans and democrats sitting here listening to your story, i can't even imagine, i can't pretend to imagine how tough it is to sit here and

relive this. i think i can safely say we are committed to bringing right to all of this wrong. every one of you have hit the nail on the head by saying, every one of you have said the story is about the individual veteran. i've only been on this committee 18 months, but the last three months, the chairman and ranking member led an intensive investigation into what the heck happened to the va. from the day it started to the mission today. and every layer of this onion we peel back comes down to the same core issue. nobody is advocating for the veteran. the culture itself, when we talk about systemic problem and the culture itself, and secretaries removed and a bunch of people removed and we are trying to help america reset a button. because americans believe in our veterans. they send us here to fight for our veterans. i want to applaud your effort.

you made such a huge difference here today. this is how laws change. this is how policy becomes correct, and this is how we move forward in this country. we do it together. unfortunately, sometimes it takes the disaster that we had in a bureaucratic system of the va. the frustrating thing for me is, i have 54,000 veterans in my district. every time i describe my veterans, i talk about, i have 54,000 veterans and their families in my district. i want to applaud your effort on two huge issues we can address in this congress and help move forward on this issue of mental health. one is the support network. i can't even tell you, and i know you know how much constituents called our office in indiana. the wife or husband is in tears and begging and advocating for the spouse that the va says hipa prohibits me from allowing you to get involved in this. i've gotten personally involved, calling the directors trying to

advocate for my constituent on behalf of a spouse. the answer is still no, hipa overrides. do you have a different law? do you describe to a different definition than we do? the answer was no. hipa overrides. just having a support network to be able to come in and be that bridge between somebody who is dying and the system. i applaud that effort. i'm going to make sure we do everything we can to get that part of the law changed because we can bring advocates into the lives of these struggling men and women. for the spouses that are trying to hold families together, we can do that, too. i want to thank you for your commitment, as well, on the issue of keeping this focus where it belongs. i think some day, i don't think this is a quick turnaround, but i think you brought light, transparency and accountability to another layer america need to hear. while you are talking to us and we are trying to relate and

share your grief and find solutions to move forward, you had an opportunity to talk to the american people today. i guarantee you that every single person you are an influence to that followed your story, i'm going to hear from my constituents today and say, i relate to that mom and that father and i relate to my fellow servicemen. i think it's a tribute today. this is how government works. we have a commitment to make sure we restore, not your sons, but certainly the america that they have been fighting for. certainly our trust and their trust in us as a government who asks them to go, fight for freedom and fight for liberty. our finest heros in that nation. reinstitute by continuing to root out the bad actors and bad policy in the va and together set a reset button. i want to applaud your efforts and thank you for helping us reset an organization that started out as a great effort

and has become a bureaucracy run amuck. you have my commitment none of what you experienced will be in vain. thank you. i yield back my time. >> i would like to yield the first minute to my colleague mr. peters who represents the somers. >> thank you. i want to thank the chairman and the committee for allowing me to be a guest. we are not members of this committee. i don't think there is any place we would rather be this morning. it takes a lot of courage to do what you are doing. thank you for that. also to let you know beyond the power of your stories, it's the education you provide that only you can provide. these are insights that only you have. it's been very valuable to us. while we are new here, i can tell you that from time to time you see testimony that's going to make a difference. that is certainly what's happened today. you can feel very confident that those brothers you talked about and sisters will be heavily affected and helped by the time

you put in and effort you put in today. i also just want to thank in particular howard and jean somers for your leadership, the time you put in on behalf of daniel and the education you've given me. i look forward to continue working with you to make these issues, to resolve these issues and make things right with the veterans that the va sees. thank you. >> thank you, chairman. thank you all for being here. i'm sorry i never got the chance to know daniel or brian. i did have the privilege and honor to know clay. not only know him but work with him on veterans' issues. the profound loss is felt by everyone who came in contact with him. it shook me to the core because of someone so strong and your point on we don't, you are not going to notice it. these are very special individuals. you and i have become friends over the years. we were in st. paul a few weeks ago working on wounded warrior

projects. you hear it from the colleagues. this is a committee of heartfelt folks that want to get this right. i would mention, and i think all of you get this. at this point and the frustration we all feel, solutions and results are all that matter. i'm done with it as you all are. i'm done with the talk. i'm done with the pilot programs. there are suggestions that are concrete. i want to read you something. i came here on the 3rd of january '07, the 9th of january i worked on a bill. one of our colleagues of vietnam veteran pilot leonard boswell. here is a couple of things it said. secretary of veterans affairs should develop a comprehensive program to reduce the incident of suicide among veterans. staff education for compassion amongst them. recognizing respect. proper protocol, screening of veterans receiving medical care.

tracking of veterans in a timely manner. on and on and on. they did not do it. it was in law. we passed it. we gave the speeches. we had the signing ceremonies and went back home and said, gee, we made a difference. it's the very same thing just like you said. i guess the thing i would ask of all you, this is the second, va is the second largest governmental agency behind the dod. yet we have one of the smallest committees. we have committees i don't know what they do and they have 80 staff on them. we can give lip service or get serious how we are going to do it. we can have this or allow if this crisis passes and the american public's attention focuses elsewhere. there are veterans behind you from vietnam and others. they've seen this before. here is what i think is different. there is no doubt the american public wants to get this right. they are entrusting us as their

representatives to get this right. the commitment i've seen from this chairman and ranking members, members of this committee, this is different than the seven years i've been here. it's different how we are fo focusing. we can't let this pass. what i would tell you. you mentioned a thank you for this. chairman miller and representative duckworth and myself along with iva paul and vfw. we are going to introduce 2182. here is what i would say is different. this is a well-intentioned bill. we are going out. this is the silver lining. there is no silver lining when your son is not coming home. you've asked for a solution. i would ask each of you as 2182 starts to move and senator walz

does it in the senate, let's together make sure it doesn't end up as this act. the secretary had the authority. the american people through us said do this and they did not do it. i would only state to each of you as my colleague mr. o'rourke said, this is how democracy can work best. this idea of wringing our hands of who could have anticipated this. really? this bill was started in 2007. here we sit in 2014. keep the faith. we have to. again, i would say this. the cameras, tv, stuff that's there, whatever, none of it means a damn thing. if we don't get results this time, shame on us because here's the thing. i'm not going to get to meet daniel or brian.

you've got the right guys up, the right commitment from the public. now it's going to be, can we do it. with that i yield back. >> thank you. >> i, too, would like to thank you for your courage being here today. please know that your efforts today will make a difference at the va. i want to thank you. mr. and mrs. somers, i want to thank you for that 15-page primer there. i appreciate you all taking the effort to put together a document like that. mr. and mrs. selke, i was disturbed by the comments you found that the environment of the houston va was stressful. could you elaborate on that? what specifically led to that

conclusion? have you been there since? has it changed? tell me more about that. >> i went by myself that day and have not been back there since. for whatever reason, i just felt compelled to go and quickly get his medical records. i wanted to see them. it was again be, for ten weeks' worth of care there so there were not a lot. you drive up to the facility. it's huge, as they all are huge. there were so many people milling around out front. big crowds. lots of people that i don't know if they were there waiting for appointments or if they just don't have anywhere else to go and hang out there. you go inside and i likened it to an airport terminal in a way. you go in and it's just a hub. very busy. lots of people milling around, lines. the cashier lines looked like in

an airport where you would line up to get your tickets or something. it was very stressful for me and of course i was in a grief mode, but not a post traumatic stress mode. i just couldn't imagine -- i could visualize clay going in and i could understand why when he left that day and he called and said i can't go back there, no one was at the information desk. you walk in the front door and they were on a break or something, but no one was there. i looked around and finally found somebody that could direct me to where the medical records are and went and retrieved those. before i left, i remember standing there for a few minutes and just imagining if i were a veteran, if this were clay. >> how do you negotiate this. you mentioned another thing. that was your son had voiced concerns about the care he was

receiving. were there specific concerns he raised? >> i'm not sure i remember what you are referring to. >> okay. let me ask sergeant renschler a question. you wrote that combat veterans in particular often approach mental health care as hesitantly or distrustfully. how would you suggest we change the dynamic to ensure that veterans who need mental health care feel more comfortable accessing the care? >> yes, sir. thank you. it kind of starts with what she was just sharing. even at our facility we have seattle and american lake. seattle is a large hospital building, not laid out very user-friendly. myself, i have a traumatic brain injury i've overcome very well. i get lost and confuse in that

place real bad. there are not a lot of friendly people to direct me. i get better customer service at best buy, quite frankly. a little bit of care training would go a long way within the va medical centers. my other medical center closest to me is a campus with many, many buildings. the building numbers don't make sense. i'll be in 81 and told to go to building 3 which is right neck door. building 61 is across the campus. the numbers make no sense. the facility is confusing, overwhelmingly packed in and not a lot of people to help guide and navigate a very confusing situation. for one, just recognizing who the audience of a veteran is and making an environment conducive to healing would be a start. another one would be, as i discussed earlier and keep bringing back to that interdisciplinary team, it takes rapport. developing a relationship and

rapport with a veteran to get him to go beyond surface level issues with a physician. i'm going to go in and triage myself. on active duty and in the infantry culture, sick call was very discouraged. if you went to sick call you were a wuss and you got crap for it for the rest of the day. so we don't go to sick call unless something is debilitating in nature. that sticks with you the rest of life. as i'm muscling through ridiculous pain my wife will stop and say when are you going to see a chiropractor and get help? it's the mentality to suck it up and drive on. when they get there, it is a crisis and needs to be treated as such. there is a two-fold answer here. number one, the va needs to recognize there is going to be a lot of crisis and come back in

three months is not acceptable. come back in 14 days to intake so you can intake in another 14 days to get treated in three months, still not acceptable. instead, to have a team to say, welcome here. this is your place, this is your team. these are the people caring for you. this is what we are going to do for you and provide better customer service, for one. for two, develop a relationship of trust and rapport so i can know i can confide in these people to provide the quality care that i know they should. >> thank you. >> i hope that answers, sir. >> thank you very much. i'm out of time. >> thank you, mr. chairman. thank you, all, for being here. your stories are just tragic and heart wrenching. i hope you can take some comfort knowing what powerful advocates you are. you have told your stories so eloquently, so ordinarily, so

thoroughly that it really will help us to move forward. i've just been noting down some things we need to address. i think we are at a point where we really can make a defense. in addition to the things you suggested, i want this committee and the people in the room and i ask you for your help on this, for us to address some other things that i think are also related to the problem. first, you are obviously very loving families. you were there for your children. many of our veterans don't have families like that. there are many homeless veterans, they are sleeping on the streets, they don't know where to go. they don't have somebody they can turn to. so we need to figure out a way how we can address the problem for those veterans as well as for those like your children. i want us to not overlook that. a second thing is the vsos are there to provide services to

veterans. when they don't have that ability to bond like they do while they are in the military, the vso is there, they can't be there 24/7 like your band of brothers and sisters can, but they're there. maybe we need to look at some ways we can help them to do more outreach and better fill that gap for when people come out. also, we heard some horror stories about the medicine and all the different drugs. i think we begin to hear medical marijuana is a possible way to address ptsd. let's don't leave that off the table as we move forward. even something as simple as the notion of companion dogs. that is something you hear, too. many vets, if they have a pet, that helps them get through some of these troubled times. let's keep that on the agenda. you mentioned about being a

firefighter. when veterans come back, they don't just need health care, both mental and physical, but they need to be able to transition into civilian life with easy access to education so some of their training counts towards college credits or employment, to retrain and have jobs so they have something to look forward to that takes a little of that burden off. those are all things we need to look at the big picture. i just thank you very much for committing to continue to go down this path with us. i would ask you, too, don't leave anything off the table. anything you can think of no matter what it might be, now's the time for us to address it. i don't know if you want to comment. i don't want to put you through more questions. >> i have one more comment. >> the door is open. >> i know that the va has the emergency crisis line, 1-800-273-talk, but i work for

an insurance company. we have what we call nurse line. any time a member can call 24/7, 365 days a year, why do we have to wait till it's a crisis to have anybody to talk when they are starting to feel depressed would be a great time for a nurse to be able to assess and triage what this person needs. can it wait tomorrow, routine two, three days what do they need? waiting till it's a crisis line, you are more down that slippery slope. >> if i might add, we are fairly new at this whole political thing, but i came across something called the independent budget, which if i'm interpreting correctly the vso put together for congress. i would ask that next time that comes to you, you really look at that really, really closely.

these are your veterans talking to you. >> i'd like to just add quickly. one of the things that clay said over the years that sticks with me and it just is wrong. he would say over and over, i have to grovel for my benefits. i just think we need to wake up as a country. our veterans should not have to grovel for anything. it just should not be so difficult to get the care they need at all. >> thank you very much. >> thank you, mr. chairman. i can't thank you enough for being here today, the sacrifices that you have made. i pray that the sacrifices that you and your entire family made will make us a better nation at the end of the day.

i think most that sign up to serve have that intention, that they will make this a better nation at the end of the day. i am a physician and also a reservist and i served in iraq for a year. that has led me to want to be here today. one of the things i know as a doctor and i'm sure dr. somers you can relate, that when you have patients, regardless of their problems, there is a level of anxiety that, because they have something wrong, whether it's muscular, skeletal or mental, it doesn't matter. something is wrong and there is anxiety. it makes it more difficult and heightens the anxiety when you have all these administrative problems. i know you started to deal with that in private practice. more so maybe than when you first started. the prescription you think is best, they're not allowed to have. those types of things increase

the patient problem in actually trying to take care of the patient. we really are here, i will say on this committee beings not just to complain but to come up with solutions. so your input today is extremely valuable. one of the things i see is if a doctor's credentialed with one va, he should be credentialed with every va that allows him to go from one to another if there is a deficit. if your prescription is good at one va it should be good at another va. you can do that if your patient is out of town, you can call another state and get the prescription filled. when you can't, think of the anxiety that comes with that. these are things we can fix. these are things we've got to fix. i'll also contend it's a big difference, too, being in uniform and out of uniform as far as care. as a reservist, i can just remember being with that family for 15 months. then all of a sudden, i'm the

last one left at the airport going home. when i get home they say you have 90 days to go back to work. i said, that ain't going to work. i'm going back in two weeks. i'm getting my house in order and go back to have something t. and so when you're just wallowing out there, and i think we need to engage. this is dod side, engage in what you're doing when you go home. and have the v.a. be part of that as well. and we've got to blend these two systems together. we have to engage in the post-deployment activity. when i have been in uniform, i had an opportunity to serve in preventive medicine. we learn a lot. we get a lot of training in uniform of what to look for and have the battle buddy and the types of symptoms you're looking for. sometimes when the decision is made that you're going to take your life, there's a calmness. you look for someone giving away their stamp collection, their coin collection, because they have made up their mind, and

they spend more time with family because they made the decision their problems are going away. those are the types of things we get. you get them in uniform, but you don't get them after. for guard and reserve in particular, you just go home. i did see -- i have seen at ft. lewis, for example, families engaged with programs, but it doesn't happen the same way with guard and reserve, and it's a different animal. i guess more than anything else, what i want to do, when you talk about solutions, we can all be trained to look for solutions and signs, but how do we go about preventing the very ideation of taking one's life? what are we doing that creates a situation where someone comes up with that ideation that this is the best way to go? and that's the type of input we need. and that to me is really preventive medicine more than anything else. and i hope that through this, we find our way, because our suicide rate is going up in our civilian population as well. so we have a national problem

here, not just a military problem. again, i applaud all your input. it's extremely helpful to us. and as you have seen, this is a determined group here that wants to make a difference in the history of our nation as we move forward. and we're glad to have you as a part of it. so your input is always welcome, and thank you for commitment. i yield back. >> thank you, doctor. check your mike. >> thank you, mr. miller and mr. michaud for allowing me to participate in today's hearing and special thanks to my colleague from arizona who represents our community so well. i want to thank all of the panelists, in particular, thank you to daniel's parents, howard and jean, for being here. we worked together quite closely, and learning of daniel's suicide, and it is an

honor and a privilege to be here with you again today. unfortunately, daniel's story and the story of the other young men who committed suicide is all too familiar in our country. and 22 veterans a day are still committing suicide. even after we have heard the tragedies of the young men who lost their lives here. and their brothers all across this country. and as we heard from mr. walz, congress has addressed this issue before, passed legislation before, said they were going to fix it before. yet, the problem has not only gotten better, it's gotten worse. i have heard a lot of testimony today about ideas to actually reform the system and make it better. the hipaa issue i think is one that the committee would agree needs to be addressed. i'm particularly interested in the pilot program that sergeant renschler participated in. my question would be about

daniel. daniel's experience with the phoenix v.a., like many, many veterans' experience at the v.a. was one of lack of concern, lack of care, lack of follow through, and a discombobulated system that didn't allow veterans to get the care they needed. in particular, one of the struggles daniel faced was as a individual who served in classified service, he was unable to participate in group therapy. because he was not able to share the experiences he experienced while in service. and yet, at the phoenix v.a., he was unceremoniously put into group therapy, and when requested private therapy, was not able to get that care. and of course, as we know, he took his own life as a result of being unable to get that care. the medical home model, i believe, in the private community has provided an opportunity to create patient center care. and allow civilians to get the care they need in one home,

easily, that's centered directly on their needs. while the private program in washington was ended because of -- well, i don't understand why. they said they didn't have enough money for it, which i think is outrageous and a horrible, horrible reason to stop providing care we know is effective and appropriate. my question for dr. jean somers is whether you believe a medical home model would work or could be helpful to veterans like daniel? we know many of our post-9/11 ved rns face ptsd, physical problems. would it have been a model that may have worked better for daniel than what he faced? >> absolutely. as daniel's irritable bowel syndrome worsened, he didn't feel he could physically leave

the house. i can't imagine that embarrassment. and then as howard mentioned, at the time, phoenix had the speed traps set up on the major highway to get from his home to the phoenix v.a., so he actually had to find a way to get off of the highway so that the flashing lights would not affect him. so absolutely. i can see that it would have been very helpful to him just to have the privacy capability. >> i completely agree. i think not only the medical home model, but what we talked about, the ability within the facility for the different people, because of his ibs and his tbi and his ptsd, you're being treated as we learned here, the term being in silos.

and what you have to do is you have to get out of the silos and you have to combine resources, combine knowledge. and we have heard of programs such as was mentioned that have very successful, where people can have problems and for whatever reason, you have an optometrist or opththalmologist in there and they say it sounds like it's not this but this, and something you might not have thought of. the medical home ability, the ability to create these panels of care would be overwhelmingly positive. >> i want to take a moment to thank mr. benishek for cosponsoring legislation we drafted with the somers to address the issue of the service members who served in classified settings and who need appropriate care when they return to the v.a. i want to thank the subcommittee and the committee for supporting just a part of the solution to this issue. thank you. i yield back my time. >> thank you very much. >> i really appreciate it.

and i appreciate the panel testifying and appreciate your courage. i want to ask about the alternatives to medication. and i want to ask the entire panel, which alternatives do you believe the v.a. could consider in addressing the mental health issue? i realize you have to have some medication in most cases prescribed, but i'm familiar with the recreational therapy that the chairman and i participated in a field hearing not too long ago on recreational therapy, the equine therapy, in my district, we have a quantum leap farms. they're all over. they travel from all over the country to go to quantum leap. the service dogs do wonders, i understand, from talking to veterans. just to name a few. but can you maybe elaborate a little bit with regard to the al turnatives to the medication for

mental health therapy, ptsd, tbi, what have you? >> yes, brian had a brother who came back and he had ptsd, and he had a friend that was doing some gardening, so he started just working in gardening with him. pretty soon, they realized they really liked it, and their garden was pretty good, so they decided to make it bigger. then they thought, let's take these vegetables and take it to market and see if we can sell them. so now they have this huge area, and they do this. i have also heard of veterans going on farms because there's not a lot of loud noises and flashing lights and, you know, the sound issues they have with ptsd. so those are two others. >> thank you. anyone else, please? >> we could just put together an extensive list of what veterans use to cope with these things

outside of medications. motorcycle riding, bike riding, equine therapy, service animals. i mean, the list could go on and on. and i would rather stress the importance of the fact that there's no one solution, and until the v.a. can get to implementing best practices system wide and tailor fitting to each individual veteran's needs and using these known best practices that exist out there until they can do that, we're not going to be able to fix anything. we can put policy in place saying you have to provide access to these individual treatments that exist, but it's the implementation of that policy that's the major issue here. and yeah, i mean, the list is extensive. >> thank you very much. definitely one size does not fit

all. anyone else? >> i would like to weigh in on that. we hear a lot of the excuses that we heard in phoenix was, it has to be evidence-based treatment. and how do you get innovative therapy if everything has to be evidence-based before they'll use it? i think they need to open up their minds a little bit and think outside the box, as you have heard, not every therapy works for every person. everything does have to be individualized, and i have heard of gardening before, too. as being very therapeutic for people. i think they need to get out of the mentality that this is all we can do. we have these blinders on. >> thank you very much. bottom line is we need to listen to the vets, just like you said. anyone else, please? >> i think it's, again too, use the word holistic. it's a community, it's a lifestyle sort of approach. i mean, the v.a. needs to do

what the v.a. needs to do the best way the v.a. can do it. but the v.a. can't do everything, so there are a lot of -- clay kind of put together his own kind of therapy program. he got involved in service. that was helping him. he got involved with iva, storm in the hill, and their community. he got involved with team rubicon, doing disaster relief programs. he got involved with ride and recover, riding bikes. that was great for him to be able to heal, but it was also great for him to be there to help his brothers and sisters heal. the problem, you know, for whatever reason, when a person decides to take their life, they have given up hope. so what do you do about that? and clay could do everything. he could go on these, you know, on these missions and he could do one-week bike rides, but what got him was being alone. in his apartment by himself,

helpless. and there's questions of matters of faith there. but it is a community approach. people need to come to government and volunteer organizations, partner, no one organization, not even the government, can do it all. and everybody needs to realize that and come together and take care of these folks. >> thank you so very much. i yield back, mr. chairman. >> mr. jolly is recognized for five minutes. >> thank you, mr. chairman. i want to associate myself with the comments of mr. bilirakis about alternative therapies. we know they work. and mrs. somers, i appreciate your comments about evidence-based. i'm not a doctor, but i have seen evidence that non-drug therapies work. that should be good enough for the veteran, it should be good enough for the v.a. i want to talk a little bit about the v.a. acknowledgment of

non-drug therapies and your experience with that, understanding every case is going to be different. i hosted a v.a. intake day recently. we had about 300 people come through the congressional office in the district. one man brought a backpack he brought to my desk and dumped out surplus medications. dozens and dozens of bottles of them. sergeant you referred fractuyou cocktail going from 11 to 14. you have expressed concerns about ambien and the use of generics and otherwise. just on its face, do you lack confidence in the way the v.a. administers pharmaceuticals, not on the merits of pharmaceuticals, but in the experience of pharmaceutical use administers and directed by the v.a.? >> i'll speak to that. i spoke earlier about the difficulty of clay getting a prescription refilled. but what has been said before in the private world, if i go to a

doctor and they determine i need sin tloid for my low thyroid issue, i go and i get it and i stay on it as long as i'm retested and that's shown to be effective. i don't understand why the dod and the v.a. have two different pharmaceutical programs and the veteran has to suffer the consequences when you separate from the service and move to v.a., especially on mental health drugs. you just, you can't swap them out and stop cold and all of that. or even on anything physical. it makes no sense to me. i don't understand why one system wouldn't work for both. why not whatever works for dod as far as pharmaceutical medications or anything, why does the v.a. have to be

different? it sounds to me like it's cost factor. they have to shift to the cheaper route. well, we have people dying every day because we have switched to the cheaper road. >> i realize very much so this is just a matter of personal impression and not clinical, but my concern having heard each of your stories is that simply because of the volume of patients, million plus volume of mental health patients, 21,000 employees. you raised the concern about personalized care. it would seem to me it's clearly lacking. i don't know what your impressions would be if you could speak to that, and also, simply whether or not alternative therapies have ever, your sons had that discussed perhaps, or sergeant, in your counseling, the ability to get alternative therapy? i say that based on a personal experience as well, at v.a. intake day, i had a man in my office who said equine therapy works. well, that was good enough for me. but it wasn't good enough for

the v.a., so can you speak to any discussions about alternative therapies, availability of, your opinions to that. >> yes, sir. so again within the v.a. medical center, they had at one point in time available the poly trauma patients, those who suffered for conditions, we were able to access recreational therapy. i was put on a six-month waiting list, and when the six months came up, they lost the recreational therapist, so that was my only experience there. never had a chance to engage in that because i was downgraded from poly trauma care when the v.a. determined my traumatic brain injury reached the plateau of recovery and probably wouldn't get better. that's a completely separate hearing day. as far as the efficacy of alternative therapies, we could, again, it really helps. and the v.a. currently -- >> the availability. >> the availability is not there

through v.a. channels. it's private community is where you have to go. >> dr. and ms. somers -- >> i would agree. daniel himself was a musician, so he was easy for him. he got a piano and a guitar, and that was his therapy, but i would totally agree with that. at the san diego v.a., i know they have pottery classes. which we were thrilled to hear about, and a guitar program. >> and when you talk about evidence-based, it's certainly not just medications. there are the psychological treatments that are out there, but they're only using two of them at this time when there are so many other potentials out there. the other thing we mentioned is the mdma, ecstasy, and lsd for pain. the mdma for ptsd and lsd for pain. because of our national phobia against these particular chemicals, we're making it very

difficult to do trials with these potential, potential benefits. >> thank you very much. thank you to each of you. mr. chairman, i yield back. >> thank you very much, members. we thank the witnesses for participating, whether or not you know it, you have been at that table for three hours. and we are very thankful that you have been willing to share your stories with us. so with that, thank you very much. and you may be excused. [ applause ]

>> i would like to invite the witnesses to please come forward. joining us at the table will be from v.a., dr. maureen mccarthy, deputy chief patient care service officer.

she will have dr. david carroll, the acting deputy chief consultant for special mental health with her at the table. our third panel includes alex nicholson, the legislative director for the iraq and afghanistan veterans of america. lieutenant general martin steele, associate vice president for the veterans research, the executive director of military partnerships and the co-chair of the veterans reintegration steering commit for the university of south florida. also warren goldstein, the assistant director for tbi and ptsd program for the american legions national veterans affairs and rehabilitation commission, and dr. sharon, chief executive officer and executive vice president for military communities for

volunteers of america. thank you all for being here. and dr. mccarthy, you are recognized for your opening statement. >> thank you. >> good morning chairman miller, ranking member michaud, and members of the committee. i appreciate the opportunity to discuss the health care for our nation's veterans. i'm accompanied today by dr. david carroll, acting deputy chief consultant, as you mentioned, and our acting chief consultant for mental health and dr. michael fischer has joined us as well. let me begin by expressing my sorrow and regret to the families of daniel, clay, and brian. i want to thank you for coming forward and telling your story and their stories. we truly believe that when death by suicide is one too many. thank you, joshua, as well, for sharing your experiences.

veterans who reach out for help deserve to receive that help. a veteran in emotional distress deserves to find there are no wrong doors when seeking help. at v.a., we must insure those doors are swiftly opened. calls are returned, messages are responded promptly, efficiently and compassionately. over1 million veterans, service members and their family members have called our crisis line and received help. suicide rates among those who are v.a. users, who have a mental health diagnosis have dereed decreased. the rates of suicide following a suicide attempt have likewise decreased. we invite veterans to entrust their care to us, and we want to insure them that we can provide the care they need or connect them with someone else who can. tragically, it is true that about 22 veterans per day die of

suicide. but another tragedy is 5 of those 22 veterans are veterans who have been in our care. we acknowledge that we have more work to do, and we are fully committed to fixing the problems we face in order to better serve veterans. our actions include the deployment of mobile vet centers to locations with the greatest challenges in providing timely mental health care. examples include el paso and phoenix. we have begun a program to insure veterans waiting more than 30 days for care may receive mental health care in the community from providers who are not v.a. employees. we have removed access measures but not expectations about access and are focusing on veteran satisfaction with the timeliness of care they received. we have initiated operation save, a training program for suicide prevention delivered by our suicide prevention

coordinatored to vha and vba staff. we have provided suicide risk management training for clinicians. this is a v.a. mandated training for all v.a. clinical staff which teaches about assessment, warning signs, risks, means restriction, and safety plans. and we've developed a web-based training for clinicians specifically focusing on women veterans who are struggling with suicidal thoughts about how to recognize their disstrtress and bring them into treatment. our actions take into meeting the increasing demand for mental health care include the addition of 2400 mental health professions and 915 peer support providers since march of 2012. we have expanded the veteran crisis services, renamed it as a suicide line to a crisis line to reach out specifically to those in crisis or not quite yet in crisis.

in order to offer both text messaging and an online chat service in addition to receiving phone calls. we've partners with the vet center combat call center to respond to veterans in distress. we have greatly expanded opportunities to access mental health, including in rural areas by telemedicine. we have created mobile apps to assist veterans with their symptoms. we have had focus on improving care in the community for those who might not seek our health. we have trained community providers on military culture and partnered in community engagement. we've partnered with the department of defense in depping clinical practice guidelines for suicide risk assessments and intervention and for the care of ptsd, depression, and substance abuse. we also reach out to guard and reserves at the mobilization events to bridge the gaps and understanding about benefits and services. we've greatly expanded the

provision of evidence based treatments, including psychotherapies for mental health conditions. v.a. is committed to working with families and friends of veterans. we know mental health outcomes improve when families are involved in care. we now have a family services continuum that includes family education, consultation, psychooeducation, and marriage and family counseling, and research remains under way to address improvement of mental health care and prevention of suicide. to maximize what we can provide, we have developed measures of provider productivity. integrated mental health care into primary care settings, and initiated several campaigns to break down any barriers or stigmas that may be associated with seeking health. we have developed a program on college campuses where student veterans may receive needed mental health care without leaving the campus. mr. chairman, we're fully

committed to insuring accessible mental health care of the highest quality for our service members and veterans who have sacrificed so much on our behalf. we are committed in our efforts to decrease suicide by decreasing risks we can identify and focusing meanwhile on improving the quality of life for these veterans. v.a. will continue to provide care in a veteran centered manner, expanding access and breaking down barriers associated with seeking help. we are compassionately committed to serve those who served, making it easier for them to ask for and receive the help they need. mr. chairman, this concludes my testimony. my colleagues and i are prepared to answer your questions as the panel proceeds. >> mr. nicholson, you're recognized. >> thank you, mr. chairman, ranking member misead and members of the committee. we really appreciate the opportunity to share with you our views and recommendations

regarding mental health access at the v.a. and suicide prevention efforts. combatting veteran suicide is v.a.'s top priority for 2014. and it's a critically important issue that affects the lives of tens of thousands of service members and veterans, especially of the wars in iraq and afghanistan. in the 2014 member survey, our members listed suicide prevention and mental health care as the number one issue facing our generation of veterans. in that same survey that was just conducted in february and march of this year, 47% of respondents reported that they knew an iraq or afghanistan veteran who had attempted suicide. and over 40% knew an iraq and afghanistan veteran who had died by suicide. we have over 270,000 members. 40% of them know someone who was

a fellow veteran of iraq and afghanistan who has died already by suicide. in response to the overwhelming need for action, iava launched a campaign to combat suicide which includes a call for comprehensive legislation that can serve as a cornerstone across the government and across the country. in addition to legislation, iava is calling on president obama to issue an executive order to address additional aspects of suicide prevention efforts. and iava is working to connect more than 1 million veterans this year with mental health services across the country. the need to examine mental health services and suicide prevention efforts provided to veterans is more critical in light of the v.a. scheduling crisis. in addition to the general delayed access to care veterans are experiencing as i'm sure all of you know, veshinvestigationse also uncovered significantly delayed access specifically to mental health care.

while no veteran should have to wait months for a medical appointment of any time, veterans utilizing mental health services and especially those in crisis should never have to wait an unreasonable time to be seen by a medical health care provider. providing timely and efficient mental health care must be a much greater priority for the v.a. moving forward. increasing the accessibility of mental health services must also be combined with access to care for vulnerable populations of veterans currently excluded from v.a. car. between 2001 and 2011, an estimated 30,000 service members may have received a downgraded discharge characterization due to a misdiagnosis of personality disorder. even more troubling, an unknown number of service members were punitively discharged for disciplinary actions that may have been related to an undiagnosed mental health injury.

it's imperative that those individuals are identified and their records are properly re-evaluated and rectified in order to provide access to earned v.a. mental health services and benefits. examining access to care should also include a review of the current five-year special combat eligibility for v.a. health care provided to recently transitioned veterans. the five-year time period may not be enough time for veterans who present with mental health symptoms later or who might delay care due to concerns of stigma of seeking care. extending special combat eligibility, though it may be costly, will provide access to care for veterans when they are ready to seek it. it is important to recognize the efforts that the v.a. has put into mental health care services and suicide prevention programs in recent years and especially as has been mentioned already in the veterans crisis line has been an enormous resource for

our community, and the v.a. has done a terrific job with promoting that, and we have been happy to partner with them in helping to promote that, and we refer veterans in crisis to the veterans crisis line through our rapid response program every single day. it's been a fantastic resource. but more, of course, needs to be done. increasing access to care, meeting the demand of that care, and providing high quality care with continuity and responding to veterans in crisis requires a comprehensive approach. and while there is no illusion that veteran suicide will be completely eradicated, implementing better approaches to mental health care and suicide prevention can and does save lives. again, we appreciate the opportunity to share our views on this topic and we look forward to continuing to work with each of you and your staff on the committee to improve the lives of veterans and their families, thank you. >> thank you, mr. nicholson.

general steele, who is the co-chair of the veterans reintegration committee. >> thank you, chairman miller, ranking member michaud, distinguished members of the committee, on behalf of the university of south florida, thank you for holding today's oversight hearing. by way of a brief background, the university of south florida is a global research university with over 47,000 students, including over 2200 veterans and their families. military times edge magazine recently ranked usf the fifth best college for being veteran friendly in the united states out of 4,000 colleges and universities. under the leadership of our president and our senior vice president for research and innovation, numerous usf researchers are currently involved in funded studies related to such topics as suicide prevention, traumatic brain injury, post traumatic

stress, robotics and prosthetics, speech pathology and audiologist, and age-related disorders. we have numerous research and health care partnerships through aff affiliation agreements to include the james a. haley hospital along with the cw bill young v.a. hospital located in st. petersburg. we have memorandum of understand with united states central command, u.s. special operations command, and work closely with mcbill air force base and the pentagon. our veterans research reintegration steering committee consists of scientists throughout usf's faculty, staff, and students who work with veterans along with representatives from the veterans administration, the care coalition of special operations command, and draper laboratories. we do have a holistic approach in regards to education to provide services to our veterans and their families. in order to address the mental

health needs of our veterans and our diverse population of at-risk students, we have embarked on a collaborative suicide prevention project. this is a three-year initiative funded by a $306 million grant provided by the substance abuse and mental health administration. some of the goals and measurable objectives of the project are to increase the number of persons involved in suicide prevention efforts, reduce the stigma associated with it, and the barriers, and increase family involvement in suicide prevention. as you are aware, the blue ribbon panel of the v.a. medical school affiliation was established in 2006 to look at, quote, a comprehensive fi philosophical approach with medical schools and affil yalted institutions. unquote. the panel believes the crisis in the u.s. health care system offered a unique opportunity to explore fundamentally new and better models of patient care,

enl kashz, and research. as the panel revealed, currently available mechanisms for meaningful dialogue between v.a. and the academic community were inadequate. some of the major challenges include credentialing as was mentioned earlier, which required considerable time along with the research approval process, which is cumbersome, very time consuming for both parties. the process takes months, and in some cases, can take over a year just for approval. there are also many barriers to innovation. one of our professors has an innovative approach for treatment of post traumatic stress and is highly unlikely, we believe, to receive approval from the v.a. health care facility. a.r.t. for post traumatic stress has proven to be successful, yet the v.a. has not accepted invitations to collaborate on a pilot study for patients diagnosed with pts. we do work with the department

of defense. i have been there in virginia and ft. benning in georgia and also to work with the protocol which has been proven very success flg. we recommend streamlining the credential process and creating fasttrack approvals for collaborative pilot studies between the v.a. and research universities that involve minimal risk to the patients but could provide benefits to treatment of mental disorders. we also recommend developing agreements between v.a. at the national level and academic communities throughout the country. we also believe the definition of academic affiliates need to be re-examined to move beyond the limited focus on health care to a much more encompassing venue that would include employment, education, business deployment, and increased research funding. in 2012, a v.a. research

scientist from usf along with a research scientist from the medical research service at james haley conducted a preclinical animal research linking post traumatic stress, mild tbi, and the potential for suicide in the military. we believe their research needs to be extended to learn more about how the brain is affected by physical and emotional trauma. more importantly, we believe this type of animal research will lead to more effective treatments for post traumatic stress and tbi, which will potentially reduce the risk of suicide in the military and veteran population and could be influential in alternative drug protocols. the 2006 blue ribbon panel also noted with concern the aging v.a.'s research infrastructure. the panel recommended that v.a. enhance its research facilities by fully exploiting opportunities to share core resources with its academic affiliates. to that end, the university of south florida recommends strong consideration of the development

of a singular unique one of a kind research clinical and outpatient treatment facility. this initiative is intended to be a collaborative venture between the department of defense, the veterans administration and usf in order to meet the health and welfare needs of our veterans and their families. usf remains committed to providing the nexus to foster research collaborations in pursuit of excellence and the rehabilitation adjustment, resilience, and reintegration of wounded warriors and their families into civilian life. our nation's dedicated heroes from all wars deserve to have the benefit of the best research and services available in order to return to productive lives as members of our society with jobs and homes for the sacrifices they and their families have made for our country. thank you again for holding this hearing and the opportunity i have to submit this testimony. >> thank you, general. mr. goldstein, you're recognized five minutes. >> thank you, mr. chairman. every day in america, 82 people

take their own life. that's one every 17 and a half minutes. since this hearing began over three hours ago, statistically approximately 12 people have chosen to end their live with suicide. 1 in 4 suicides is a veteran. 26% of suicides are veterans. and veterans only make up 7% of the population. the stakes could not be higher. we must find a solution to this problem. chairman miller, ranking member michaud and members of the committee, on behalf of our national commander dan dillinger and the 2.4 million members of the american legion, i thank you for taking on one of the most serious challenges facing america's veterans. finding solutions for this mental health crisis. the mental health of veterans is something the american legion takes very seriously. the american legion established a committee on tbi and ptsd in 2010 because of growing concerns about the unprecedented numbers of veterans returning home with

what is come to be called the signature wounds of the war on terror. since then, legion staff along with senior leadership has met regularly with academia, medical consultants, experts in mental health and science, and we published the finding of a three-year study to treatments and therapies in a report called the war within, which is also available on our american legion website. following up on that report, we recently conducted an online survey to evaluate the efficacy and availability of treatments and what we found was somewhat disturbing. the result of the survey culted in coordination with the data recognition coordination showed a third of veterans had turninated treatment plans before completion and almost 60% of veterans reported no improvement or feeling worse after having undergone treatment. clearly, there are problems with the current practices in place.

the american legion convened a symposium last month to discuss these findings and highlight over areas where complementary and alternati tative treatmentsd prove helpful. we listened and saw first hand the encouraging results of veterans who benefits from animal therapy with service dogs, art therapies, acupuncture and a pohost of other nontraditional treatments. the american legion believes by exploring options like these, we can work together to help the veterans get the treatment they need. it's devastating when a veteran can't get timely appointments. 50% of veterans reporting no changes or worsening symptoms says that what care they're getting is just as important as whether or not they can access the care in the first place. this is not to say access doesn't matter. indeed, over the past several months, the difficulties veterans face accessing care have been front-page news and have been a major focus for this

committee. for the american legion, it wasn't enough to sit and watchidally as veterans struggled to get help. we had to go do something about it. that's why the american legion developed veterans crisis command centers that have been deployed across the country. as specifically where it had been reported that veterans were being stonewalled while trying to seek care. by utilizing american legion posts already located in every community in america, the american legion has combined town hall meetings and coordination of care for veterans so they can get the immediate counseling and medical help they have earned and desperately need without getting in the way of v.a.'s ongoing efforts. we're there to augment their efforts and be a force multiplier. so far in phoenix, arizona, el paso, texas, and fayetteville, north carolina, we have been able to reach 2,000 veterans and next week, we'll expand operations to two new locations in st. louis, missouri, and ft. collins, colorado.

with more locations to follow as we try to get help to veterans. yes, there are things v.a. should be doing to make sure veterans in crisis get the help they need, but we now see that veterans can't just depend on v.a. to fix the problem. that's why the american legion has full-time staff and a leadership community dedicated to studying the challenges of mental health treatments, to insure the way america treats veterans is a way that will bring real improvements to their lives. that's why veterans, v.a., and local business across the country are supporting our veterans crisis command centers and donating their time and efforts to link veterans with the resources they need. by the time the panel finishes ouronaling remarks, america will have lost another person to suicide. that is a terrible tragedy. we all have to work together to insure that this rate cannot and will not continue. thank you. >> thank you. >> thank you, chairman miller,

thank you mr. michaud and committee for convening and asking me to testify. i currently serve as executive vice president for veterans communities. while i'm not a veteran, my life's calling has been to serve veterans. having works for a decade at vampt as a psychiatrist and chief of mental health, i have been able to observe the v.a. from both the inside and out. this experience has given me a unique perspective as to the nature of access problems facing veterans and possible solutions. in general, i contend that the most immediate solutions reside in growing capacity through more robust partnerships between v.a. and local communities. working alongside v.a. last year, voa supported in-house more than 10,000 homeless veterans, a number that will increase this year. though significant, the opportunity for impact in partnership with v.a. is much

larger and can include helping veterans at risk of watching their unmet needs become urgent problems that evolve into mental health crises. due to inadequate access. the v.a. has a golden opportunity to lead this effort right now by leveraging organizations like voa to grow capacity and improve access. in contemplating partnership strategies, it is important to recognize that access barriers go way beyond wait times. red flags in isolation, and inadequate knowledge of available resources, an unwillingness to engage in the health seeking process. difficulty navigating complex systems and lack of care coordination all impact access. recognizing this array of access barriers, voa has developed the battle buddy bridge program. a program rooted in trust and designed to mitigate access

barriers through real time peer-to-peer engagement and local resource navigation. peer approaches which are used by other organizations including the augusta warrior project, team red, white, and blue. iava, the mission continues, team rubicon, and others transform the access dynamic in many cases. as such, it is my first recommendation that community-based peer engagement and navigation programs be brought to scale with federal support as part of an all-out assault on access barriers at the v.a. and beyond. leveraging this model further, my second recommendation is for the v.a. and the private sector to set up rally points in communities as well as on v.a. campuses that are endowed with trained peers, vehicles, resource maps, and tightly linked to v.a.'s suicide prevention program, the national crisis hotline, 211 exchanges,

tech based veteran community portals and any other referral sources of relevance. rally point networks could have a profound impact on access in any geography. as a final point, i want to highlight a major partnership -- a major partnership success story that supported services for veteran families program of the v.a. this program administered by v.a.'s national center for homelessness among veterans has fostered relationships between v.a. and communities that are unprecedented. in the opinion of many experts in both the community and the v.a., the streamlined structure of ssvf offers the best means for managing partnerships going forward. as such, my third and final recommendation for resolving mental health access issues and improving suicide prevention going forward is to -- for the

v.a. to adopt an ssfv like mechanism as the basic template for v.a. to use in developing more robust partnerships. by using this mechanism, v.a. can most effectively leverage partners to create programs that improve access to the vast array of resources which address mental health conditions. to close, more robust partnerships between the v.a. and community will not only help veterans enrolled in v.a. to get better access. it may also help veterans -- it may also help provide access to veterans who refuse to enroll in the v.a. as well as veterans who are located in remote areas. let's all take advantage of recent untoward findings at v.a. and recognize that while inadequate access to care in the veteran population reflects the shortcomings of a federal agency, it also reflects a fundamental failure of the

american community and process. it is time to roll out a new era of public/private partnership that grows capacity and insures veterans have access to the resources they need for successful community reintegration. >> thank you very much, doctor. dr. mccarthy, on tuesday evening, this committee heard from a whistleblower, the former chief of psychiatry at the st. louis v.a. medical center. are you aware of his testimony? >> i'm aware of it, yes, sir. >> he stated he could not identify within his clinic the average number of veterans that are seen by a provider per day or the time a provider spends on direct patient care per day. when he asked other psychiatry chiefs to estimate similar data at their facilities, he received answers that ranged from 8 to 16 veterans per psychiatrist per

day. we worked with the v.a. database administrator and psychiatry director, he said he was shocked to find that outpatient psychiatrists at the st. louis v.a. were only seeing six vettens on eight hours for 30-minute appointments with a rare 60-minute appointment, only three of those each week, and he could only account for three and a half hours of work in an eight-hour day. as we have already heard people talk about a nationwide shortage of mental health providers, do you feel the utilization of staff at v.a. is appropriate? >> sir, that's why we have what we call the spark tool. this is something we have developed as part of our productivity model. >> my question, i'm sorry, my question is, do you think that utilization of staff at this level is appropriate? >> i do not believe that what you said is an appropriate way to use staff. however, i have data that may

not be the full story. >> do you know what the mental health staffing is and productivity requirements throughout the system? >> i know the model which is in terms of the number of psychiatrists in a given population. >> whose model? >> it's our model, sir. >> v.a.'s model? >> yes, sir. >> okay. should we be using what v.a. wants now or should we be looking outside of v.a.? >> it seems like it may not be a right answer to your question, but i can tell you why the model developed. it's a team-based model of care. >> from v.a.? >> yes, sir. >> okay. do you know what the health staffing and productivity requirements are throughout the system? >> we have a quadrant type model which looks at productivity and other measures to determine if we are staffing appropriately. >> do you know what the standard is? >> okay, help me understand, are you asking how many are used per

physician per day? >> i guess that's good enough. do you? >> i don't have the exact expectations -- >> the other question is, is v.a. meeting the standards? >> sir, i can't answer that question. if we look at our work value units compared to the national average for physicians who are psychiatrists as well as for psychologists, we are meeting the national average for productivity. >> according to whose numbers? are those numbers that v.a. establishes or -- >> no, they're external -- >> no, no, i'm talking about internal numbers. >> okay. >> are your folks reporting a truthful number? >> what that model is based on is the actual encounters that occur. >> no, no, are your folks telling the truth? >> yes, sir. >> everywhere? >> i can't answer a question like that, sir, but about the model, i can tell you that the

numbers are duriven from a cystine that can't be manipulated. >> based on what we have seen the last three or four months, do you trust the numbers people are given? >> if you ask me about access nebs, i don't. there has been affidavits before the committee that shows that access numbers are not reliable. >> but you think the other numbers are reliable? >> there are some numbers that are reliable, yes, sir. i have been looking for numbers that we can try and understand measures of our access and timeliness of care. and we have, for instance, numbers of -- >> let me ask you a better question. would you bet your life that the numbers that people give you are truthful? >> i'm sorry, sir. are you talking about numbers related to productivity? >> i don't care what the number is. would you bet your life on any number that somebody gives you as a truthful number because we just had a panel of witnesses

who have lost their children. they lost their lives. now, i'm asking you, would you bet your life that the information that people are telling you is truthful? >> sir, i would not. i would not bet my life. >> that's all i need to hear. thank you very much. mr. michaud. >> thank you very much, mr. chairman. dr. mccarthy, we heard an earlier panel issue dealing with hipaa. my question as it relates to hipaa is actually in the department. and i actually did find the oig report, and i heard that the veterans health administration and the veterans benefit administration could not exchange information because of hipaa problems. they both work for the same department. i'm not sure why there would be any hipaa problems with vha talking to vba. my question is, is the

recommendation from the oig back in 2011 was that the v.a. medical center directors and vba directors will meet monthly. they meet monthly and discuss this issue. has that issue about any hipaa problems been resolved between vha and vba? do you know what the outcome of that is? if not, could you get back to the committee? >> i could give you an example. if i do an exam on a patient, that's not considered a vha document. it's considered owned by the veteran or by the vba, and so that's not something that vha releases. there are some separations that are aimed at protecting veterans. >> but both vba and vha works for the department of veteran uz fairs. so i'm not sure why there would be hipaa problems between vba and vha. so yeah, if you could get back on that, i would appreciate it.

doctor, i agree with you that v.a. can't do it alone. what has been your experience with trying to partner with the v.a., provide the service to, you know, in the communities, and has it been different, you know, outcomes depending on what region the doa has been in around the country involved in? >> that's a great question. i do believe there is variability in getting back to my final point. i think it's important that we look to the v.a. to develop a consistent mechanism that's responsive. and that program that i described which i'm sure you're familiar with, ssvf, is one that is very responsive and very effective. the bigger question, as i see it, what is vha's mission? vha's mission to deal with all reintegration problems? and i would say probably not.

and because so much is trying to stream through vha to deal with reintegration issues outside of health care, it's created a strain on the system and has diluted its primary mission of providing outstanding health care, including mental health services. >> thank you. getting back to the v.a., i noted in your opening remarks, v.a. spending on mental health is approaching $7 billion, double the amount in 2007. what is the v.a.'s -- what is v.a. using as a measure of success of this investment in mental health services? >> thank you, congressman. there is no single measure that we can point to that is going to

satisfactorily answer that question. what we have heard today, over the last few weeks, points to the fact that v.a. has a lot more to do. at the end of the day, what matters most is whether or not we have met the needs day, what matters most is whether or not we have met the needs for individual veteran to presented himself or herself for v.a. mental health care, whether we have addressed those needs at the time they came in, or whether they left with a better plan to move forward. that's the ultimate outcome of our care. it has to be addressed and assessed for each individual at the time of care. i think we can point to some things in our system. we know over the last years, there have been 37 rescues or saves that have been facilitated through the veterans crisis line. on the one hand that's a remarkable number. on the other hand it's not enough and we know that.

we can look to veterans with mental illness, case management program, we know they are able to live in the community of their choice to find employment and to stay out of the hospital. we know that when veterans drop out of care with serious mental illness, we can successfully rein gauge them in care. there are multiple other examples. i think at the end of the day, it's the individual veteran and whether or not we have addressed their needs to do is the ultimate test. >> thank you. >> thank you, mr. chairman. thank the panel for being here. i want to go ahead and continue along the line for just a moment the chairman did, dr. matthews. in st. louis v.a., 60% of the veterans did not return for care. then we hear in other testimony a third of veterans dropped out of care and 60% showed no

improvement. this is difficult to treat. i understand that. it's a very difficult issue and very individualized with each patient that you see. but how can you explain that kind of dropout when these people are lost and you don't know what happened to them. those are the folks that may be needing a hot line, the ones committing a suicide, this astounding rate. you have more veterans committing suicide than dying in combat, then we have a true crisis. we've added several thousand providers to the v.a. during the last, i guess, couple three years. so how in the metric he's talking about, productivity, i don't agree with that it's meeting the same metric. what we found out with oversight investigation hearings is time after time after time, the v.a. self-analysis is not true. this turns out when investigated by an outside party, what we've been hearing -- let me tell you how frustrating it is for me to

sit up here. i expect people when they come to that diocese, whether they are sworn in or not to tell the truth, not to make themselves look better. let me tell you what the v.a. has done. as a surgeon you have to have a lot of trust to let a patient lie down and let you open them up and operate on them. the v.a. has lost a tremendous amount of credibility and trust. it's going to be very difficult to put that humpty dumpty back together again. what can we do now moving -- that's ault all in the rearview mirror. how can we move forward? that's what i'm asking. >> we do have a lot of work to rebuild that trust. we absolutely do. our department is working on that, our secretary laid out expectations about ways to restore that trust. what we can tell you are things like for the veterans who seek our care and entrusted mental health care to us, for those veterans receiving our services,

the suicide rate is actually going down for all veterans to seek v.a. care and are involved in our care for all of them, not just mental health veterans. their rate of suicide is going down. we do have some successes. i guess what i want to do is not discourage the veterans reaching out who -- >> i don't want to do that at all. my time is limited. dr. sharon, a couple things that interested me is dollar lot of programs around, outside, others you've heard of, what you do, how does the v.a. help coordinate? you're right. some veterans don't want to go through this big maze of things v.a. walk, this big building, wind their way around and follow a dotted line to someplace. how do you coordinate all that? >> it's a great question. there are a number of efforts around the country, won in l.a.,

los angeles veterans collaborative which brings together 250 organizations a month, including the v.a. with the aim of developing coordinated systems. the idea i shared with you, recommendation number two, to create rally points is to get proactive by creating navigation networks that is operated by veterans who can function as surrogate family. we heard them talk about the need for a support system, special relationship between brothers and sisters in the community. we need to leverage that. that's a way to get information from people suffering. it's a way to introduce a process and content expertise into communities with navigators who engage and then advocate. >> one of the things in my local

community my wife is involved in, humane society, we find out veterans sometimes won't go to the hospital because they leave their animal, dog at home. they don't have anyone to take care of them because they are alone. humane society are taking care of those animals so veterans can go to something i never thought of. i had no idea that was going on, that people would not get care because their companion, their animal, didn't have anyone to care for them if they wept in to seek care. i think one of the great challenges, i applaud you trying to do that, a lot of people trying to help. you'll see a renewed effort here. how do we coordinate that. with that, mr. chairman, i yield back. >> mrs. brownly, you're recognized for five minutes. >> dr. mccarthy i want to follow up on doctor's line of questioning.

talking about the issue of trust. one of the issues, what data -- when you state the successes, what data are you looking at? is it we've heard a lot about bad information and people not telling the truth. so it's hard to believe there are successes if there are. i'm not feeling good about the data which you would make those conclusions. >> thank you for asking that. we have in the last few years been able to obtain data from the states, some with the help of members of this committee. we now have suicide data from 48 states, not v.a. data, that we are using to analyze rates of suicide for veterans, including veterans who may not be seeking our care. the data we're using include the data we're getting from the

states about actual suicides. we often did not hear about veterans in our care who completed suicides. now we have data about them but also other veterans. that data doesn't go back to 2001 but if you start counting in 2001 after 9/11, that's the data we're following the trends for now. >> so do you believe that there's a crisis going on in the v.a. and certainly in terms of academic to mental health care. >> absolutely. >> what are some of your -- what are your top three things you are planning on doing to resolve this crisis. >> among them are extending hou hours. they have expanded services and hours to also provide for care.

some are with the american legion and we're grateful for that. >> so with partnerships, public-private partnerships, i hear over and over and over again that it's very difficult to work with v.a., expand to veterans in our communities. what are you doing to alleviate some of those barriers. >> they are in the various medical centers. we've reached out to all kinds of people of goodwill in the community, people that would like to partner with us, site specific. >> reaching out. we've done that in my district. that's a good first step. because quite frankly in my area the v.a. didn't know about all

the services that the communities are providing for veterans. i think now they do. how are we going to -- >> as far as access to fee basis care, we are using models of payment for fee basis care traditional models but expanding contracting services that would be available. el paso, for example, has reached out and formed a partnership with the practice that provides in-patient mental health care to provide more outpatient. >> what about alternative therapies.