to ensure that we have accessible folks there now, as an advocate you have been personally involved with this epidemic. you have seen the investments that have made. -- are theredicine other things out there that are working besides, medicine -- telemedicine and is it working well? >> i think it is working well. it is a wonderful thing. a veterans rep program, one of the first ones that brought it to montana. it is valuable. no question. i think one of the other things i thought was really good was, the va really struggled to staff

its inpatient facility and helena. it just sat open and they could not run. i think the way that they were able to change their staffing structure to use it with one inpatient psychiatrist, one outpatient and a couple of nurse practitioners, that willingness to adapt on the ground in montana, we don't have three inpatient psychiatrist to run a facility like that. .he va learned one of the other things, the peer support is critical. it also provides much-needed jobs for veterans that struggle with these kind of issues. the retention of the counselors in some ways is the bigger than whether or not they

have served. many veterans that i talked to just say it is a matter of changing bodies in front of them. if they open up their soul and described their combat need, all of their issues going on, and the person is gone. i talked to one who works across the street treated he had three counselors in a year. while we need to focus on getting the perfect training and everything, -- >> multifaceted. what is the issue on retention? why are they leaving? , what is it? are they burning out? why are we seeing the turnover? >> it is really hard to tell.

it is different for everyone of them them. what shocks me is how in the box and constrained they are. the limits of what they are given to work with. i think they are pretty heavily worked. they don't even give them business cards sometimes. no voicemail for some of these counselors. how do you -- >> right. do you want anything to add to the as far as what is working? >> i have seen that same telemental health demonstration. i would agree with his assessment and agree with matt's perspective on the retention issue, which i don't think is

limited to counselors. we attempted about 1.5 year ago to serve a mental health clinicians. i would not want suggest it was a scientific survey. it was disturbing to see results that suggested serious morale problems at these facilities. time oflected a understaffing. i acknowledge that as well. many spoke of the system as top- down, as failing to appreciate the importance of allowing clinicians to build that trust relationship of imposing performance requirements that were highly focused on evidence- based practices, exposure therapies which, while having solid evidence base, were not appealing to the veterans. many could not handle the dealings on a weekly basis to

experienced.ey had that was the directive from on high. a survey of its own last september on clinician attitudes. i think it would be helpful to see the results of that study. helpful to understand the factors that drive the 10% vacancy data that dr. petzel cited. wouldor their clinicians be a system that would be more successful. >> i will ask you a question i was going to ask dr. petzel. i did not want to keep them here all day long. you guys can maybe answer it any better way than he could. you are driving the bus at the other end of the experience.

professional mental health counselors, marriage they make upst's, about 40% of the overall mental health independent practice workforce. in the va, they make up less than one percent. is there a reason for that? other than the fact that -- is there a reason on the ground that these folks, are they less desirable to be counselors are not our am i missing something? can you help me with this? >> there may be a reason for that. i would say flat out, it is not a valid one. we need them. >> anything to add to that? >> i would not disagree. >> i want to talk about the gaps that you talked about in

your testimony. some real inhibiting things in our society about people who go in for mental health treatment. there is stigma attached to it. employment problems afterwards. not because they have issues with mental health, but the employer might not want them to begin with. what can we do to minimize the stigma? are more likely to go in and get help when they need it. it is curable, we know it can be fixed. is there anything we can do about it? i do think there has been a probably 20 year effort to address stigma. have played an important part in that. i think there is evidence that suggests that veterans thiselves, warriors of

generation, are distrustful of mental health care. it is not solely a stigma issue. canpeer to peer counselors play an enormously important the lyinglying -- those views and drawing warriors into treatment and helping sustain thaem/ we have to honor those employees and make them feel they are an important part of the team and make their working conditions appropriate. the infrastructure, the policies are in place to close those gaps. >> anything to add? >> i have two things. one is, i think we need to take the magic out of what this is through research.

a really big problem with the lack of understanding -- stigma is based on lack of understanding. we don't there stand -- understand well enough. especially diagnostic patterns. reallyt clinicians struggle to identify what a person has and i think because we don't have valid scientific instruments to measure whether or not people have these conditions, they are measured by the behavioral health surveys, it just leads to a level of distrust. people don't have a way of saying, my narrow circuitry is distracted. circuitry is disrupted. the other thing is, we have a lot of different anti-stigma efforts.

they don't really highlight ptsd andle that had depression in the past. we don't read about or see the anti-stigma things to talk , churchill's depression, abraham lincoln's depression. some of the greatest american struggled with these conditions. why don't we bring them up? to see a little bit more of that. >> good. partnerships. particularly between the va -- there may be some that i am unaware of. or opportunities for partnerships we could make them aware of. aware of and then out on some programs like healing waters in montana and you mentioned a project odyssey in your testimony. which is maybe classified in

or peer to peer program maybe separate? >> it has a strong element of peer to peer. light on could shed programs like that, their we mightness and how be able to expand on other programs. ,here are programs out there animals, horses in particular. dogs. this kind of talk about opportunities out there to collaborate on peer activities related to the outdoors to release stress. , projective follow-up odyssey is one of 18 different that our organization operates. it is a program that takes likeiors out into retreat- settings. it might be montana for an outdoor activity, mountains in

vermont, wherever. it takes them out in groups, has it trained therapist with them, and focuses on building peer to peer relationships. to confront, in some cases for the first time, your post dramatic stress -- traumatic stress disorder. it has been successful in helping people confront those issues and get into treatment and overcome the stigma and barriers. it is a program that we have run for a number of years and ran in collaboration with the va and vet center program. to our disappointment, the va pulled out of it in about 2010. the suggestion was they lacked the authority or felt they lacked the authority to continue. since then, congress enacted legislation to make it crystal clear that that authority -- we

hoped that would lead to reinstitution of the partnership. that has not happened yet. ,> my favorite program for this i am totally biased it is a helped start it, my sister and a veteran from missoula started exports for vets in missoula. they take -- it was based on river boarding on a six-week program. it engages them in extremely --h adrenaline of it he activity and was tied in with counseling afterwards. the level of success in what i saw from that program was just astonishing. the veteran purchase a patient -- participation, they took it over themselves and run it.

it really is amazing. it is done in partnership with the missoula that center -- vet center. it is a model that could be expanded with other sports. the neat thing is, it is not a retreat. it takes them in their community, and a sport or something that they can do afterwards and get involved with a group of men and women that they eventually form bonds and and introducesh them to civilians like the rafting guides that help start it. i was the first civilian that some of these vets have bonded with, and they respected him because he takes a tiny raft on .he river it really is remarkable. i have not seen any effort from the top to try and expand that

beyond montana. one.st question, a quick who funds project odyssey now? >> we get donations, typically small donations around the country. all private sector. .e don't take federal money >> thank you guys for very much. i want to thank you for your testimony this afternoon. this hearing has underscored some of the important progress i think we have made, also highlighting some additional efforts we need to make. i look forward to working with ranking member portman and our witnesses today on these issues to make sure that we can address the healthcare needs of our citizens and they are met, regardless of where they live. to thankegard, i want you fellas for being here this morning. this hearing record will remain open 1