it would be priority number one. efficiencies.e the end result has to be maximizing combat power of what we have. that is a continual coloring process to make sure you are -- culling process and make sure that the ratio is as good as you possibly can. third is something i have taken very seriously is maximizing the idea of one army, a total force, active guard and reserve. we talk about the army going from 490 to 450 and that is just the active component. we cannot do what we are asked to do. if we just think in terms of an active component. we have to think more creatively going forward about how we operate as a total force. as i mentioned earlier, i would really want to focus on

theisition, specifically standup of a rapid capabilities office. the army has some capabilities based on what we are seeing on the ground in ukraine, syria, so forth. our overmatch is not as great as it should be. changecally we should about the navigation and timing, electronic warfare and cyber, and survivability of platforms particularly aviation. i see these as great problem sets we could launch and a new rapid capabilities office. sen. reid: as part of your development of one army, i would presume you are going to take an active role in engaging the tags, -- mr. fanning: absolutely. whenever i travel to a state i always ask if the tag is available to me and took the

vice chief of staff of the army out with me i believe in december, might have been november. i bring a number of relationships with me from the air force and plan on increasing that in the army working closely with the tags and governors. issuesed: one of the made reference to is the new legislation which was guided through last year with respect to the services role in acquisition. i presume that would be one of your significant priorities in getting the army fully engaged with new responsibilities and acquisition. can you give some perspective on that? absolutely, there are many gr8 professionals in my experience in working with these departments even in the same building as one of the reasons i prefer working

with the military is those that do are much closer to the troops. i think that is very important in terms of setting and monitoring requirements. what i would say about reforms, and i do think putting more responsibility in the military is the right direction, it is easy for people to conflate the acquisition process and the arms process. they are fundamentally linked and overlap. where i think there is the most potential is the requirements process, getting the right to start. at various points in acquisition, being able to make trade-offs. technologyre if the is insured and they good program manager should be able to come back to the chief of staff, service secretary, and say i can get this to you one year faster if you can cut 5% of the requirement you set. i can mean that in a different way and save money if we don't chase this. are smart decisions and

reaction to the green vectors turning red. think one of the aspects use adjusted in your comment is holding those program offices accountable and one thing i think we all know is that accountability has been so diffused these systems take a life of their own and nobody is responsible. in yourassume that development of the new approach that you would have accountability at the forefront in terms of program managers and others under your command. mr. fanning: absolutely. one of the most intriguing parts about these changes is it is hard to hold program managers accountable a stomach process. how long they serve, how long the process is. this gives an opportunity to iterate through a process in ways where we can design more fundamentally transparent metrics that we can hold people accountable to. sen. reed: thank you. >> thank you mr. fanning.

i want to thank you for your service and it is great to have you here. i want to ask you about the sides of the army and what your viewpoint is on that. as you know, we are drawing down the army on the 450,000 by 2018. as a result, we are seeing a huge number of involuntary situate -- separations. many have served the country admirably. and to get a pink slip after you have come from serving is appalling. but i want to ask, are you think we have the right size army and what about a reduction to 450? and before our committee in july, one said that 30% of army brigades are at acceptable levels of combat readiness and he noted that number should be between 60% and 70%. what do you view the biggest

problem is and has it improved since july? readiness has not improved since july, it is still 's and whatf our bct the army would define as decisive action, ready for a big, large, land fight we might face against russia or north korea. ways to get in plan there, but there are impediments in place. the demand on the force, the size that it is makes it difficult to be trained and go through rotations. sen. ayotte: when you strengthen the army you get the dweller to diploid ratio is different. mr. fanning: demand is not thinking at the same rate. sen. ayotte: should we push for more resources for a larger army given the threats we face? mr. fanning: i do worry about the size of the army today. when we were directed to go down to 450 in the active component,

it was testified that this was with risk. i know you said this quite a bit, i was across the table in the air force. we can milley testified meet the requirements at 450, but the risk is increasing and i don't see the vector changing. two years ago when we targeted for 50 we did not have iso-or rock -- isil or russia's persecution. the ideas to keep it ready her keep it whole. i've directed the chairman of the joint chiefs on the army specifically in the next month with is what i think is really telling. sen. ayotte: i look forward to that especially when we look at this readiness issue which is fundamental to the strength of our force and obviously how we treat our men and women in uniform. this needs to be a priority for you. i also wanted to follow-up on an seen in newe have

hampshire with our guard and that is military construction. hampshire, the condition of our readiness center in new hampshire is unacceptable. the army national guard, readiness center transformation master plan, if you look at where we are, we are ranked 51 out of 54 states and territories evaluated nationwide with our infrastructure. in total, the new hampshire army national guard, if you look at our readiness centers, all except one are rated poor or failing. in fact, if you look at our manchester readiness center constructed from 1938 to 1940, it does not comply with building health safety, or any anti-terrorism force protection standards. i would ask in the upcoming budget requests, i hope the army does not continue to postpone requests for funding for the new hampshire army national guard

vehicle maintenance shop and in rochester as well as our centers in pembroke. we are just in a very deplorable situation if you think about it, 51 out of 54. i hope this confirms you will commit to examining the allocation of military construction dollars, not only between active and reserve components, but also allocation among state army national guard to make sure the army is prioritizing what our guard means as well. this is a total for situation and we could not have fought in afghanistan, iraq, or what we are doing against isis without the guard. mr. fanning: i will and i think we need to take a fundamental look at the total number of dollars as well. this is a place where, across all the military fronts where i work when we take the greatest this includes ranges, testing facilities, that is become in and of itself a readiness issue. thank you mr. fanning and

your family and all the support you have. .ou have quite a resume all the experience you have, i think would be a tremendous asset for the army and what you can bring to organizational skills. the thing i would like to ask is, i am concerned as you are about the reduction of forces. give me the ratio of forces versus contractors. if adjustment can be made, there's not a west virginia and i know that would not sacrifice the military but they want to make sure you are using your money right. we need to use it as efficiently as we could they believe we sometimes become top-heavy. every time someone comes before us and wants more money they tell us how to reduce centers, albeit administration is high, contractors are high, but the

people we actually want to do the fighting for us are the ones in critical need. there has to be an adjustment. give me your take. and mr. fanning: i would say there are tremendous individuals and products i come out, an integral part of how we fight and mobilize, train, and equip. we rely and lane on the contractor workforce to serve when we need to and i don't think we do as much in calling one we can. the contract force is something we need to be analyzing continually. sen. manchin: can i interrupt? being a former governor and there are some here, we know we were in charge, commanders in chief of our national guard. it was our responsibility to do wet needed to be done and led the charge. we think there are some much more our guard could be doing in the role that we are paying

high-priced contractors to do. we think it is ridiculous, the redundancy that we are paying contractors and have a guard in waiting that is trained and ready to do the job and go to the front line. we don't see that correlation or that commitment to using what resources we are to have. mr. fanning: i think you and what general milley has talked about is confirmed. that would be a priority of mine and i spent two years working that hard in the air force. the right thing to do to make sure that we are utilizing all the components properly. we are in an interesting position now where we are almost doing the national commission's report, the structure in the army. i am optimistic we will get interesting ideas out of that there will help push us forward and using the guard more productively. going back to the contract workforce, that is something we need to rationalize all the time. in the navy department we started contractors court where

everyone has to justify the contracts. it doesn't interesting thing. you it's -- it does an interesting thing. you knew they couldn't justify it to the bosses. by the time you got to the top of the pyramid we did it every well. the army has something similar, but it is confirmed to be something that i personally. sen. manchin: do you have a handle on how many contractors we have? i can't get anyone to give me an accurate count. mr. fanning: that is the first thing, to know how many contracts you have. to make sure we know how many are behind the contracts. it is difficult to figure out what the number is. sen. manchin: as far as procurement, what would you do? every time someone asks you if we have enough money, you always say you will need more. on the other hand if you only with,k amount to work what can we do here to make you more effective and use that in a

more proven way? my experience, the bureaucracies are additives and processes are made to prevent the next bad thing. i would give more flexibility to program managers. those people you're holding accountable, and hold them accountable. that includes people in leadership positions and us inside of the organization so we -- program a more managers spend the vast majority of time putting things together and breaking people as opposed to running the programs. we are not as agile as our adversaries are or even private sector companies that don't want to compete with us because of the barriers we put out for them to do so. i would look for ways where we can strip out some of these requirements that slow us down and allow us to be more agile, better tap into innovation and both sides of innovation and

processes so we can iterate more rapidly than we are now. sen. manchin: i time is running out but i think you're uniquely qualified because very few people have come to this position having the background to have had. i hope you put them to good use and we can give you the ability to do that and i hope you use the forces that we have to make sure the front-line forces are strong and we have the right amount of people to do the job and make sure we don't have an abundance of contractors that we don't need overpriced using our usingmore effectively and the force we need to protect our country. we will be behind you 100%. mr. fanning: thank you. >> thank you mr. chairman and thank you mr. fanning for your willingness to serve. i have a number of questions and hope you can answer these specifically. succinctl as well as in

russia'sy other numerous provocations over the past few years., as you know, general dunford, they saw russia as a big threat to the united states and secretary carter also testified that he saw the significance for teaching importance of the arctic and how we relate to the guard, that coast we are not in the game relative to russia's massive buildup in the arctic. you agree with that? i do think that we are not nearly enough in the game in the arctic as we should be. sen. manchin [no audio] [no audio] admiral harris testified that he saw one of the greatest threats in >> the pacific was north korea. you agree with that? mr. fanning: we have been supported in a bipartisan way in the rebalance. sen. sullivan: last year the army decided to get rid of the base for airborne

infantry troops strategic asset for the country did take in the door capability. seven or eight hours can be anywhere in the northern hemisphere given the strategic .ift the we have general milley's credit, he is put decision on hold and reevaluating it aching it may be a strategic estate. -- strategic mistake. you think they are equipped and , mountainight climbing like those in the arctic or north korea? mr. fanning: no, not like the ones in alaska. sen. sullivan: the four to five as part of the strategic reserve.' and the contingency in korea. it was called an over the hill cabaret to be there in seven hours. do you think removing these forces and the already unstable leader of north korea in terms

of his buildup in the arctic? mr. fanning: when we are removing literally the only inborne bct trained soldiers that part of the world, i would look for ways to reverse many of the combat cuts the army made last year to include alaska. sen. sullivan: let me talk about quickly, we have been supportive of the president's rebounds and language talking about how we should not be cutting forces in the asia pacific. how is cutting the only airborne brigade combat seen in the asia-pacific supporting the rebalance? that is one element of the army's rebounce. think that increases the number of soldiers, maybe 70,000 over 100,000 today since 2007. sen. sullivan: if the army retains its 425, with that send

strategicessage, a message to north korea and russia and our allies about america's commitment to defend our strategic interests in the korean peninsula, the arctic, and support our allies? would that be a strong message? mr. fanning: i think it would be. the army last year had to balance cuts across all requirements and properties. sen. sullivan: let me get to the 450 number. a lot of members of this committee think it is low. it is way too low, strategically risky for the country. mr. fanning: i do believe it's a risk. the has been testified to by many others. sen. sullivan: to his credit and you have touched on it, general milley is working hard to balance the ratio making sure we have a lot of much more in the teeth category than the t

ooth. of the 450, 1100 of them are counted as prisoners. sen. sullivan: how many soldiers of the 450 are out processing? mr. fanning: a combined total of over 15,000. sen. sullivan: when we talk about the 450, there are literally tens of thousands that are not deployable or capable of fighting. mr. fanning: that is correct. sen. sullivan: does it make sense that the army is proposing cutting thousands of healthy, deployable airborne infantry soldiers to make room for tens of thousands of non-deployable's that are counted as part of the 450? mr. fanning: it would be nice not to count them against the 450 and i don't think people realize what percentage

is not deployable for reasons even greater than you have mentioned. article profiles, there are legitimate reasons. they are already deployed or training now. when we say we are heading towards 400 50,000 active component in the army that is not 450,000 people ready to be deployed. sen. sullivan: my time has expired but only get one final commitments. we have had a lot of commitments. your 100% commitment to make sure the very last soldiers that we are cutting are the combat effective tip of the spear strategically located infantry soldiers who can fight asight if they need to opposed to so many of the other soldiers we are talking about, in other words, you and general milley would commit to cut the trigger polars strategically located like a 420 five

absolutely last relative to any other soldiers. can i get that commitment from you? mr. fanning: you do. >> thank you mr. chairman. they give for being here and thank you to the family, it is wonderful to have you here, your dear friends. mr. fanning, one of the things is in theve seen spike inrter, a big suicides especially among guard members. what are your plans to improve mental health services and to make that number go down? mr. fanning: we have seen a spike. with the sheer size of the army, the number in absolute terms is too large. i think the army has made some impressive progress in increasing access to health care by embedding it at the brigade

level so that it is more readily accessible. in terms of care across the board, sexual assault prevention, behavioral health, suicide, i think that is a key component in making access to care as easy as possible. that's one thing but i think also a lot more work has to be done fighting the stigma against seeking behavioral health. sen. donnelly: one of the things done in the israeli defense force is they have pushed down to the platoon level that the soldier in charge keeps and i out for the other members and someone getting a little sideways. to you looking in any way push the decision-making down a little bit lower as to enable them to have the ability to say

that maybe we need to help this person? mr. fanning: absolutely. the army is looking at this. it has a number of other programs like that where the senior master sergeant of the army has something called not my squad to cover a range of issues. part of that is training people to look for indicators they should act on and report on. sen. donnelly: it really helped -- reduce the number in the idf. said the army recognizes tactical importance of the humvee fleet and maintaining a relevant and capable fleet. toyou expect the army neutralize a large humvee fleet even after it has been fully fielded? mr. fanning: absolutely. as i recall, the ultimate end state as they rationalize requirements for the ground fleet was to maintain a 50,000 humvees.

cullso allows them to the newest and one maintain so it will be a relatively young and maintain fleet and sizable still. looking in the middle east, one of the things that has struck me as we have seen refugees through world. at the same time that we won't put in a no-fly zone or saison -- or safe sozone. support putting in place of a no-fly zone or a safe zone? i do think we have not done enough collectively to isvent the crisis which unlike any refugee crisis i've seen. you will bey: looking for the department of

defense and secretary of defense. this is a critical issue to all of us. we need you to provide the unvarnished truth. i'm wondering if you look into this and put this information together and come to some conclusions. mr. fanning: i will. the secretary's responsibility is to make sure we have forces that are ready and trained for what they are asked to do. i am also hopeful that secretary , they say look, here's why it makes sense or doesn't. here is a mission that is critical and important to the success of our nations future. i commit to you i will give my unvarnished opinion whenever asked. depending on taking him aside privately and saying to him here's my view of this.

you have served this nation well and with distinction. we appreciate everything you've done for this country and think you for being here. fischer: i would like to begin by thanking senator sullivan for bringing to your attention some questions and comments that he has about our concern that we have with russia, especially in the arctic. times we don't focus on that because of the truly large challenges we see all around the world but i do appreciate his comments and i do share his concerns that he has about the four to five -- 425. thank you for the commitments you've made to him. one of your main challenges is going to be to balance that investment made against future threats and the demands we face

involving modernization and force structure. prioritysaid your top is readiness and noted to me when we met last month the need for more investment and facility sustainment. how do you plan to prioritize all of those remaining demands? if we are going to be able to address needs in the future and be able to balance, i want to see what your thought process is. we take risk in all parts of our budget right now. what i look at having seen this happen incrementally, and part of it is the uncertain fiscal isironment we are planning looking and sometimes we lose sight of the aggregate risks. that is what i'm trying to get at now and if confirmed, would do so in the army. it is not unique to the army

where be have taken aggregate risks that a lot of people have not fully realize yet is in facility sustainment. it is becoming a fundamental readiness issue for all services. as i said earlier, ranges are part of that and we need to ensure we are not leveraging -- mortgaging our future. all that means is we would move risks to another part of the budget. we have taken year after year risk in facility sustainment and a concern to me. isent to fort bragg and that a critical, very busy base. the minute i landed and i could tell the base looks tired. we have to look into that seriously. sen. fischer: as members of this committee we are hearing a number of predictions and ideas about what the future is going to look like.

do you see any kind of major shift on the horizon for the will do,what the army how it will operate and what it will need in the future? mr. fanning: secretary gates always said we have a perfect record of predicting the future and we get it wrong every time. i think he was talking about the future kind of war. what i try to do and if confirmed will do it in the army --protector that future is is predict what that future is and make the army more agile at getting capabilities to the field. i think we are losing the competitive we had against our adversaries either on how to use technology, which is a big part. we must empower soldiers in the .ield with the tools we have but how to incorporate new ideas and technology faster into what we do produce and what we do feel. -- field. sen. fischer: is a specific

equipment the army has that you believe is outdated and should be replaced? do you have a list of what needs to be done -- ended in order to move forward for what you will need? mr. fanning: i don't know in the current state, there's lots of things we could end because we are reliant on them and a lot of platforms are old but have the technology and capability. they say three phases to procurement which is modernizing what you have now, recapitalizing over the next generation, and science and technology keep investing in what comes after that. , last year before i went over, just because of the budget pressures, decided to invest more in modernizing the platforms they have an keeping science and technology going in

taking risk to developing the next generation of platforms. that's a concern for me and if confirmed it's an area i would look at closely. where have we taken too much risk and platforms we will try and hold on to long. sen. fischer: thank you. mr. fanning, i appreciate you being here and i have to say you are one of the most refreshingly candid witnesses i can recall. i want to join senator donnelly and encourage you to carry that quality into your work. you have a great deal of experience and knowledge and i've learned a great deal of wisdom. hesitant and even if it friction, that is your value to the united states and i hope you will maximize your input. i believe you have a lot to contribute.

there has been a theme in our discussions today and it occurs is whathat bothers me we are talking about is turning one of those expensive aircraft carriers. we make strategic decisions that have long-term implications and long-term implementation based around assumptions that turn out to not be very good. i was in iceland recently and if there is a strategic spot on this planet it's iceland in the north atlantic. yet because we thought the cold war was over we close the airbase. i think that was a tremendous mistake because the world has changed and suddenly we are in competition with russia again. i use the word competition advisedly. the army size we are talking about today, the assumptions upon which that decision was made, were valid when there are made but they are no longer. i share my colleagues concern that we are facing a new round

of challenges around the world and we really have to revisit that decision. i am not so convinced as some of my colleagues about the danger of contractors because of the cost of training and high level of training our army and our tooth if you will. we ought to be using for contractors for everything but fighting. we shouldn't have somebody that costs half $1 million to train to do the work contractors can. that is something that has to be constantly evaluated. do you agree? mr. fanning: i do, i think it's a integral part of the workforce. the challenge is getting the balance right and making sure. in my view, the contract workforce provides invaluable services to the dod and is a place you can go to when you need to search. and rather than using

our uniformed personnel to do things that are not war fighting. mr. fanning: the challenge is making sure we have those three components properly balanced. the one that grows the fastest properly overseeing can be the contractor workforce so that something we have to watch. suggest andnever hope i haven't that they are not valued and important. some things are best done with the contract workforce because there is an expertise you need and some things you want in your civilian workforce and others you want uniformed. sen. king: i do think we need to talk about the army and the end strength. i hope that is something you will initiate. the third area we are talking about having made strategic decisions that now appear in important, senator

sullivan has emphasized, huge activity by the russians in terms of their military buildup. populating ore diminishing our workforce availability in that region seems to me, given the change, may have made good sense five years ago but i'm not sure it makes sense today and we have to continue to reassess these inisions and be flexible responding to the current realities. the final one the chairman talked about is afghanistan. we have to assess what is going on on the ground as opposed to saying we will make certain decisions based on the calendar or two-year-old assumptions. i think all of those are examples of the importance of flexibility and constant reassessment of what the realities on the ground are. do you share that sort of

concern? mr. fanning: absolutely. we are a learning organization and that doesn't mean much if we cannot make changes based on what we learn. in alaska in particular. when i became the acting secretary of the air force one of the first things i did was reversing the decision to move jets out of alaska because of the strategic importance and the range of space we had and proximity not just to adversaries or potential ones in the pacific but proximity to our partners in terms of training and so forth. have had a particular interest in that region for a long time. in yourg: i noted testimony, do use the words mobile.d your might be of my high school football coach he said he wanted us to be agile, mobile, and hostile. andpreciate your testimony your service to this country,

thank you. no longer possible for the senator. ernst: thank you and thank you for your capacities there are various departments and i want to thank your mother for joining us today. know, last month, secretary carter announced all military occupational specialties will be open to women. i do support providing women with various opportunities to serve in any capacity. as long as we are not lowering standards to allow participation and that we are not decreasing our combat effectiveness. in order to ensure women are fully integrated into these previously closed positions, i believe the implementation strategy must be thoroughly and fully developed to include

having an understanding of the secretary -- secondary and tertiary effects so we are not setting our women or our men of for failure. over the past few weeks i've had the opportunity to visit with the number of soldiers and marines. i visited fort bragg, north carolina as well as marine base quantico in virginia. to in fort bragg was able sit down with a number of operators and airborne paratroopers from the 82nd to discuss the gender integration. i did the same at quantico. out of these groups were mostly , more juniorncos and noncommissioned officers and of course some junior officers. both men and women. we really talked about gender integration. have you had the opportunity to go out and talk through gender integration with soldiers and

are you committed to doing that if you have not? i'veanning: i have and been to fort benning, fort bragg, fort hood. i spent a lot of time at benning in particular. if confirmed it would be a dialogue i would continue. that we needview to get this right. it is critical we get this right. sen. ernst: absolutely. i think we have to make sure we are planning wisely and that we are understanding what any follow on effects would be, whether it would be positive or negative. one of the top concerns i've heard about the implementation is that it should not be done haphazardly. withve seen this recently short terms of getting plans turned in and short turnaround for implementation. i am directing those comments at the marines.

we want to make sure the army does a right and that everybody does it right. do you think having such a quick planround of 15 days for a to work that out, do you think that's enough time to get it right? mr. fanning: i have not seen the marine corps plan. i do think getting it right means doing it methodically and deliberately and however much time it takes. the army plan as i saw it before i left is just that. a long-term plan that i think is carefully thought through starting with validated requirements for an entry position. what requirements do you need to meet to do the job of infantry man? if you meet the requirements we start from there but i don't believe in the army plan and all the plans are with the secretary of defense for review, that you will see anything that looks like a rush to judgment. sen. ernst: i am very hopeful. mr. fanning: that would set back

the opportunities for women and take us more time in the end. sen. ernst: i agree that we have to be very methodical and talk about the implications of the standards and what that might do to orders of merit lists and promotion opportunities. are we setting women back are moving them forward? we don't know what those implications are. i appreciate your thoughtful approach. also, do you believe that women now that we have opened up those areas in combat, do you believe they should be required to register for the selective service? mr. fanning: i think that is something the administration has taken up and is looking for a recommendation for secretary carter so i cannot get out in front of him. i would say we are focused on a cooperative the, i think part of that is equal responsibility. opportunity, equal i think that is part of equal responsibility.

senatorst: i know sullivan has spoken about the 425 and we want to make sure we are protecting our assets in the pacific northwest. that is of great concern, many of us have talked that through. i would appreciate your consideration with that as well. thank you, ranking member read and thank you mr. manning. heinrich: thank you, mr. fanning. welcome back. say i appreciate your willingness to serve this country in many different roles. in particular i want to thank you for the work we did together on operational responsive space. senator king was talking about the ability to reevaluate information and change directions. that is a skill that is often lost on people in this town. i think you have it and i

appreciate that deeply. ndaa, thisar's committee expressed its concern about the lack of investment and sustainment of major range and test basis. the committee noted that some test ranges and i know i mentioned white sands missile range, others have not received a project in direct response to evaluation in over a decade. the committee urged the department to complete its comprehensive assessment of test range only needs and investments. i want to ask you if you know what the status of this comprehensive assessment is at this time. mr. fanning: i think the assessment, the draft i is done. but i share your concern and i saw it acutely in the air force.

not investing in the ranges and testing facilities means we cannot replicate real-world facilities -- scenarios and ineffective testing doesn't tell us much. sen. heinrich: you have thoughts on what metrics you will use if confirmed to assess the quality and capability of the army's testing evaluation and infrastructure? mr. fanning: i think two fundamental metrics, i start with the end user to see what they have from the range and did not get from the facility. but if we are focused on investments in the facilities, a series of metrics will be how often facilities are available for what we need them to be. sen. heinrich: switching gears, morrell, welfare, and recreation programs are a key component to soldier retention and quality of life. as you noted in your advance policy questions, it is important to continue to provide high quality m wr programs and

sustain them for the future. i would say that is acutely .mportant intend to address those challenges in sustaining the programs, given the current fiscal environment, and particular, at those remote and isolated installations? mr. fanning: i share your commitment to these isolated facilities. one of the most important things assess what isis of value to the soldiers and families. we lay off on a lot of programs and we don't rationalize them and pull money out of ones that are not effective to put back into ones that are and people cannot access because we are not investing enough. and be on the lookout for how things evolve and how needs are evolving to look for new ways to provide services.

i think that is particularly important because needs change and we need to meet people where they are especially if we will be able to have the kind of people we want serving at remote and isolated institutions. mr. fanning: as a former engineer i was pleased to see your commitment to expanding at a particular outreach programs that foster stem professionals and we need to make sure we are getting the best and brightest within the army and all the services with regard to the next generation of scientists and engineers. can you talk a little bit about how you are going to approach that issue at the army in particular and how we make sure that we have a constant to engagein place scientists and engineers early so we can get them into the services and doing that kind of

work? to fanning: i think we need start by explaining what the civilian workforce is and isn't. a gets bandied about in the political process and a lot of people assume it is a large bureaucrats. our engineers, scientists, national treasurers. what hit me the most a few years back when we were furloughing civilians, what was happening to the laboratories and test ranges. these were people that can make more money doing things outside of the government that are committed to the mission. that's where we can do the most, people.g finding ways to expose them to the mission and problem sets and get them excited. as we decrease the civilian workforce and convert from contractor to civilian, we need to make sure we are keeping this talent organically that is very hard to recruit and replace. sen. heinrich: thank you very much. mr. fanning: thank you senator

heinrich and i have been informed my colleague might return which gives me the great opportunity to initiate a second round. you bring to this job extraordinary experience and management. criticismspersistent of the department is that it has not been able to successfully pass an audit. can you give us insights as to how you, and the army, but hopefully influence the department of defense across the board, can get the dod on track for a successful audit? all,anning: first of success needs constant senior leadership. -- a shot thetary arm by secretary panetta. it's the first thing i would

make to this process if confirmed. there areto the army, two things. i've seen them in each military department and its different with what the right rates are. i have long been a proponent of learning through doing. we have gotten to a point across all military services where i think we have prepped enough and it was time to test what we have done. we are learning a lot from that. 15, the armyow and had an auditor that put down its pen. and so we did not complete the army -- audit, but we are learning. we are not only learning where we have weaknesses that we need areut more emphasis, we learning where we have made enough improvements that we can pull resource off of that and so finding the resources. the first thing is creating a series of work schedules based on those problems and holding people

accountable. , maybe even more so to the army, the army is fortunate in that some of its systems are more robust and are fielded and making sure that you shut down the legacy systems when you are supposed to because those systems are not audit compliant. you need to force the service and workforce into the compliant areas. thank you. i know my colleague, senator graham, has arrived. let me forgo things in the second round. sen. graham: have you been following media reports that there may be consideration at some awayon to take from general betray us? atreus?ral betrap

i just want to say for the record, i hope there is bipartisanship for this approach. think a great answer, i the general like everyone else fighting this war, only god knows how many years was detroit -- how many years he was deployed. i think in recent memory, and i would urge the secretary of defense to follow the recommendation and not go down this path. army itself, i know you have been asked about the structure. what does it mean to have 490,000 members of the army versus 420 and terms of things you can do? what's the difference? 70,000 more people but what is it mean in terms of engagement. i think when you look at 490 down to 450 in the current construct under 420, we

first werehen we targeted on the 450 number. general milley has testified the i think it would require a whole new set of assumptions and guidance on what the army is supposed to do. everyone has testified and i would do it today that we could not do even as a total force, not just the active component, what we are asked to do if he went on to what sequestration would force us to do. sen. graham: president obama called for congress to give him authorized military force against isil. i think that is reasonable. do you think congress would do it? mr. fanning: i do. sen. graham: i think you are well-qualified, would you like to see limitations on time when

it comes to finding isil? mr. fanning: i think my preference would be not to have a limitation. sen. graham: if i am in the army i would not want to tell the army after three years we have to start and start all over again i think from a national perspective, we shouldn't have a limitation on time. what about jockey? bestiality ==\ \][ geography? is there any means you want to do to take off the table? mr. fanning: i don't. sen. graham: thank you. i look forward to voting you for secretary of the army. >> i don't i got a can top that. let me just say as the staff has said, there are no more of my colleagues that are returning. let me thank you. g -- on behalf of

senator mccain some the meeting is adjourned.

>> eric fanning nominated to be army secretary, former chief of staff to ashton carter. if approved by the armed services committee, he could get a full boat in the senate. although, senator pat robinson has vowed to block the nomination over president obama's plan to transfer guantanamo detainees to u.s. location. the armed services committee has to on the nomination of eric fanning.

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>> eric fanning on your screen, nominated to be the next army secretary. former secretary retiring carried president obama nominating him in september. the hearing gaveling out a bit earlier than expected. a vote is understood -- is underway and they failed to move forward on the override of the presidential veto of the disapproval resolution on the interstate waters bill. the senate moving forward on that -- failing to move forward on that just moments ago.

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>> last day of business in the senate, including the committees as the service armed committee wraps up. they failed to override president obama's be two of the resolution that would block the clean water regulation handed down by the epa. washington examiner writes that the epa says the water of the rural would protect streams and wetlands that affect water quality and defined waters protected by the clean waters act but ranchers, farmers and state disagree. the house and senate blocked a resolution to block the role, but president obama vetoed the measure on tuesday night and it the senate needed 60 to move forward and they failed to move forward on the president's veto. that will wrap up work in the senate and they will gather out before too long -- they will

gavel out before too long. the east coast is under the threat of a major blizzard beginning friday afternoon. [laughter] [indistinct chattering]

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[indiscernible] [laughter] >> thank you very much. and honor to meet you. [indiscernible] >> where do you live?

>> the philippines. >> what brings you to washington? [indiscernible] next week? i will not be the secretary of the army by next week. [laughter] >> maybe. >> how long are you here for? >> i am in maryland. >> oh, maryland. [indiscernible] [laughter] >> thank you for coming out today. and honor to meet you. thank you for your service. >> have a good day. [laughter] [indiscernible]

>> i am so happy i got to be here. >> i live a few blocks from here. >> i will send you an e-mail. thank you, sir. one to me to take it for you? -- want me to take it for you? >> yes. [laughter] >> thank you. >> you are welcome. i am so happy for you. >> i will talk to you later.

>> i can't believe i missed that one. good to see you. thank you. >> during eric fanning's hearing today, he is nominated for secretary of the army. john mccain and senator lindsey graham mentioned the expansion of the fight against isis in

afghanistan. "the washington post" writing that the have branded the you -- then you authority has granted to strike islamic state in afghanistan. commandersens authority against militants there and more generally illustrate the expanding u.s. campaign against the islamic state behind their home base, that is from "the washington post." our coverage of the state of the state speeches continue. california governor jerry brown will lay out his priorities later today. it will be his 14th state of the state address, and he is pushting to continue the to combat climate change and has peeled rail lines -- high-speed rail lines. we will have that live at 1:00 p.m. eastern on c-span. more "road to the white house" coverage today with two democratic candidates. bernie sanders holding a meeting

hampshire and hillary clinton talking to supporters at the university of iowa in iowa city. that is scheduled for 8:30 eastern. both of those life and here is more from a reporter. at nytimes.com, the headline -- alarmed clinton supporters sanders'sng on socialist edge. joining us is jonathan martin, national political correspondent for the new york times. we heard this from clinton surrogates, talking about this socialist moniker for senator sanders. what is this about and what is the strategy? >> i think they want to remind democratic primary voters in iowa and new hampshire that they are not just registering their views on politics today, they

are not just indicating that they have been more motivated, but they are going to be taking [indiscernible] and they want to make the case that senator sanders, while he has a compelling message, is somebody who will have a hard time winning the general will also hurt the parties down ballot. socialism has certain connotations. that is why they are doing it. it would not be doing it if he was sailing into iowa or new hampshire, but she is having real problems and they're trying to find creative ways to take down mr. sanders. >> we saw that in the latest poll numbers and an almost 30 point lead by senator sanders. one sentence from your peers said he is looking less like a threat and more like a runaway train. think it may not be that

, [indiscernible] youple, butung can stomach to losses out of new hampshire. i think the clinton folks put almost all their effort into pulling a winning iowa. >> we are talking about electability from the clinton people, and a sanders consultant says this is a debate between a candidate who inspires younger people, bernie sanders. >> that is right. it sounds very familiar. he is making the case that hillary is using an outdated playbook, summer around the edges of suburban voters, and that that is not the way to win. in a polarized country, you have

to turn out people who are sympathetic to you and to vote. listeners, for your if that sounds familiar, there is a reason. ted cruz is doing that with the gop nomination. race the team the expected before the iowa and new hampshire. endorsements, a sense .hat it was her turn it has not been anywhere near where the expected it to be. this has been a dogfight against someone who nobody that would be a serious contender, let alone a threat to win the first two states. that thiseat reminder year, everything has sort of

been unpredictable. as the saying goes, [indiscernible] in the cycle certainly has. to hillaryard clinton, her candidacy, and her own appeal or lack thereof to voters, jonathan martin, what is the problem? i talked to one long-term advisor of secretary clinton and this person said she has done papers,ng right, policy putting her message of where she is, better organized, running more of a grassroots campaign, closer to voters in iowa, has moved up on cultural issues where democrats are now, and it has not mattered. it is remarkable.

the e-mail story did not hurt last year, but democrats did not show any concern about that. they have questions about hillary and they are more excited about learning. -- about bernie sanders. theet me ask you about third candidate, governor martin o'malley, who is back in new hampshire later this week. he has not moved beyond single digits. this he pose any threat at all why has he not been able to resonate among voters? it is because of that bernie sanders phase. if you are looking for the clinton alternative, you are probably on the left side of the spectrum. partnd o'malley looks the of conventional politics, he has the resume of conventional politics, a two-time governor, straight out of maryland, and he has not tapped into a moment of anger and another demand for the

threat of the status quo that bernie sanders represents. look for your reporting online and in the newspaper. jonathan martin, in manchester, new hampshire, thank you. as i have been watching the campaign this year, it is so much more interesting to look at that republicans than the democratic side, and that may have something to do with why there is more interest in these candidates and the books. a sunday night on "q&a," nonfiction book critic for "the washington post" discusses books written by the candidates. >> everyone does have interesting stories in their life. and politicians, who are so single-minded in this pursuit of power and ideology could cap particularly interesting ones, but when they put out these

memoirs, they are sanitized. they are vetted, they are therefore minimum controversy. at 8:00 p.m.ht eastern on c-span's "q&a." campaign 2016 is taking you on the road to the white house for the iowa caucuses. monday, february 1 on c-span and life pre-caucus coverage, taking phone calls, tweets and text messages. live coverage begins of the republican caucus on c-span and the-span2, live coverage of democratic caucus. join in on the conversation on c-span radio and on www.c-span.org. bills that would change the mental health system in the u.s. are pending before congress. it will hold a hearing next week on bill offered.

anotherl also introduce bill. next up, but hearing on what the federal role should be in treating mental health disorders. the senate health committee held a hearing yesterday. we will show you as much as we can and so the california state of the state address coming up at 1:00 p.m. eastern. >> senate committee on health and pensions will come to order. senator murray and i will have a statement and then introduce eyewitnesses. testimony,tness there will be five minutes of questions. before we begin, i want to mention the information of the committee. we have had progress on two or three items on our agenda.

yesterday, i announced we plan to hold our first markup on february 9. it is considered the first set of bipartisan bills aimed at programs.y medical have you working on this for a number of bipartisan pieces of legislation. the house has completed their work on the 21st century cure act. the president has reiterated his support for the initiative. in the state of the union address [indiscernible] it is urgent the senate finish its work and turn into law these ideas that will help virtually every american. we have also been working for months to gather legislation to interoperability for doctors, hospitals and their health patients. there is a lot of agreement on what to do about that and the committee will release today of bipartisan draft of that legislation for public comment.

this february markup will be the first of three committee meetings that have been planned to debate and amend bills as the committee moves forward on the goal of modernizing the fda and nih to get safe drugs to patients more quickly. the bills that will be considered in february all have bipartisan coat sponsorship -- cosponsorship. same for those submitted in april. in addition, this year, the committee intends to be busy on oversight of every student succeeds act. this is probably not worth the paper it is written on, so we will spend time on making sure the department of education implements that the congress wrote it and the way the president signed it. we have done a lot of work on reauthorizing higher education, which expired at the end of last year. we have a number of bipartisan proposals that will make it easier and simpler for

students to attend college and to manage the 6000 colleges and universities. we have a lot to do this year. important hast to do with the mental health crisis we are discussing today. i agree on this that we can move promptly to offer bipartisan recommendations on how to address the mental health crisis. we have done a lot of work on it and passed the mental health at center murray and i introduced. senator cassidy, senator murphy have introduced legislation and senator murray and i are working with them. we hope to bring a combination of those recommendations to the full committee. not everything the senate might want to do is in our jurisdiction, so we are working with senator blunt, who with senator murray runs the health appropriations subcommittee on

ideas senator blunt has proposed and we are working with senator cornyn on issues the judiciary committee is considering. we want to move promptly to take the things in our jurisdiction and have them ready for the floor and working with the other committees so the leader can bring them to the floor if he chooses to do that. the reason there is such interest in the mental health crisis today is that one in five adults had a mental health condition than the past year according to the mental health services administration. that's nearly 10 million adults with disorders like schizophrenia, bipolar disorder, and depression that interferes with a major life activity. 60% of adults did not receive mental health services in 2014.

only half of adolsecents wtih mental health conditions that remain untreated can lead to dropping out of school -- substance abuse, incarceration, unemployment, homelessness and suicide. suicide is the 10th leading cause of death in the united dates. 90% of those who die by suicide have an underlying mental illness. i hear that from many tennesseans. between 2010 and 2012, one out of five adults in tennessee reported having a mental illness. 4% had a serious mental illness. the most recent data shows our rate of suicide has reached its highest double in five years a couple of years ago. it was the second leading cause of death. in october, the committee heard from administration witnesses about what the federal government is doing to address mental illness today. we look forward to hearing from doctors and advocates who work every day with americans who struggle with a mental health condition about how the federal

government can help patients and communities better address these issues. we want people to take advantage of the most innovative research. we heard about that at our recent hearing about the raise study. i am interested to hear how the government can support state efforts to implement evidenced-based treatment programs. this will require modernizing our leading agency for mental health and require involvement from patients, families, communities, law enforcement, and many others who are involved. i look forward to hearing from our witnesses about the challenges we face and the solutions they offer. senator murray? senator murray: thank you, chairman alexander, and our colleagues who are here today. i'm really glad we have this opportunity to continue our discussion about ways to improve

our mental health care system, and we have an incredible group of witnesses joining us to share your experiences. thank you all for coming. as i'm sure all of us do, i hear far too often about loved ones, friends, and neighbors struggling with mental illness and are not getting the support they need. it is heartbreaking because when someone does get treatment and support, it truly can make a difference. i heard from a woman in seattle who i will call amanda. she was experiencing mental illness so severe, she was in dumpster, living in fear of being abducted by aliens. she was connected with primary care and given supplementary income benefits. today, she is enrolled in school and pursuing full-time employment.

jack is a veteran from king county and he enrolled in outpatient support services after he was hospitalized for attempted suicide. he had serious addiction problems and was becoming alienated from his family. but after being connected with support, he was able to find recovery even while recovering from cancer. he now is recovering with the help of his teenage son. it shows a comprehensive mental health care can truly give someone their life back. unfortunately, a lot of stories don't end that way. only 63% of people with serious mental health illness received treatment in the past year. i am going to focus on a few challenges today that i believe our witnesses will have a lot to say about as well. the first is inadequate access to treatment. far too many communities lack access to mental health professionals.

half of u.s. counties don't have a single psychiatrist or social worker. that means for many patients and families, it is unclear where to turn for help. we need to make sure communities have access to train and treat those struggling with mental illness. in addition to strengthening our mental health workforce, we need to make sure when someone presents in crisis or chooses to seek help, there are providers who can take them in and meet their needs. no patient should be turned away, asked to wait in an emergency room for days, or be left on the street because there is not an available bed. ms. blake, i'm sure this is a problem you have seen all too often in the e.r., and i think we can and must do better on all of this. i'm looking forward to hearing your thoughts. another issue i'm looking forward to hearing about is the need to integrate physical and mental health care.

the two stories have something important in common. amanda did not just need psychiatric help, she needed primary care. jack needed help with addiction and depression, but he also needed treatment for cancer. the silos that exist between mental health care and physical care do not match patient realities and that needs to change. the legislation senator murphy and senator cassidy have worked on together would take important steps to better integrate mental and physical health care. i am also interested in innovative steps being taken at the state level. the university of washington has a residency program that allows students focused on psychiatry to get experience working in a physical health settings. dr. hepburn, i know you are focused on this challenge and i'm grateful we will have your insights today. i want to reiterate something from the last hearing. if we are going to confront the

challenges within our health system, we have to take down the barriers the stigma creates for those suffering from mental illness. that means prioritizing research which helps enhance our understanding of and ability to treat mental illness. and it means raising awareness so those struggling don't feel they have to struggle alone. today nearly one in five people in our country experience mental illness. far too many don't receive treatment when they need it. part of the reason is stigma gets in their way. mr. raheem, you have worked for over a decade to raise awareness and moat understanding of until health and communities across the country, and you have been an inspiration to many people who otherwise may not have had the courage to seek your help. i am eager to hear what you think congress should do to lend our voice to efforts like yours.

thank you to all of our witnesses today. we have a lot of urgent work ahead of us to make sure our families and communities have access to comprehensive, high-quality mental health care they need. and i look forward to working on a bipartisan effort to strengthen our mental health system and give patients and families the opportunity to lead healthy, fulfilling lives. senator alexander: we welcome our four witnesses. you all have disease can then other things to be doing and we are grateful for that. i'm going to ask senator mikulski to introduce one of you since she has a conflict which will require her to leave soon. senator mikulski: thank you very much, senator alexander. i want to thank you for your progress on holding hearings on the issue of mental health. i know this is our third hearing on the topic, and i want to salute you and senator murray for moving in this direction. the commerce justice subcommittee is holding a

hearing on president obama's proposals on gun control, and as the vice chair, i must be at my duty station and have to excuse myself. i really want to be at this hearing because i am a professionally trained social worker. we have been working on these issues all of my professional life. this is why i came to the senate , to listen to good people with great ideas on how we could help our people. we have two distinguished marylanders here. one is dr. hepburn who headed up the state of maryland's agency on mental health, and himself a university of maryland-trained clinician who went on to breathe mental health into a bureaucracy and bring care to our people in

a state that mandates an affordable budget, so we are going to have some great ideas. dr. william is a professor at the department of mental health at the famous on topic and school of public health. dr. eaton is a professor there and chairs the department of mental health. it is the only department with that unit of public health in the world. usually public health thinks about vaccinations. what dr. eaton thinks about is how can we do the preventive work and build the personalities. he will talk about his work, his research and recommendations, understanding the thrust will be everybody who has a mental health problem needs individual treatment. but they live in a social world. they need to look at the social indicators, epidemiology, and how we can strengthen the institutions of the family and the school. learn a lot from him.

i really look forward to where we are going on this issue of mental health in a nutshell. when i got out of graduate school, i went when they were training social health workers. president kennedy led the battle to establish community centers, to get rid of the old type of mental health hospitals. everybody at the table remembers that. and i am sure you have heard stories. maybe it is not that we need new ideas, i mean new institutions. maybe we need to look at something like we thought we are going to do and we never did it. we never followed through on community health centers. maybe that is the way to go. we never followed through in an aggressive way to enforce the

wellstone-domenici parity act. it may be that is the way to go. speaking as a social worker, we know that mental health requires a team approach. it is on the part of the psychiatrist, but it is also others trained in these matters. my colleagues never thought i had a therapeutic personality, but i will look forward to working with you to advance ideas that will come forth and how we can really meet this crisis that is growing and expanding. senator alexander: we will now hear from witnesses. again, dr. hepburn. he is part of the system that represents the systems in all 50 states. he has been a clinical professor

for nearly 20 years, and he has cared for patients for more than 20 years. penny blake has been a nurse for 40 years and worked in an emergency department for 15 years. she chairs the national council for emergency nurses. expert of hisn field, written hundreds of articles. much of his work has focused on mental health issues, but also diabetes and heart disease. mr. raheem is the ceo of live breathe, this is focused on the stigma associate with mental health care he brings his own invaluable perspective of his own journey through mental

illness which began during his freshman year of college. we look forward to hearing from the four of you. if you'll each try to summarize your words so that we can have comments about your testimony. why don't we start with dr. hepburn. dr. hepburn: thank you very much. thank you, chairman alexander and ranking member murray. thank you. it is hard to think of maryland without senator calls a. thank you for the opportunity to address this committee on state services regarding mental illness. thanks goes to this committee and its members of the house and senate working to find ways to support, strengthen, and augment

the country's mental health system. i want to especially thank senators cassidy, murphy, and also senator franken. i also want to congratulate senator franken on his second grandchild, being a good grandparent, that is where it all starts. we appreciate the full congress passing the legislation on the imd demonstration. also, we appreciate the support from congress on the first episode psychosis program. the organization which i represent, the national association of the state mental health program directors, represents executives of the mental health authority, representing agencies that have $41 billion in public mental health services and deliver services to 7.3 million people.

we work with state and partners to promote wellness and resiliency. members work to promote prevention and early intervention, integration of behavioral and physical health, trauma informed approaches, minimizing contact with police, developing the workforce, promoting supportive employment and decreasing homelessness. support the use of data and health information technology. the state mental health authorities vary widely in terms of how they are organized, however they share common functions, planning and coordinating a comprehensive array of services, submitting annual application for block grants, educating the public, operating and funding inpatient services. this could be with state hospitals or with buying inpatient services within the

private sector. the state mental health authorities work with samsa which has been an excellent partner. the acting administrator is a respected leader in the field. we respect her as a partner. samsa has provided strong leadership in providing the best practices for individuals with severe mental illness. the best example of that is the first episode psychosis program. this program started with research. the research showed that it was a best practice -- to promote the program. its implementation is now across the country. it is an excellent way to show how the federal government can work with the state and providers in order to promote best practices. it is important to note that the role of the state mental health

authorities has changed over the last 30 years. 30 years ago states were primarily involved in state hospitals. 75% of the budget went to state hospitals. now most of it goes to the community. 30 years ago the private sector was not really addressing issues in the public sector. now it is hard to separate them. when it comes to admissions to state hospitals, now almost all admissions are court related. almost all the civil admissions which were uninsured individuals going to state hospitals, now they get the same care as insured individuals and they go to the private sector. talking about -- i want to say something about the funding for the state mental health authorities. basically, the funding for most states is primarily from the states themselves, so that the state budget and medicaid make

up for almost all of the expense in the budget by the state mental health authority. the block grant accounts for less than 1% of the mental health in the state. what are some additional actions congress and the administration could take to support the state mental health authorities? one is the first episode psychosis program, an excellent program. the fact you have agreed to it is excellent. what we will ask is for a change in the methodology. the smaller states are not able to move ahead with the program the way to larger states are because of the block grant methodology. the second is to modify the exclusion so that imd's can get paid for taking care of individuals with medicaid or adults.

at least to start with the private sector. in maryland, we participated with a demonstration that showed the average length of stay in the private hospitals for 10 days. cost per episode was about the same as for the acute general hospital psychiatric units. we would ask to reauthorize the money for the program, this is an important program. senator alexander: could you wind down, please? dr. hepburn: yes. ms. blake: thank you for inviting me to testify. i am an emergency nurse working full-time at good samaritan hospital in west palm beach. this is an acute care hospital. in addition to work in the

emergency department, i am the chairperson for the council of emergency nurses association, the largest professional health care association dedicated for emergency care. as a registered nurse for almost 40 years, my career has been devoted to providing the best possible care to every person who comes into the emergency department. increasingly, this involves treating patients who are suffering from mental illnesses. the emergency department at my hospital has 32 beds. it serves a very diverse community, including extreme poverty and some of the wealthiest neighborhoods in the country. since the federal law prohibits hospitals from turning away anybody seeking emergency care, i see practically every kind of urgent medical condition. on a typical shift, at least 10% of cases involve psychiatric patients.

the reasons for the surge in this include the veterans who suffer from ptsd, drug abuse, and stresses brought on by weak economy and joblessness. but the principal cause in my view is the lack of adequate treating options in the community. mental health patients often find they have no or turn for treatment, so they go to the one place, the emergency room, that is guaranteed to be open at all times and willing to care for every patient. in florida, a physician or law enforcement officer can invoke a state law that allows for the involuntary hold of the 72 hours for a person who is deemed as a threat to themselves or others. after 72 hours, the emergency department must clear the patient of physical illness and then the person is placed in a 10 by 10 room until we can find a facility that can accept the patient. because at my hospital, we do

not have any psychiatrist on staff. we do not have a psychiatric unit. all patients requiring inpatient care must be transferred to one of the four psychiatric facilities in palm beach county. i cannot think of a single time in the past year that any of our patients have been accepted immediately. a mentally ill patient typically stays between 12 and 24 hours before they are transferred to a psychiatric facility. however, two, three, and even four days boarding in the emergency department is not unusual. and this is also the case at other hospitals and it is made worse by the lack of insurance coverage for people who suffer from mental illnesses. our experience is consistent with research conducted by emergency nurses association that found that the average boarding time in the emergency department is 18 hours for psychiatric patients, versus four hours for other types of patients.

inadequate community health services and extended boarding times are detrimental, both for emergency departments and for the care of the patient. for hospitals, mental health patients are personnel intensive care. not only do they stay in the emergency department longer than other patients, but they often require close supervision and personalized medical attention. by necessity, it diverts nurses and technicians. this takes away from other patients. whenever they are placed on hold, there is a protocol we must follow to ensure safety. a security guard is placed at the door. for the patients experiencing mental health crisis, the emergency department is far from the ideal place to receive care. e.d.they are chaotic, often loud areas and the nurses and physicians are stretched to their limit and carry for the

-- in caring for the other patients. and our emergency physicians are reluctant to prescribe psychoactive medication for these patients because this is not the area of their expertise. we usually give a form of anti-anxiety agent. they do not begin therapeutic interventions because there is no professional there to provide it. so imagine you are already stressed, anxious, possibly suicidal or psychotic and perhaps having hallucinations and you are confined to a small space. all belongings are taken away and there is constant chaos and emotion. -- and motion. and because of the shortage of beds, the situation continues for many hours or even days. mental health care patients would be better served in facilities that have specialized expertise. the most important thing that we feel is needed is that communities must have the

infrastructure and funding to provide resources needed to keep this population healthy. they need to have parity and coverage and in a high quality mental system, which will provide care, access to mental health clinics, outpatient and inpatient treatment, and the availability of a 24-hour crisis services that will allow the patient to be integrated fully into society. i want to thank you for allowing me the opportunity to represent and speak for my fellow emergency nurses. we passionately care about providing the best possible care to all of our patients. and we strive for them to have the best outcomes possible for their illnesses. that includes the most society,e in our

the person who suffers from mental illness. senator alexander: thank you. dr. eaton? dr. eaton: can you hear me now? senator alexander: yes. senators alexander and murray and the rest of the members of the committee, i thank you for the opportunities to speak to you. one thing i want to first point out, we all feel, we all know some of you with mental illness of one type or another. and we feel strongly about this, but there have been developed a new metric in the field called disability adjustment. that metric allows us to compare

the diseases, the mental and substance abuse disorders as well as cancer, stroke, all of physical diseases. and when we do a comparison of population basis using the data, it clearly shows that mental and substance abuse disorders of the most important category of disease burden. and depression is the single most important disease itself in terms of disease burden, so the importance of mental disorders has been recognized many times in the past. the surgeon general's report and so forth, so now we have a metric that will establish scientifically that depression is the most important form of disease category. and one of the reasons for this is that the mental disorders begin early in life. somebody who just got depressive

disorder and you find out and started 10 years earlier and the consequences of the disorder will not show up for another 10 years. so the mental disorders, especially depressive disorder, predicts onset of stroke, dementia, heart attack, diabetes. it predicted more powerfully than risk factors we know. somebody with depressive disorder has a higher risk for heart attack than those with diabetes. the point is these start early. they take a long time and the consequences for physical illness are very strong. and we need more research to figure out why these consequences are occurring, but also the consequences have been stated for primary health care for psychiatric care, because now the primary care doctor is interested in saving the life of his patient and that means he should screen for depressive