▶ 0:04:35Good morning everyone. The subcommittee will come to order. I would like to welcome our witnesses, my fellow members, and the audience to this hearing of the subcommittee on oversight and investigations. Today we will dig deeper into VA's mental health policies to gain insight into the processes and quality of care decisions regarding veterans mental health care. From speaking with veterans in my district, it's clear that we have a lot of ground to cover to fix the mental health crisis in the veteran community.
▶ 0:05:01Of the concerns I hear most from veterans is how long it takes to set schedule their appointments for mental health treatments. Delayed mental health care in the age of teleaalth is well within our ability to address. Veterans deserve timely care. Despite the VA investing billions into PTSD treatment, suicide prevention, and alternative approaches to mental health, we continue to lose too many veterans to suicide. One veteran suicide is too many. In 2022, 6,47 veterans died by suicide.
▶ 0:05:31That is 17 veterans a day. Unfortunately, it does not stop there. An additional 20 veterans die by self-injury mortality, which generally means overdose. I've heard horror stories from constituents who have been prescribed pain medication and told to take more when they feel bad and less when they feel better. As a provider, I would not feel comfortable prescribing two medications that might interact with one another without first consulting a psychiatrist. This is unacceptable.
▶ 0:06:00It's impossible to cover every detail of every case, but we know that we are losing veterans. Despite a seemingly endless amount of resources spent, these numbers have failed to substantially decline. One veteran suicide again is too many. These men and women volunteered to serve their country in a variety of roles throughout our armed services. They have answered the call to serve. And as a veteran and a nurse practitioner, it's alarming that we have allowed the VA to fail to move the needle for this long. We must do better.
▶ 0:06:30We've tried to throw more money at the problem. The VA's budget has r risen 7 479% since 2001. And yet, despite a shrinking veteran population, the veteran suicide rate has remained virtually stagnant. Unfortunately, the VA's own numbers have only shown that they are doing less with more.
▶ 0:06:51This is not a question of spending more taxpayer dollars, but getting veterans what they need when they need Making progress means that we must take a closer look into the VA's bureaucracy and improve our oversight of the processes and policies that determine the quality of veteran mental health care. Suicide prevention and veteran mental health are bipartisan issues. Losing these veterans impacts red states and blue states. I hope this hearing will yield results to important questions about VA mental health care.
▶ 0:07:20How are these policies developed? What steps has the VA taken to adjust its approach? How does the VA use science and data to improve veteran care? And most importantly, how can the VA better serve the veteran? The answers that we hear today will inform our next steps to address these urgent issues. Veterans should not have to wait for mental health care, and it is our bipartisan responsibility to ensure the VA has up-to-date policies and is enforcing these policies to ensure no veteran slips through the cracks.
▶ 0:07:48Again, this is a bipartisan issue and we cannot let politics stand in the way of making progress. There was spirited conversation during our last full committee hearing on the VA's workforce reform efforts. The the impact the VA's workforce reform efforts would have on delivering mental health care to veterans. The secretary has addressed this misinformation. And let me reiterate, no missionritical employees, including those at the Veterans Crisis Line, have been terminated from the VA.
▶ 0:08:14I am committed to ensuring that the VA works for veterans and their caregivers with a functioning quality workforce. That being said, I look forward to hearing from our witnesses and I now recognize our ranking member Ramirez for her opening comments. Thank you, Chair Kiggins.
▶ 0:08:32For many years, I worked at a homeless shelter where I saw a case of veterans confronting alone, without anyone to turn to, mental health Imagine after wearing the uniform and serving our nation, these veterans were dealing in silence with the pain of PTSD, depression, substance abuse, and the risk of self harm.
▶ 0:08:55So, I'm really glad that today we're having this hearing to truly discuss the necessity of adequate mental health and suicide prevention screening for veterans. The topic of today's hearing really gets to the crux of why VA and this committee exist.
▶ 0:09:14Our responsibility is to ensure that when veterans need help, they are connected to the clinicians who can provide the care and the services that they need so that no veteran has to confront these challenges alone. That's why we cannot have a complete conversation about mental health and suicide screening at the VA if we're unwilling to also address the cuts to personnel and the resources the agency and the work environment clinicians are currently operating in. We have to look at the entire picture.
▶ 0:09:43You see the mental health and well-being of veterans does not exist in a vacuum especially when upwards of 30% of the impacted workforce are veterans themselves. The must trump fueled uncertainty and the chaos being created for veterans and VA staff impact the mental health and the well-being of veterans. We are hearing directly from veterans who are worried about losing their VA care because of the Musk Trump cuts.
▶ 0:10:13We know veterans have lost their jobs across the federal government and are now facing the trauma of unemployment due to this Research shows that unemployment and job loss puts individuals at increased risk of suicide. And let me tell you, uh, being someone that ran a homeless shelter, uh, who saw veterans who were unemployed, who had no housing security, I can attest to this.
▶ 0:10:40So, it's really clear to me that we cannot have a conversation about adequate screening without also discussing adequate staffing across the VA enterprise. We can't talk about adequate intervention without talking about adequate investment. Psychiatrists, psychologists, primary care physicians, and medical support assistants have long been on the VA Inspector General's severe occupational staffing shortage list.
▶ 0:11:06It's easy to see how shortages of these positions, which directly coordinate and provide mental health care to veterans, would affect VA's ability to adequately screen veterans for suicide. And we had a talk about the work environment in which clinicians are now forced to provide mental health screenings and treatment since Doge and Trump's April 15 return to office order that left facilities scrambling to find space for clinicians.
▶ 0:11:33We have heard report after report from providers who are conducting teleaalth appointments in compromised conditions from open spaces to closets to even showers. I can tell you as someone who served as the executive director of a social service organization that served people experiencing trauma and struggling with suicidal ideiation, a shower is not the appropriate place to have these conversations.
▶ 0:12:00Providers are worried about the privacy of veterans, about the comfort of the veteran in disclosing their needs, and about having delicate conversations in unfit environments. And they have every single right to be worried. It is unacceptable that clinicians are taking their screenings in a closet.
▶ 0:12:20Sadly, a VA spokesperson dismissed the concerns about veteran privacy as nonsensical, saying that the VA will make accommodations as needed so employees have enough space to work and comply with industry standards for privacy. But we're hearing directly from clinicians that those accommodations are just not happening. Hypocrisy is a word I feel like I'm using a lot these days.
▶ 0:12:44My colleagues cannot act concerned about the mental health of veterans while ignoring the mental health toll that the must Trump agenda is taking on them and cheering that agenda on from the halls of Congress. I will close with this. I believe we have an obligation to ensure that every single veteran accesses access the care they need and they've earned.
▶ 0:13:09Secretary Collins and President Trump have turned their back on LGBTQ plus veterans by shutting the VA's door to gender affirming care, which in many cases includes mental health care. That too is unacceptable. If we want to talk about threats to veterans mental health, we have to have an honest conversation about one of the biggest threats and that is the Trump administration.
▶ 0:13:33Through their actions, they are creating the kind of anxiety, the uncertainty, the trauma and stress that directly and negatively impact veterans mental health, their well-being and their care. With that, I look forward to this hearing to truly forgetting about R&D and putting our veterans first. And that also requires the veterans that are part of the workforce that protects our veterans. With that, Chairwoman, I yield back.
▶ 0:14:03Thank you, Ranking Member Ramirez. I will now recognize our witnesses on our first panel testifying before us today. We have Dr. Dr. Weakers, the deputy executive director of the Office of Mental Health of the Veterans Health Administration, the Department of Veteran Affairs. She's accompanied by Dr. Anthony Stzone, the chief medical officer of Veterans Integrated Service Network 9 of the Veterans Health Administration at the Department of Veteran Affairs. We also have Dr.
▶ 0:14:30Julie Kroiaak as act acting assistant inspector general for the office of healthcare inspections of the office of the inspector general. While the witnesses please stand and raise their hand. Do you solemnly swear the testimony you are about to provide is the truth, the whole truth and nothing but the truth. Thank you. You may be seated. Thank you. Let the record reflect that the witnesses answered the affirmative. Dr. Dr.
▶ 0:14:55Wakers, you are now recognized for five minutes to provide the VA's testimony. Care for our veterans. My name is Elsa Weekers and I it has been my honor to serve the past three years as the deputy executive director of the Veterans Health Administration Office of Mental Health. Joining me today is Dr.
▶ 0:15:25Anthony Stone, chief medical officer of the VA Midsouth Healthcare Network. I have had the privilege of working with and caring for veterans as a practicing board-certified adult and geriatric psychiatrist for the past 15 years. VA's mission to care for our veterans drives us to improve daily. Veterans face unique mental health challenges, including higher rates of PTSD, depression, and substance use disorders, all of which significantly elevate their risk of suicide.
▶ 0:15:53Currently, 17.6 veterans die by suicide every day, reflecting a grave public health crisis that impacts communities nationwide. While many veterans are successful and fully integrate back into society, some experience invisible wounds of war, conditions like PTSD, depression, and substance use disorder combined with the challenges of life after military service contribute to an elevated risk of suicide.
▶ 0:16:19In response, VA has developed a broad continuum of mental health services to ensure veterans receive the help they need. This includes crisis intervention, sameday access for urgent needs, outpatient, residential, and inpatient care across VA medical centers, community-based outpatient clinics, vet centers, the 247 veterans crisis line, and a nationwide network of suicide prevention coordinators or SPC's.
▶ 0:16:46VA's mental health services are designed to be accessible, evidence-based, and recovery oriented. We emphasize early intervention, continuous support, and seamless integration of mental health into overall health care. Most veterans utilizing VA services report positive experiences and satisfaction, appreciating the availability of essential services, the privacy of medical records, ease of access, and the professionalism and courtesy of our VA staff.
▶ 0:17:13In 2018, VA published the National Strategy for Preventing Veteran Suicide, emphasizing a public health approach to suicide prevention. This combines community prevention and clinical intervention actions to directly serve veterans. Our commitment to preventing veteran suicide is integrated throughout all mental health programs and supported by enhanced staff education and suicide prevention. The secretary has made preventing veteran suicide a top priority for VA.
▶ 0:17:41VA leadership is closely examining all current suicide prevention efforts and we are committed to challenging the status quo in order to find new and better ways of helping veterans. We cannot continue approaches that have failed to produce meaningful improvements despite substantial resource investments. Recent reports by the Office of Inspector General have highlighted VA's deficiencies in VA's mental health care intake process and adherence to suicide risk identification screening.
▶ 0:18:07These findings underscore the need to strengthen initiatives and ensure high quality care. VA has implemented a standardized suicide risk screening and assessment process known as the suicide risk identification strategy or risk ID completed annually for all veterans receiving VA care. This process includes a primary screen using a standardized questionnaire and a comprehensive suicide risk evaluation for any positive screen.
▶ 0:18:33This determines the severity of suicide risk and helps develop a risk mitigation plan. To ensure adherence, VHA issued a memorandum requiring all veterans integrated service networks to implement risk ID requirements by April 7, 2025. In fiscal year 2024, VA completed over 2.6 million uh suicide risk screenings. To stay at the forefront of suicide prevention, VA continually updates clinical guidelines and training programs.
▶ 0:19:01In 2024, VA and DoD released a new joint clinical practice guideline for the assessment and management of patients at risk for suicide. Additionally, all VHA staff must complete suicide prevention training. VA has also implemented specialty training for SPCs and mental health clinicians on topics like lethal means safety counseling, ensuring highquality care for at risk veterans. VA is taking decisive action to transform the department's mental health care system for veterans.
▶ 0:19:27The path forward requires VA to embrace innovation, accountability, and proven practices across every facet of its operations. Meaningful change requires collaboration within VA and with partners across government, private healthcare, and veteran organizations. This whole of society approach is essential to reach veterans wherever they may be. The oversight from this committee strengthens VA's work and helps ensure our focus remains on what matters most, providing veterans the exceptional care they have earned.
▶ 0:19:55VA looks forward to continuing to work with this committee and we look forward to answering any questions you may have. Thank you. Thank you, Dr. Weekers. Dr. Kroak, you are now recognized for five minutes to provide your testimony. Thank you, Chairwoman Kegins, Ranking Member Ramirez, I am grateful for this opportunity to discuss the OIG's independent oversight of VA's mental health services. The OIG recognizes that meeting the complex needs of veterans requiring mental health care comes with extraordinary challenges.
▶ 0:20:23The Office of Healthcare Inspections routinely assesses VHA's services and how well they address those challenges. Our clinical teams regularly make recommendations to improve VA's delivery of health care through reviews of mental health and suicide prevention programs, inpatient mental health units, reports of harm to patients at individual medical centers, as well as inspections of vet centers.
▶ 0:20:48OIG recommendations for corrective action are based on identified deficiencies and non-compliance with VA policies and established standards of care. As my written statement details, deficiencies can be grouped into three stages of suicide risk reduction interventions with the first focused on screening and assessing veterans risk.
▶ 0:21:09A December 2024 II review of VHA's suicide risk screening compliance found that in fiscal year 23, the annual adherence rate was just 55%. Interviews revealed that the reasons for non-compliance included staff feeling uncomfortable with initiating screening and lack of clarity for who should be overseeing the staff compliance.
▶ 0:21:31A tragic example of a failure to properly assess a veteran was documented in an OIG report that found a veteran's crisis line responder did not fully assess a caller's alcohol impairment and access to lethal means. Shortly after the call, the veteran died suicide. The second stage of risk reduction is the effective management of acute care needed after a veteran's suicide attempt or ideation.
▶ 0:21:57In two separate 2024 hotline reports, our teams found non-compliance with mandates to remove belongings from a patient that could be used in a suicide attempt and with requirements for staff's one-to-one observation for a patient with suicidal ideiation. In both instances, the veterans attempted suicide during their hospitalization and tragically, one died.
▶ 0:22:19Our mental health inspection teams consistently review the environment and care practices of VHA's acute inpatient mental health units, repeatedly finding lapses and preparing patients for discharge. Because the highest risk for suicide occurs within the first 30 days hospitalization, VHA staff should unfailingly carry out activities such as pre-discharge screenings, determinations of access to lethal means, and a suicide prevention safety plan to confirm that a hospital
▶ 0:22:50discharge is appropriate and safe for each patient. Third, while the tragedy of a veteran's suicide can overwhelm survivors and health care teams, lessons learned can and must support efforts to reduce future suicides.
▶ 0:23:04Our work has identified numerous delays and deficiencies in important internal VA reviews after a veteran completes suicide, including root cause analyses, peer reviews, institutional disclosures, and family Such delays not only impede improvements but also deprive loved ones of important grief management resources.
▶ 0:23:28The last report in my statement was published just last month on the role of vision chief mental health officers across these 18 regional networks. The chief mental health officers reported they lack clarity about their role and the authority to effectively address staff In effect, VHA's governance structure may contribute to problems with performance and hinder opportunities for improvements. There will never be a single solution to the devastating problem of veteran suicide.
▶ 0:23:58Still, we must continue to work towards saving every life. That means not losing sight of what needs to happen today and every day, providing wraparound services that treat known risk factors for suicide. from prevention such as anxiety and depression management, substance use disorder interventions, PTSD and military sexual trauma treatments, and grief counseling.
▶ 0:24:22VHA providers must meet veterans where they are and be ready to effectively intervene during their greatest moments of need. The OIG is committed to conducting oversight to ensure all veterans have access to the highquality and compassionate care they need and deserve. Madam Chair, this concludes my statement and I'd be happy to take any questions. Thank you, Dr. Kroak. We will now move to questions and I yield myself for five minutes.
▶ 0:24:50I just wanted to to start with uh with you you spoke a little bit, Dr. Kroak, about uh staff non-compliance and about the the vision mental health chiefs being uh kind of frustrated with their ability to understand what their role is. could you expand on that just a little bit because I know we've talked about that in different parts of of this committee and what that looks like. Yeah, I I think there's this poorly defined or lack of clarity in what these critical leaders roles should be um in place of just being a consultative arm.
▶ 0:25:21We just repeatedly find that when we're in a facility, if there is an issue brought up and we go to the vision to understand their knowledge or interventions, they either weren't aware or felt they couldn't intervene because because that wasn't in their authority to do so. So, would it be helpful to clarify that authority? We we think so. We very much think so. And you know, the one report on the chief mental health officer is one example.
▶ 0:25:48And we've published other individual hotlines where we really um tried to get that message across that it was concerning that the facility was undergoing such trauma and the vision either didn't know about it or didn't effectively intervene or monitor the events that were occurring. So the monitoring is there but just the enforcement of what to do once they identify a problem what they can what's next steps they can take. Yeah.
▶ 0:26:14it be it becomes unacceptable um for this regional source to just serve in a consultative role to wait to hear about the issue has been ineffective and we've repeatedly identified that in reports. Thank you. Thank you very much for clarifying that. Uh and then we've we've all heard the saying if you've seen one VA you've seen one VA and my concern here is that all VA facilities should be operating off agencywide standard standardized policies for mental health.
▶ 0:26:41How is it that interpretation adherence to VA's mental health policies vary so much between visions and facilities? Either Dr. Wers or any of you can answer. Why is there variation? Um there there are several possible causes for that. One could be uh that our policy needs to be better clarified and written more clearly.
▶ 0:27:11And that's something that I take personally to heart and that I'm working with my team as we constantly review and update our policies to ensure that we have clear language. Um the other uh could be about ensuring that there's clear training um to help educate the field staff uh and our colleagues at the Vizen level um about that. Uh we work hard to ensure we have those trainings available and that they're consistent across the system. Um we work closely also with our vision partners and our facility leaders uh with open communication.
▶ 0:27:42We have regular meetings with our vision uh chief mental health officers every week. Um we and then the visions and I'll let Dr. Stzone say more about the communication that they have regularly between facility leadership and and vision leadership. But I think it's a matter of uh ensuring we have uh clear policies with uh standard trainings and clear lines of communication. and we're working on all of those things thanks to the OIG providing us some opportunities uh and areas where we may have gaps uh to focus on.
▶ 0:28:10Could that role clarif clarification include role clarification at the vision level? What what Dr. Kroviaak was just talking about? Yes. and and I'm pleased to report that office of mental health has already uh drafted uh a functional statement and roles and responsibilities uh with our partners in the the vision chief mental health officer role and we look forward to um having that role clarity um for everybody across the system in each of the vis. Thank thank you Dr. Szone. Do you have anything to add?
▶ 0:28:39Uh no I appreciate Dr. weaker's uh comments and as she said at the vision level our goal is to make sure we have the policies from office of mental health and office of suicide prevention uh we meet regularly with them as well as in the vision we have regular huddles and also meetings regularly with the facility leadership to make sure those things are going forward I think it's important that there is some standardization and understanding authorities across the network as any healthcare network you need to have standard processes and policies to follow through and our goal is to make sure those are being followed through
▶ 0:29:10to to the front lines. Uh healthcare is a very complex uh system and trying to make sure we have the right processes in place to follow the policies to make sure our frontline staff can do the right things and follow through with those is critically important and communication across the network also up to central office and down all the way to the facilities is key and I'll speak with vision 9.
▶ 0:29:32I we try to do that as much as possible with our chief mental health officer who reports directly to So, I'm just curious about the uh communication flow. I know in my district in Hampton Roads, Virginia has one of the largest veteran populations and just practicing in primary care there and uh I know we had many many patients who would receive some level of care at the VA uh because it entailed great services that they enjoyed cheaper hearing aids, eyeglasses, medications, this type of thing, but then they would come uh to receive community care
▶ 0:30:02from different civilian providers. So, one of my biggest frustrations uh was just trying to get patient notes and documents related to my patients, especially on the mental health care side, which I know there's certain privacy issues with mental health and even from the civilian provider side, it was challenging to get to get notes and uh and an accurate prescribing record, which I thought was was perhaps most important, too.
▶ 0:30:25But how does the VA work with community providers to make sure that information is shared so providers are making informed decisions about a veteran's especially mental health care? Thank you for that question. Um so our um the office that oversees community care uh works with our third party administrators and helping manage the network uh of providers in the community.
▶ 0:30:47um and working together to get that uh information back is a key area that we need to focus on and and sure for the reasons that you've mentioned uh because that continuity of care and that information is really valuable for the providers back at VA um to understand what's happening in the community and is there a person that that goes behind and is is doing that personal followup too with with the veteran and ensuring that once they've left the office just talking about continuity of care again that that piece I feel like is is where we lose
▶ 0:31:18people. A lot of times they especially when we get them in the door, we have them seen, we have a plan of care, we start a new medication or or have a follow-up visit. And who goes behind and make sure that that on the compliance side that that is actually happening is sort of process in place for that. I'll have to take that back so that I can make sure I get you the most up-to-date information about that. And I've always been a proponent just on the personal side of using home health as a home health nurse especially. I mean, I think there's a lot of benefit to to a visit or two in people's homes.
▶ 0:31:47We've we've tried to to you mandate that or make that it's it's hard. we don't have enough home health providers either, but but I just think that piece or what are we doing with that continuity of care piece because they go home and and I mentioned in my opening statements just about uh veterans who taking multiple psych meds and and I know you all understand what that interaction piece looks like and frustrates me when I have surviving family members that will show me bags of medication that they don't know what they this is that was a combination of things that
▶ 0:32:17they would again take more if they felt worse and less if they felt better and uh and there was some disconnect between when these medications a lot of disconnect between when these dis medications were prescribed, how they got to be lumped together uh you know and and that just goes back to the communication flow which is a which is a source of frustration for me again on the civilian provider side. I think you know the electronic health record may may be a a helpful thing. We'll keep working through that.
▶ 0:32:44But uh uh but just that that communication piece, that follow-up piece, that contin of care piece, I al along with role clarification, all the other things that I know you all are focused on and talking about, that piece is just important to me personally. And my time's expired for now. I'll yield to my ranking member. Thank you, chair. Well, I want to thank you all for being here again. Really appreciate it. Dr. Wakers, I want to especially thank you for being here today. behind me in a moment.
▶ 0:33:15Um, you will see are the instructions that accompanied a rubric VA supervisors were required to fill out justifying why their employees should not be subject to the agency's plan reduction in force or what we call the riff. Supervisors who are clinicians themselves and who manage employees providing mental health care were obligated to fill out this rubric.
▶ 0:33:41And as I look at it, having been a manager myself, I find it absurd that the VA could measure mental health providers value and justification through these very limited scales. Dr. Wickers, these instructions require supervisors to provide one to two sentences explaining their special skills, their competencies, and their institutional knowledge for their positions. How would you fill out this for a mental health provider and the support staff the provider relies on?
▶ 0:34:12Thank you for that question. Um, I can't really speak to a hypothetical. I'd have to have an example of a specific individual provider uh to be able to answer the question and I'm I'm just seeing uh the information that you're providing now in terms of the details. So I would uh respectfully like to take that back and would be happy to take any specific questions you have and and report back afterwards. So thank you for that and and let me just be clear, Dr.
▶ 0:34:39Rickers, this was provided to supervisors already. So this rubric is already available and and I'm concerned that you would not have seen it prior. But but let me ask you this. Do you think one to two sentences fully capture a provider or their support staff importance to the mental health and well-being of I think that uh our mental health providers are invaluable resources to our veterans.
▶ 0:35:05Uh and obviously they uh the work that they do is complex and um is something that is hard to capture in one to two sentences. But nonetheless, I can appreciate the need to have a rubric to make decisions. So following up on that, the rubric is there. Supervisors have to take time to fill this out. Can you explain to me why supervisors, many of whom are clinicians themselves, were required to take time away from patient care to fill out this rubric?
▶ 0:35:35And let me let me add a little more. Some providers reported that they had to fill this out for over 300 employees, this rubric. and spending some time trying to figure out is how in one sentence at most they could be able to explain the negative service impact of letting that staff person go. I I I just don't understand.
▶ 0:35:58Tell me, do you think it's a good use of a clinician's time to perform administrative tasks that justify the critical nature of their employee jobs instead of using their time to provide mental health care for veterans? I think putting veterans first is the most important thing that any one of our employees does. Um, and putting the uh ongoing and sustaining mission and uh and the work that we do is what's most important. I I agree, Dr. Wickers.
▶ 0:36:24And and we're also here to discuss ways the VA can better screen veterans to ensure that no veteran dies by suicide. So, I have another follow-up question for you. Will the VA provide gender affirming care if it saves a veteran from suicide?
▶ 0:36:39Uh the department has made changes to uh provision of hormone therapy related to uh transgender patients, but those who have been receiving that service can continue to as well as service members who are transitioning into veteran status uh who are eligible for VHA healthcare. All of our mental health services and preventive health services remain available for all veterans um who are eligible for VHA. So what you're saying, Dr. weaker is that the VA will provide that gender affirming care if it saves a veteran from suicide.
▶ 0:37:10I'm saying that uh the VA is providing uh services based on the new policy and that mental health services and preventive medical services remain available to all eligible veterans. Okay. Well, let me let me pivot for a second here. I know my time is up soon. Dr. Kravak, what are the top five clinical severe occupational staffing shortages the inspector general identified last year?
▶ 0:37:36Um, you know, offhand I don't know the top five, but I do believe the top ones were nurses, physicians, mental health, in particular, psychologists, and psychiatrists. Got it. And since I only have 15 seconds, Dr. Waker, are you aware of the VA barring staff in the field from performing their assigned duties to do veteran outreach within their community? Yes or no? I am not personally aware of that, but if you have examples, please share and I'd be happy.
▶ 0:38:03So, just to wrap up, just to put on record, in Chicago, we know that the VA staff were told to no longer go out to the ward offices to do veteran outreach. And I guess my last question to you is, do you agree that meeting veterans where they are is a central component to suicide prevention? Yes. Thank you. With that, I yield back. Thank you. And we're going to do another round of questions. I just have a couple more uh since we have a little bit of time. Dr.
▶ 0:38:29Wers, could you please explain what policies the VA has reviewed since January to ensure better communication and procedures for service members transitioning to VA care? I know we we've had a change of administrations. We have a new a new VA secretary. What improvements have been made to care coordination between the DoD and VA? And what what do you feel like we should be focused on uh moving forward? Thank you for that question, ma'am. Um the uh VA is working closely with our partners in DoD on transitioning service members.
▶ 0:38:58That's work that's been ongoing for some time and continues uh to this day. I think ensuring a seamless transition from uh service member to uh veteran status is important in particular uh ensuring that we have continuity of mental health care uh especially for those who may be receiving medications or therapy treatment uh as service members and ensuring that we get them uh transitioned as smoothly as possible to receiving those services at VA. Is is that happening?
▶ 0:39:26Is that happening where there's a a flawless transition or a seamless transition with charting and records and we are working to ensure that it happens uh smoothly for everyone. Um and uh we have lots of uh folks working together with our colleagues in DoD to help ensure that that's taking place. Okay. Tell us what you need and what we can be helpful with to to make that happen. And I I think that transition piece is is critical and challenging in so many ways.
▶ 0:39:54But uh but I think with the mental health care piece, we we should prioritize that and we owe that to to our veterans, especially now. Uh can you talk to me, Dr. Koviaak, about uh just staffing staffing? Is there do you feel like there's issues with staffing shortages? Is that uh you know there's there's a lot of talk, a lot of misinformation, a lot of fear-mongering. I I don't I don't believe that.
▶ 0:40:17And then also could you uh talk to me a little bit about your use of advanced practice nurses and if you feel like they're being uh best utilized in the mental health environment. Um so in terms of staffing, you're right. We haven't um seen the secretary's plan for what the actual um final staffing um cuts or decreases in staff will be. But we report annually on critical staffing shortages. That's a congressionallymandated report. We are doing our work on that now and that will be published probably by the end of the summer.
▶ 0:40:47Those are perceptions at each individual facility level as to what their most critical clinical and nonclinical shortages are. A reminder that you know it is so important the um staff member that meets with the patient. But in that arrangement there are multiple backstage staff who are coordinating so many activities to ensure the effectiveness of that meeting between the provider and the patient.
▶ 0:41:13Um the work we do on our cyclical reviews, hotlines, nationals will capture when there are staffing concerns. you know, we we might go in for an allegation specific to um substandard care and find out that the staff are reporting in um ineffective staff, too few staff, prolonged vacancies. So, our work will continue um to ask those questions and we will absolutely report the findings.
▶ 0:41:40And in uh your question about nurse practitioners, we haven't looked specifically at their use or barriers to using them um more so in the mental health arena, but we know they are used um across the system. And with the shortages of mental health providers within VA and without, I I can't imagine that um there's not an increased need to encourage their participation in that care. Yes.
▶ 0:42:06and and they're a great source of uh if I might add just of of being able to to fill those gaps in care. So, uh so please make sure we're we're utilizing uh all of our advanced practice nurses as well. And uh you Hampton VA, which is the VA facility in my near my district, um lot lot of challenges we're working through, but when I've had the opportunity to visit and on the mental health care side, I think they do a great job and I hear great things about that piece.
▶ 0:42:32there's some other pieces we could we could work to do better, but uh but I'm thankful for that and I I hope that all VA facilities are prioritizing that care. I know it takes a team. This is not just a provider, but that's an important piece and making sure our providers are are supported uh is important, too, when we think about staffing. So, so that's good. And providing that reassurance and I know Secretary Collins has done a good job uh throughout the country really. He's been down to Hampton Roads, but uh other places as well.
▶ 0:43:02Just reassuring people that we're focused on staffing. We've picked up the phone and sure we are focused. We are going to be protective of of the actual provider piece, the nurses, the physicians, the allied health partners who who touch our patients. So, so just again providing that that reassurance piece I think is important. Wanted to have each of you, if you don't mind, talk about just alternative treatments for mental health. I think that everyone responds different. and we have to meet the veteran where they're at.
▶ 0:43:28And we've done some discussions in this community or in this committee uh talking about alternative treatments from psychedelics to uh ect to different you know there's there's a a variety of treatments out there. Uh can can each of you respond just about how you feel that's going in the VA? Is there room for improvement? I feel like we we need to do more and probably quicker about again meeting the veteran where they're at. What do they respond to? But I'm just curious as to your opinions. Thank you for that question, ma'am.
▶ 0:43:57Um, so VA has been growing its use of um what we call the sematic treatments. So those are things like ECT, uh, transcranial magnetic stimulation, ketamine infusions, and intraasal esetamine. Um, over the last uh, five to seven years, we've seen growth and expansion across the system. Um, could we do more? Yes. Uh, and we continue to try to expand uh, access to those both in direct care and also through referral to community providers.
▶ 0:44:24Um we have uh as I know you are aware we have announced an RFA for funding of psychedelic research. Um and that is something that continues moving forward at VA. We also have um studies ongoing for stellate ganglen block excuse me um and other um uh kind of emerging therapies as well. So I think we're doing a lot in the research space and the innovation space.
▶ 0:44:49Uh and then in terms of our existing standards of care for difficult to treat depression uh or uh other types of mental health conditions that fail uh to respond to initial courses of treatment, we have a menu of options available to veterans. Uh and we're working on expanding access to those. Good. Thank Thank you, Madam Chair. As Dr. Wicker said, um we look at evidence-based therapies to make sure we're doing the right things for veterans. That has been proven effective.
▶ 0:45:18Uh there's lots of research in the VA as well. I'll say our geriatric geriatric research centers also have research into dementia and psychosis as well uh for mental illness in the geriatric population which is important. Um at this time treatment resistant depression I'll I'll speak for vision 9. We are trying to implement all three modalities of treatment ect transranial magnetic stimulation and kamine infusion at all of our sites so all veterans have access to the most up-to-date and evidence-based treatments. Um I know there's much research going on as Dr.
▶ 0:45:48Rick has already spoke about and as those um new studies come forward with possibilities you know we will adapt those with evidence-based treatment. Um I I will say from an oversight perspective, nobody does mental health care like VA. They are absolutely pioneers um in this field and we are very encouraged by the ongoing previous ongoing and um forward-looking research that continues and I hate to say it, but we look forward to doing oversight work.
▶ 0:46:19Good. I I appreciate you're you're just uh always working to expand the treatment options for veterans and on the geriatric side too. I mean, I I think that's a that's a whole another discussion probably for for a whole another committee, but uh but I I feel like there's not enough focus on that. Our veterans are older adults usually and geriatrics is technically over the age of 65. So, that's a large probably percentage of our veteran population and I know like at the Hampton VA we had one geriatrician on staff and and that wasn't enough.
▶ 0:46:47And uh she had some great nurses working with her, but but focus on that piece and I and thank you. I think we could always have more when we talk about studying dementias and cognitive impairment. That was that was my specialty as a geriatric nurse practitioner. But I just in my perfect world, yeah, we we have a whole another section of the VA that focuses on geriatrics. It's we talk a lot about mental health and and uh another just personal passion project of mine.
▶ 0:47:14But on the geriatric side, we don't have enough advocates for older adults and their specific needs for the patient and for their families and caregivers. So, so we'll we'll table that for now, but look forward to future discussions about taking care of our older adults. Uh, with that, I'll yield to my ranking member if she has any last questions. Thank you. I I just want to uh follow Um, Dr. Wickers, as the chair mentioned in her opening, overdoses claim for too many veterans lives.
▶ 0:47:43Do you think that Narcan saves lives? Yes. Will the Trump administration cuts to Narcan funding lead to more overdose deaths, including veteran deaths? I can't speak to but you do agree that Narcan saves lives and we should have adequate funding to be able to continue to provide it. I agree that Narcan saves lives and the VA's overdose uh education and uh Nlloxxone distribution program has been award-winning and has saved many veteran lives. All right.
▶ 0:48:12Well, let me shift here then for a second to talk more about it. Can you please describe the partnership between the Substance Abuse and Mental Health Service Administration or what we call SAMA and the VA? Follow up with the second part of it. How does that partnership improve mental health treatment and support services for veterans?
▶ 0:48:31Um, what I can speak to is the uh partnership that I personally have been engaged with uh colleagues at SAMA in as it relates to ongoing uh work in our development of strategic plans for psychedelic uh treatments. Um, and I believe that our partnership is strong and uh the connection between our two agencies uh helps both uh SAMA and our veterans uh at VA.
▶ 0:48:54Are you concerned that cuts to SAMA will affect VA's ability to provide services to veterans suffering from substance abuse disorder and other mental health challenges? I believe that uh the VA will continue to provide highquality access to substance use disorder treatments and for mental health treatments for its veterans. Okay. Well, let's get a little bit more into that. I want to know how you're going to do that. How will the VA fill in the gaps if SA if SAMA is gutted? Uh, I will have to wait and see.
▶ 0:49:22Uh, and again, I can't provide uh a response to hypotheticals. Uh, so we will adapt and ensure that all of our veterans continue to have access to SUD treatment and but Dr. Wickers, I I hear you say that you don't you can't work on hypotheticals. You should be planning as you're already hearing that there's going to be cuts to particular programming.
▶ 0:49:44And so for me, if we're having real conversations about ensuring that veterans have the resource they need, then you should already be planning accordingly on what you're going to do to fill those gaps. If you're telling me that you will be prepared to be able to ensure that veterans continue to get the resource they need. So, it's hard for me to hear you say we're prepared to ensure that um we continue to provide the resources, we have the partnerships we have, but you're not doing any planning.
▶ 0:50:10And I think that's part of the challenges that we've seen particularly in this committee is that there is no adequate planning or even real strategic consideration when we're talking about letting staff go. I mean, we really have to be asking ourselves when we're making these major decisions and shifts and changes, what will the impact in fact be for our veterans and what are we doing in advance to ensure that the veterans that we say that we serve are not impacted by it.
▶ 0:50:38So I have to say that as you say that it's really difficult for me because we can keep saying well I can't really plan on rhetorical but if you're not actually planning for things you already know that are coming then that's a concern for me especially as we know how critical the work of this committee is in oversight. Let me let me come back to something real quick that I started u talking about at the end and with that I'll yield back to the to the chair.
▶ 0:51:02I mentioned to you that uh the VA is barring staff in the field from performing um their assigned dutings duties to do veteran outreach within their community on a number of occasions. We've uh invited uh the VA to come to some of the outreach events that we do particularly around housing, healthcare, and other resources. So, I submitted a letter March 6th asking why this is happening. Uh you said you weren't aware that this was happening.
▶ 0:51:27I want to make sure that on the record I know that I've submitted a letter over a month ago and I've not received a response. I wonder if by any chance if you know that a letter was sent and if you know there's any update on when I can expect a response. Thank you for the question, ma'am. Um I will uh take that back and look into it and get you uh an answer as to when you can expect your response. Thank you. Appreciate that. With that, I yield back to the chair. Thank you. And I I have no further questions.
▶ 0:51:57So, ranking member Ramirez, do you have any closing remarks? Oh, I'm sorry. Well, we have a a new member just joining us. So, we will recognize Congress Congressman Kennedy for five minutes. Sorry. And then we'll close. Yeah. Thank you very much. Uh and thank you all for being here today, for your service to this country, for your testimony. Uh before entering public service, I served as an occupational therapist.
▶ 0:52:22My work focused on helping people navigate the challenges of daily life and understanding that health isn't just about physical recovery, but it's also about mental and emotional well-being. I saw firsthand how addressing mental health was just as critical as treating physical conditions. Without quality mental health care, true healing is incomplete. So, our veterans deserve no less, as we know.
▶ 0:52:49And I'm deeply concerned that VA's mental health services are not meeting the rising demands of veterans. And because of reckless cuts by this administration instead of muchneeded investment in our bravest veterans are facing long wait times, workforce shortages, and barriers to accessing the full range of services that they need.
▶ 0:53:10So, if we're truly committed to honoring our veterans service and sacrifice that they've made, we have to ensure quality, timely mental health support at the gold standard level of care alongside their physical care. And so, with that, I have a few questions. Um, you know, first and foremost, the the VA and this administration are now forcing employees, many of whom were hired as remote workers, to return to office.
▶ 0:53:40Uh, Dr. Wickers, was the VA aware of the space constraints for mental health providers before ordering them to work in the office? Thank you for the question, sir. Um so we have a process in place to review at each of the local facilities the space available uh before any uh return to office orders are uh submitted to employees to return.
▶ 0:54:06Uh so the space available is being considered uh as we return people to office. Uh, is the agency concerned about HIPPO violations as providers have reported staff overhearing sessions and a lack of privacy after being placed in congregate settings? All of our facilities uh and uh providers are held to the highest legal and ethical standards related to privacy.
▶ 0:54:34Um, and we have processes in place. Should people uh be concerned that the space they have available is not suitable for privacy uh concerns for the care that they're providing, we have processes at each of the facilities that allow uh those staff to report those concerns so that they can be addressed and ensure that uh privacy of our veterans is uh held uh sacred as it should be. Thank you. Uh Dr. Dr.
▶ 0:54:59Rickers, on March 4th, it was announced that the VA planned to eliminate over 80,000 jobs, which would certainly include mental health providers. Thankfully, that directive is now on hold. Uh, since the VA is already facing a shortage of mental health providers, how does the department plan to provide responsive mental health services in light of these cuts? And were you consulted before the announcement of these cuts? Thank you for the question, sir.
▶ 0:55:24So, there are 30,000 uh frontline provider uh and staff positions that are exempt uh from the hiring freeze and other uh actions. And included on the list of those 300,000 uh staff and providers are all of our different types of mental health providers.
▶ 0:55:42So, psychologists, psychiatrists, uh uh social workers, uh uh marriage and family therapists, uh LPMHC's, all peers, um all of those folks, uh and our frontline mental health providers are on the exemption list. Uh is there hiring taking place right now? There is hiring taking place right now and I believe Dr. Stzone can speak for uh explicitly about Vision 9. Thank you, Dr. Wickers. Thank you, Congressman. Uh yes. Uh as Dr.
▶ 0:56:12Wicker said, 300,000 positions were exempted from the hiring freeze. There's ongoing hiring for those positions. Uh in Viz 9, we have a dashboard for workforce management that lists the vacancies. We follow through with those and continue recruitments for all the frontline positions that have been exempted. While there's hiring that is uh taking place, are these folks being onboarded? Yes.
▶ 0:56:36Congressman, can you commit to sending this committee data on the number of employees and occupations that have been on boarded since uh January of this year? Uh yes, I'll take that back, Congressman. For all employees, I can only speak for Viz 9, but there is a a dashboard from workforce management. I believe they can get you those numbers. I I think it's vitally important that we have that data. It's one thing to make an argument that there are exemptions.
▶ 0:57:01While there's tens of thousands of potential cuts, it's and we need to know what those exemptions are, where they are. We also if there are if there's an argument that there's hiring that's taking place, we need to know if those people are actually being hired and on boarded and put to work rather than just put into a process uh not to be brought on board. So, it's a very important information. We would appreciate you uh bringing that to us and uh Madam Chair, I yield back. Thank you.
▶ 0:57:30And now we will uh move to our closing. Ranking member Ramirez, do you have any closing remarks? Thank you, Chair. I want to ask as we're wrapping up uh unanimous consent to enter a few news articles related to veterans mental health into the record from Ruters on Democracy, the New York Times, NPR, The Hill, Military.com, and NBC News. So ordered. Thank you.
▶ 0:57:55I would also like to ask for unanimous consent to enter six testimonials from veterans uh whose mental health is being affected by the cuts to the VA workforce and their ability to receive care. So ordered. Thank you. And I want to end by reminding my colleagues that in order to honor our veteran service with action, we must defend and protect our access to mental health services. and that starts by making sure that mental health providers are available.
▶ 0:58:23So, I look forward to our work and the follow-ups we'll get from the witnesses today. Thank you. And with that, I yield back. Thank you. And and for my closing remarks, I just want to thank the witnesses for coming in to testify today. We've gained better insight to the VA's mental health policies, the effectiveness of the services they provide to veterans, and how you're working to improve these processes. Thank you very much for clarifying about the mental health providers and partners that are exempt from the cuts and hiring freezes.
▶ 0:58:50And we have said this time and time again straight from the secretary's mouth. Thank you very much for your all your presence here today to clarify that. We will continue to clarify that and to uh remind uh our veterans that mental health care and their healthcare in general remains a priority. Uh I have personally picked up the phone multiple times to ensure that these positions are not being cut so I can provide some personal validation to that as well. But thank you very much for putting that on the record.
▶ 0:59:19We all know that while the VA has worked hard to provide support for mental health challenges, uh our veterans continue to struggle. We also know that providers are working hard. So wanted to say a special thank you to them because they are often an underappreciated group. our our physicians, our nurses, and all of our our allied health partners uh and their staff who work so hard every single day. We cannot let fear-mongering or partisan politics get in the way of achieving results for our veterans. It's one of the reasons I love working in the healthc care space.
▶ 0:59:48I feel like it should always be a nonpartisan issue. So, I think that we should work to hopefully remember that and hopefully we can get there. The VA must continue to prioritize a quality workforce that can deliver world-class mental health services and meet veterans where they are. We can no longer ask the veteran to navigate the VA's bureaucracy when what they need is help. And I know we're all working hard and have the same the same objectives here. It is essential that we have our veterans backs and we reform our approach to improve the policy and services that the VA provides to veterans.
▶ 1:00:19Thank you all so much for taking the time to be here today and I ask unanimous consent that all members should have five legislative days on which to revise and extend their remarks and include any extraneous material. Hearing no objection so ordered and this hearing is now adjourned. Okay.