▶ 0:19:31Chair Moran: Good morning and welcome. Before we begin the hearing, I want to highlight up today at 3:00 in emancipation hall, congressional medal that was authorized by the senate and the house will be presented to the african-american women who in world war ii delivered the mail by the millions.
▶ 0:19:58Chair Moran: We would welcome you to attend or at least honor those women today who served our country. It is a touching story. A number of networks across the country have carried the story about these women who rolled up their sleeves and got the mail delivered to service members in world war ii. Today we are on the topic of mental health. Veterans' well-being.
▶ 0:20:32Chair Moran: The veterans mental health improvement act was signed into law five years ago. I let this legislation with support of many who are here today. I would also indicate this was a piece of legislation the senator was engaged in. Better collaboration and made improvements with cutting edge precision research.
▶ 0:21:03Chair Moran: This landmark legislation also authorized federal funding for the parker gordon fox suicide prevention grant act. It was the goal of congress and this committee specifically for the v.a. To work more seamlessly with veterans serving's community organizations to provide care and nonclinical support services they deserve.
▶ 0:21:29Chair Moran: We are here to discuss suicide prevention services and hear directly about what has worked well and what needs to be altered. We will hear from the v.a. To receive a perspective of implementation on this grant program. We will hear from advocates for their perspectives and from veterans who have benefited from the program. We will receive input from the v.a.
▶ 0:21:55Chair Moran: And feedback from the advocates on four bills, which includes the hope act, my legislation, the brave act, sponsored by ranking member blumenthal, and every state counts for vets mental health act.
▶ 0:22:27Chair Moran: With that I yield to the ranking member for his opening remarks.
▶ 0:22:30Sen. Blumenthal: Thank you Mr. chairman. On this critically important topic that we are here today to discuss. The issue of veterans mental health, including access to care from a safe, reliable provider. A safe, reliable provider that has the expertise and trust to provide the best possible care.
▶ 0:22:59Sen. Blumenthal: I welcome senator warner to testify on behalf of the program. It has been a game changer for so many veterans. It is geared toward meeting veterans where they are. Trusted community partners and targeting underserved communities. My hope is we will have bipartisan support for reauthorizing the fox grant program.
▶ 0:23:31Sen. Blumenthal: We will have bipartisan consensus of a couple of really essential points. The rate of veterans of suicide, 17.6 per day, is absolutely intolerable. The level of services to veterans for mental health is woefully lacking.
▶ 0:23:55Sen. Blumenthal: The efforts underway to address the lack of mental health are completely inadequate. My bill on today's agenda, the brave act, re-authorizes the fox program but goes farther. I hope we will have bipartisan support to ensure not only this program but others to address these issues are for filled.
▶ 0:24:21Sen. Blumenthal: The fact is, the veterans crisis line as seen a dramatic impact in call volume, largely from veterans either terminated from the workforce or are concerned about losing their benefits or both.
▶ 0:24:38Sen. Blumenthal: At a time when veterans are uniquely anxious and apprehensive and need our support the most, we are seeing the trump/musk/collins conglomerate trashing and thrashing their way through the federal government. Contracts have been canceled.
▶ 0:25:04Sen. Blumenthal: Some have been reinstated but not before employees were left high and dry and forced to choose between paying out of or canceling their appointments due to contract cancellation. World-class researchers studying disorders are among the ones who have been terminated. It makes no sense. It is nonsensical. It is shameful and disgraceful.
▶ 0:25:34Sen. Blumenthal: On the issue of privacy, a recent memo obtained by npr recommended health providers tell their patients, "while I will do my utmost to maintain your privacy I cannot guarantee complete confidentiality." they are telling veterans they cannot maintain privacy or confidentiality due to space limitations caused by a rushed and reckless return to office
▶ 0:26:07Sen. Blumenthal: Mandates. Again, disgraceful. Shameful. Concerns about privacy will destroy the hard won trust the v.a. Has spent decades building. After this memo was disclosed, v.a. Backtracked to say it was temporarily delaying return to office requirements for tele-mental health providers.
▶ 0:26:39Sen. Blumenthal: These providers have not been exempted from the return to office mandated. The facilities have been asked to confirm their return to office spaces are private. This strategy of cut first, plan later, fire first, analyze later -- terminate, cut, freeze, ask questions later -- is apparently continuing.
▶ 0:27:11Sen. Blumenthal: It is at the expense of veterans and we have yet to hear in this committee from the secretary of the v.a. Despite my repeated requests for him to tell us what the rationale and reason is for these massive cuts and firings. We all know that even before the trump administration's crusade against veterans, the v.a.
▶ 0:27:39Sen. Blumenthal: Projected a 59% increase in inpatient and outpatient mental health care demand in the coming years. 59% increase. The department was already suffering from critical mental health staffing shortages. There were already 40,000 open positions in the v.a., some of them for mental health professionals.
▶ 0:28:05Sen. Blumenthal: In his confirmation hearing the secretary claimed -- he claimed -- suicide prevention was a priority. But instead of bolstering access to lifesaving mental health, he has fired thousands of critical employees, including veterans crisis line employees. Some have been reinstated. Others have found new employment.
▶ 0:28:30Sen. Blumenthal: That is understandable because they have bills to pay and lives to live and waiting for the administration to correct another unforced error can't be there burden. We have to make sure the administration answers our question, our responsibility oversight and scrutiny and to prevent the firing of another 83 thousand v.a. Employees over the coming months.
▶ 0:28:56Sen. Blumenthal: We know from this committee -- we have all been on it for a while -- that outreach is essential to bring veterans into mental health. We cannot rely only on veterans calling the crisis line, or coming to the v.a. Facilities. There has to be outreach.
▶ 0:29:20Sen. Blumenthal: 10 of those 17 per day average veterans taking their own lives, 10 of them have had no contact with the v.a. If we can reach more, we can save more. If we fire the counselors and others doing outreach, we will cripple efforts to save veterans from suicide, including the fox program.
▶ 0:29:46Sen. Blumenthal: While we are here today I hope to hear from our witnesses about the importance of outreach and how it can be bolstered and strengthen. Thank you, Mr. chairman.
▶ 0:29:56Chair Moran: Ranking member, thank you. We are now delighted to have before the veterans committee on a temporary basis the senator from virginia, senator warner. This is a rare occasion when other senators not on the committee appear before us.
▶ 0:30:16Sen. Warner: Thank you. This is obviously a very important topic. You have given me four minutes so I will try to hit under four minutes. Very much appreciate the work of this committee. The issue of mental health with our veterans is extraordinarily important. I think this is something we all realize is part of a core commitment.
▶ 0:30:43Sen. Warner: This is not a nice to do, this is an obligation we owe to the men and women who serve us. It is not charity. It is something we must fulfill. Unfortunately, as the chairman and ranking member and the all the committee members realize, veteran suicide is a scourge that have to be addressed. For the past several years the fox suicide prevention program has been a valuable tool.
▶ 0:31:13Sen. Warner: Senator boseman and I came up with initial legislation back in 2019. A number of members of this committee were supporters. It led to the staff sergeant fox grant program. $150 million has gone out in my home state of virginia.
▶ 0:31:36Sen. Warner: $4.5 million have gone to organizations providing the critical outreach to make sure veterans who are in duress know that the services are available, as ranking member blumenthal, we have a large number of veterans in hampton roads. Of the 17 suicides a day, 10 never interact with the v.a., that is something we have to overcome. This was a temporary grant program.
▶ 0:32:06Sen. Warner: It is time for its permanent reauthorization. I am joined by senator boseman with legislation to do that. I know the chair, ranking members and others have similar legislation. I want to add my voice. This is something we have to get done. The sooner the better. Veterans' lives depend upon it. Anyway I can help, please count me as one of your allies.
▶ 0:32:34Sen. Warner: I appreciate the opportunity and I will note that I am ceding back one minute and 40 seconds.
▶ 0:32:40Chair Moran: Opportunity for senators to learn from senator warner. A message well delivered under the time allowed.
▶ 0:32:50Sen. Warner: Thank you, Mr. chairman.
▶ 0:32:51Chair Moran: Thank you for joining us today. I remember the hard work that you are in senator boseman did early on to get this legislation in place. Testified not today first panel is Dr. thomas o'toole, the veterans health administration. He is accompanied by michael fisher. Thank you both for being here.
▶ 0:33:24Chair Moran: Dr. o'toole, you are not recognized for your testimony.
▶ 0:33:28Dr. O'Toole: Thank you for inviting us here today to present our views on several bills particularly the staff sergeant parker gordon fox grant program. Joining me today is Mr. mike fisher, chief officer. The staff sergeant parker gordon fox suicide prevention programs enables v.a.
▶ 0:33:57Dr. O'Toole: To provide resources toward community-based suicide prevention efforts to meet the needs of veterans and their families through outreach, suicide prevention services, and connection to va and community resources. In alignment with v.a.'s national strategy for preventing veteran suicide, this grant program assists in further implementing a public health approach that blends community-based prevention with evidence-based clinical strategies through community efforts.
▶ 0:34:27Dr. O'Toole: The grant program is part of the commander john scott hannon veterans mental health care improvement act of 2019 that was signed into law on october 17, 2020. The staff sergeant parker gordon fox suicide prevention grant program began on september 19, 2022, when v.a. Awarded $52.5 million to 80 community-based organizations in 43 states, the district of columbia, and american samoa.
▶ 0:34:56Dr. O'Toole: Since its launch in september 2022 v.a. Has awarded $157.5 million to 95 organizations across these 43 states, U.S. territories and tribal lands.
▶ 0:35:12Dr. O'Toole: Early results show that 33% of participants are new to va services, and 75% of participants who complete services show improvement in mental health status, well-being, social supports, and financial stability, as well as a decrease in suicide risk.
▶ 0:35:32Dr. O'Toole: All of the bills on today's agenda would in whole or in part, amend the authority for the parker gordon fox suicide program. The v.a. Strongly supports the reauthorization of the program as it is critically important for sustaining and expanding the notable progress we have made thus far.
▶ 0:35:57Dr. O'Toole: The additional grants have already shown promising results, and continued congressional support will be essential for ensuring that we can reach even more veterans in need. We greatly appreciate the committee's interest in continuing this program and stand ready to implement the extension of this authority as soon as possible to continue this work in fiscal year 2026.
▶ 0:36:21Dr. O'Toole: We welcome the opportunity to meet with the committee to ensure any amendments to the terms of the grant do not interrupt operations or delay these awards. The department's position for each bill is detailed in my written statement. This concludes my statement and we are happy to answer any questions you may have.
▶ 0:36:43Chair Moran: We will begin a round of questions by members of the committee. Let me start by asking you as congress looks to reauthorize -- it is really pleasing this has brought support in congress and strong support from the department. As we work to improve this program, what has the v.a.
▶ 0:37:11Chair Moran: Learned about outcome data so far and one of the lessons that have been learned toward shaping your approach to suicide prevention? One of the highlights is a lack of awareness among v.a. Staff about the fox grant program. I would ask, how is the v.a.
▶ 0:37:33Chair Moran: Working to ensure its own employees are fully aware of the program collaborating with organizations making this program better?
▶ 0:37:45Dr. O'Toole: Thank you, senator. The three-year authorization for this grant program has allowed us to be on a learning curve to try to do a better job. Any suicide by a veteran is one too many. We very much view this grant as an important part for reaching those veterans we are not reaching.
▶ 0:38:12Dr. O'Toole: The lessons learned to date -- much of this is captured in the report that provided a snapshot view of early experiences, highlighted several areas we need to continue to improve on. Obviously, enhancing our outreach and engagement particularly for those disconnected veterans is critical.
▶ 0:38:36Dr. O'Toole: Ensuring our grantees have all the services they need and the expectations and skills they required to effectively engage not only in outreach but in services is critically important. The other area but I think is essential is making sure the v.a. Is there and ready and has capacity and a clear path for ensuring that mental health care is available to those veterans who need it.
▶ 0:39:08Dr. O'Toole: Obviously that incorporates several different elements. One of which you mentioned is an awareness of the programs by the grantees. It is something we acknowledge and it is addressed and several of the bills going forward.
▶ 0:39:23Chair Moran: You used the word capacity, clear path. How would you indicate the department of veterans affairs is prepared and capable on a clear path to reduce suicide by veterans in the country, more broadly than this legislation? Tell me about the capacity of the capabilities?
▶ 0:39:48Dr. O'Toole: We have a very robust mental health services program within v.a. That incorporates tiered levels of care, including screening throughout the agency. And did our health care settings, not only -- and in our health care settings.
▶ 0:40:16Dr. O'Toole: Behavioral health teams providing more intensive care as well as specialized services for higher need/higher risk veterans including inpatient care program.
▶ 0:40:31Dr. O'Toole: It is a continuum of care and services that as noted by senator blumenthal requires maintenance, requires an ongoing capacity to effectively serve the veterans in need. It is a more robust service that we can oftentimes find elsewhere. Our veterans benefit from it greatly. Are there things we can do better? Absolutely.
▶ 0:41:02Dr. O'Toole: Other things we need to improve on? Absolutely. I'm not here to defend things that are not working but more importantly to commit to our ongoing work with the committee to do a better job.
▶ 0:41:13Chair Moran: What would be the things you can see you could do a better job, aside from what we have talked a lot about, outreach?
▶ 0:41:24Dr. O'Toole: The veteran crisis line has been a lifeline for a lot of veterans. We need to continue to support that and do the best we can. What is critically important is making sure we have pathways to treatment and ensuring safety for those veterans who do screen positive. We do well in that capacity and support.
▶ 0:41:52Dr. O'Toole: Our ability to reach those veterans who are transitioning from the military is a critically important focus and capacity and interest. It is one that our agency is working on several different efforts to try to improve and enhance. That becomes a critical element.
▶ 0:42:15Dr. O'Toole: It is also important to note that suicide risk extends beyond a mental health approach and status. There are economic drivers and social drivers and taking a whole health approach to the veteran is critical to ensuring that not only the immediacy of the suicide risk is addressed but sometimes the underlying issues and drivers of that suicide are also being considered.
▶ 0:42:44Chair Moran: I would note that I utilized senator warner's extra minute and a half it that I recognize senator blumenthal.
▶ 0:42:53Sen. Blumenthal: Thank you. I want to begin by thanking you both for being here and for your service to our country and the veterans of america. I know this time in your professional careers is probably one of the most challenging. Not because of anything you have done but because the leadership at the v.a.
▶ 0:43:18Sen. Blumenthal: Is slashing positions and freezing hiring and cutting funding. It is necessary for you to do your jobs. You have devoted your lives to doing this. To you and all of the professionals, I offer my thanks for continuing to persevere in this very difficult time. Dr.
▶ 0:43:45Sen. Blumenthal: O'toole, you would agree with me that outreach is critical in preventing veteran suicide and enabling them to what you have called a pathway to treatment?
▶ 0:43:58Dr. O'Toole: Yes, sir.
▶ 0:44:00Sen. Blumenthal: That takes human beings on the phone or in a meeting. It cannot be done by an automated message machine, correct?
▶ 0:44:10Dr. O'Toole: Yes, sir.
▶ 0:44:13Sen. Blumenthal: What rationale, what reason could there be to cut those positions as is now happening?
▶ 0:44:22Dr. O'Toole: Thank you, senator, and I appreciate your kind words and the attention you are focusing on this issue. I am happy to report that the veteran crisis line staffing members have gone up and not down since last january.
▶ 0:44:45Dr. O'Toole: As you know, this is an exempted position from return to office and along with 300,000 other direct care physicians exempt from any hiring freeze or any firings.
▶ 0:44:57Sen. Blumenthal: Those returns or reinstatements were done after vocal protest from myself, others on this committee, in congress and across the country. Yes, that is good news. But it is not just the crisis line. It is positions in the westhaven facility, outreach counseling.
▶ 0:45:29Sen. Blumenthal: There were already 40,000 vacancies before this administration took over. Would you agree with me that a lot of those positions in the field are open now and some people in those positions have been terminated?
▶ 0:45:44Dr. O'Toole: Thank you. I am just up the road from you in providence, rhode island, so I can appreciate the challenges of local staffing at local issues. Quite frankly, our challenges in maintaining the workforce in health care extend beyond the challenges we are facing now --
▶ 0:46:08Sen. Blumenthal: I will interrupt because I will run out of time if I do not interrupt. The fact is there are challenges in recruitment, correct?
▶ 0:46:17Dr. O'Toole: Yes, sir.
▶ 0:46:19Sen. Blumenthal: Those challenges in recruitment are deeply and dramatically aggravated when the prospect of firing 83,000 employees -- why go to work for an institution that is about to fire probationary employees? There are opportunities in the private sector where you get paid more. Duh?
▶ 0:46:50Sen. Blumenthal: I know you are not in charge of personnel, but isn't that a recipe for disaster?
▶ 0:46:57Dr. O'Toole: 300,000 positions, direct care positions, are exempted from any hiring freeze. This is a critically important element to trying to ensure that we are retaining and ideally growing our workforce as best we can.
▶ 0:47:17Sen. Blumenthal: I am about to have my time expire but I just want to say that we know there have been firings of researchers , counselors, outreach personnel.
▶ 0:47:34Sen. Blumenthal: There is simply no way to save veterans -- and I have heard nothing here that would convince me otherwise -- if we engage in this slash and crash approach to the v.a. My thanks to all of the veterans, Mr. fisher and Dr. o'toole for all that you are doing.
▶ 0:47:58Chair Moran: Senator cramer.
▶ 0:48:01Sen. Cramer: Thank, Mr. chairman and ranking member. Thank you to our witnesses, as well. I am going to get to the specific points that is addressed in legislation I have introduced, an amendment to the act before we reauthorize it. Introduced with senator coons.
▶ 0:48:28Sen. Cramer: What resulted in this is the fact that as important as this program is -- and it is important and I strongly supported -- neither north dakota or delaware received any funds despite a very good application, particularly the one I am most familiar with, the north dakota department of veterans affairs. The north dakota department of veterans affairs because of the five criteria, that meets five of them.
▶ 0:48:58Sen. Cramer: We are a little disappointed that north dakota's application was rejected. I do not know if it was not qualified but it was not prioritized. I would like to have you maybe explain to me a little bit about why that happened. We received testimony yesterday that the v.a. Is opposing by language in my amendment.
▶ 0:49:26Sen. Cramer: I want to give you an opportunity to explain that before I try to explain my position better.
▶ 0:49:30Dr. O'Toole: Thank you, senator. While I cannot speak to the specifics of that individual grant application and the decision to it, I think it is important -- first, thank you for your support that we are very appreciative of and we share in our need, want and desire to grow this program and these efforts.
▶ 0:50:00Dr. O'Toole: I think our challenge and are concerned with -- I think our challenge and our concern with increasing the number of grantees, which we acknowledge is essential to being able to reach more veterans, engage more veterans and get more veterans into care and services, it is a shared objective.
▶ 0:50:28Dr. O'Toole: Having two potentially different or a prioritized pathway would be difficult to logistically administer if we have two tiers. Our larger concern is we want to make sure all of the projects and grants being approved our meeting the high quality universal standard. Our concern is we do not want to create tow standards -- two standards.
▶ 0:50:57Sen. Cramer: Just so people know, the bill, it recognizes a couple of states did not receive funds from the program and we want to prioritize states that have not received funds for four. It is a one time deal. We want to get these other states in the loop and then clear the deck. Particularly very rural states.
▶ 0:51:26Sen. Cramer: North dakota is a big state, 350 by 200 miles, rectangle in the middle of the continent -- we have a monument to prove it. 55,000 veterans who need this service. We think that is important criteria. I have done this before with other bills. Senator heinrich and I did something similar. Grant programs of the department of transportation were not reaching rural states.
▶ 0:51:56Sen. Cramer: We fixed that and got them back in the loop. It has worked out well. I have read the objections. Some of them reference multiple applicants within the state, the competitive nature of things you have highlighted.
▶ 0:52:10Sen. Cramer: When it comes to an entire state , regardless of the small population -- it is why there are two senators from each one, every state does matter -- I think it is worth fixing in a way that prioritizes states that have not received funding previously. It is not complicated. I know the testimony says it is complicated but it is not complicated. If we make it simpler, we would like to do that.
▶ 0:52:39Dr. O'Toole: Thank you, senator. We agree. We are interested in working with the community to figure out a good way to approach it.
▶ 0:52:49Sen. Cramer: I suspect more resources would be helpful. I yield 10 seconds because we are keeping track. [laughter] >> I think it is really important that in order to improve our mental health care outreach we need to hear from veterans and v.a. Providers about their experiences.
▶ 0:53:18Sen. Cramer: However, last week the trump administration denied the ability to both host and participate in my women's veterans roundtable. I held a roundtable anyway at a local vfw but v.a. Would not participate. The conversation laughed in my opinion -- the conversation lacked in my perspective of much-needed perspective. Dr.
▶ 0:53:46Sen. Cramer: O'toole, can you explain why having both the v.a. And veterans together is important for a robust conversation?
▶ 0:53:55Dr. O'Toole: Thank you, senator. I am not familiar with the situation you are describing so unfortunately I cannot comment to the specifics or approval, or lack of. We are informed by our veterans. It helps us be a better agency and organization and something we try to encourage and as many capacities as we can.
▶ 0:54:23Sen. Murray: Do you know if the new policy that prevents meeting at facilities comes from within vha or political leadership at v.a. Central office?
▶ 0:54:33Dr. O'Toole: I would have to defer that to our leadership in terms of describing it better than I can myself.
▶ 0:54:44Sen. Murray: This is really important and I hope that secretary collinson says he is running the most transparent v.a. In history decides v.a. Can be transparent enough to let the senator hold the discussion about v.a. Health care on-site at the local v.a. That I have done for 30 years. I am not done with this topic. Let me ask you, though, Dr. o'toole, even the women are more likely to seek care through v.a.
▶ 0:55:15Sen. Murray: They are more likely to deal with depression and anxiety or sexual trauma. In 2022, suicide rates for women veterans with history of sexual trauma were 75% higher than those without. Getting in contact with these veterans and providing them the resources they need can truly be life or death.
▶ 0:55:37Sen. Murray: However, in february president trump and musk fired more than 2400 employees including those who staffed the phone at the veteran crisis line. What steps is v.a. Taking to reach out to survivors of military sexual trauma?
▶ 0:55:53Dr. O'Toole: Thank you, senator. First, in relation to the veteran crisis line, that decision was reversed and we have seen a net increase in staff working in the veteran crisis line. I'm happy to report that outcome.
▶ 0:56:14Dr. O'Toole: The outreach and specific efforts for women who are victims of military sexual trauma has been incorporated into our algorithm so we are specifically identifying and engaging those women to make sure we are providing better care. I would like to defer to Mr. fisher, who can speak specifically to some efforts at the veteran resource centers.
▶ 0:56:44Mr. Fisher: Thank you for the question. Senators have historically reached out to any cohort eligible, that includes women veterans and individuals who experienced military sexual trauma. We have continued to do this since the change of the administration. Our staff are exempted from any hiring freeze.
▶ 0:57:14Mr. Fisher: Specific to women veterans, every year we see increases in the number of women veterans coming into vet centers. With the high trust scores from women who receive services. Last year was that 93%.
▶ 0:57:29Sen. Murray: I do not see how 80,000 more employees being removed will help the v.a. Gives services. . I want to talk about the return to office policy. I have spoken to a number of providers about the rule that forces them to work in person. Those providers have been working remotely since before the pandemic.
▶ 0:57:54Sen. Murray: Now instead of taking video calls in private offices they are speaking in open floor spaces where there is no privacy. This is a violation of veterans' privacy, this is a violation of hipaa. I am almost out of time. The elimination of telework agreements is really affecting our veterans access to mental health care and we need to have a further conversation with you about how to fix that.
▶ 0:58:23Chair Moran: Senator blackburn.
▶ 0:58:26Sen. Blackburn: Thank you, Mr. chairman, and thank you for being here and approaching the subject today. The veterans that are a part of our team, they talk with me about this access to mental health services all the time.
▶ 0:58:47Sen. Blackburn: The grief that people experience when there is not loss of life of someone they have served with and putting attention on the mental health needs is something we need each and everyone to spend more time doing. Making these services available that our veterans need, this is something also very important. Dr. o'toole, I want to come to you.
▶ 0:59:18Sen. Blackburn: We have talked about this -- and thank you for your testimony -- we have talked about what you are doing to make services available. What you have not addressed is the fact there seems to be inconsistency of access and there seems to be gaps in this service. If you would build that out a little bit.
▶ 0:59:44Sen. Blackburn: How are you addressing those gaps and the inconsistencies, and what is the strategy for moving forward so that people know that at the v.a., there is a standard of care that they can expect?
▶ 1:00:00Dr. O'Toole: Thank you, senator, I appreciate that and I appreciate the way you framed it. This underscores the importance of the foxconn and -- of the& fox grants. The importance of the 17.6 veterans that complete a suicide every day, 10 have no contact with the v.a., that was noted earlier.
▶ 1:00:31Dr. O'Toole: We need to do a better job of invasion -- engaging those veterans with care. We need to meet them on their terms, and their homes, and their home communities. This is what the fox grants are providing for us.
▶ 1:00:55Dr. O'Toole: I think your question is spot on and it underscores the approach we have two really using these grants and these grantees to create that connection. And use then those connections to facilitate the trust that is needed to break down the baiers individuals may have to actually being able to engage in care.
▶ 1:01:21Sen. Blackburn: How do you simplify the ability for individuals to access that care and the -- in their communities? We know telehealth is important. We know easy access is important when you are dealing with mental health issues. If you have to wait on the v.a.
▶ 1:01:50Sen. Blackburn: And a caseworker to make up their mind, then it is something that delays you getting the care. Talk to me about simplification of the excess.
▶ 1:02:01Dr. O'Toole: There are two points -- actually, three points -- but I would like to bring up. The first is the issue of outreach and engagement that are critical to the 10 veterans a day committing suicide without a connection to the v.a. The second is ensuring we are properly screening veterans who received care in the v.a. To make sure we are determining if they are at risk for suicide.
▶ 1:02:34Dr. O'Toole: Universal screening of all veterans is that strategy. The third issue that is critically important is when veterans are in crisis we are able to respond effectively and meaningfully. This is where I would highlight the success of the veterans crisis line that truly provide the safety net for veterans in crisis.
▶ 1:02:55Dr. O'Toole: Both the uptake and increased utilization of the veteran crisis line and the responsiveness of the veteran crisis line to engage individuals are great examples. Is this saying it is perfect? By no means. Do we have to do better? Yes. But those are our strategic approaches.
▶ 1:03:21Sen. Blackburn: I appreciate that. I will send you a question about the continuum of care from active duty to veteran status with those ehrs. Mr. fisher, I am sure you deal with this every single day. And people trying to make certain they have access to their records so they can get the care they need. Thank you all for being here.
▶ 1:03:47Chair Moran: Sen. hirono: as you testify about the need to provide the services you need, for that you need workers. The v.a. Has always had thousands and thousands of physicians needed to be filled. We enacted legislation to make it easier for the v.a.
▶ 1:04:15Chair Moran: To hire people faster. My colleagues have pointed out -- I will add it to that. This is for Dr. o'toole. At a time when there are some 300,000 positions that need to be filled and you have 2500 or so already fired, another 83,000 to be fired, does it make sense to you that this is happening to the v.a.?
▶ 1:04:44Dr. O'Toole: Thank you, senator. Just a clarification -- the 300,000 positions at the v.a. Are exempt from any hiring freeze.
▶ 1:04:56Sen. Hirono: Can you tell me how many positions need to be filled in the v.a.?
▶ 1:05:02Dr. O'Toole: I do not have that information readily available.
▶ 1:05:07Sen. Hirono: We are talking about thousands. Does it make sense to you? This is an environment you have to live with to provide the services you talk about that need workers. Does it make sense to you that this is happening to the v.a.? Yes or no?
▶ 1:05:26Dr. O'Toole: We are trying to do the best we can with the resources we have. The focus of the cost to date have been of administrative personnel.
▶ 1:05:38Sen. Hirono: Let's face it, there is other chaos going on in the v.a. A lot of veterans make up the workforce. The slash and burn of the workforce has affected veterans. The v.a.'s 2024 report identified financial loss as a significant risk factor for suicide. Do you know which veterans have lost jobs in the federal government?
▶ 1:06:09Sen. Hirono: Knowing 30% of federal employees are veterans. And knowing that loss of a job as a risk factor for suicide. Do you know the veterans who have lost their jobs in this administration?
▶ 1:06:23Dr. O'Toole: I do not, ma'am. There might be leadership that does.
▶ 1:06:32Sen. Hirono: How are you supposed to help these veterans with a significant risk factor, a loss of a job, if you do not even know who they are? It really concerns me that as you talk about the need to outreach and suicide prevention, which is an ongoing issue with homelessness to the v.a., you do not have the kind of information that, in my view, you should have to provide the support that
▶ 1:07:02Sen. Hirono: You need to provide. [laughter] with everything that is going on and with the tariffs and the impact on our communities the fear and the potential for tariffs, do you have a sense of what the impact will be on the veteran community?
▶ 1:07:34Sen. Hirono: Do you know what kind of impact it is having on the cost of everything for the veteran community?
▶ 1:07:42Dr. O'Toole: I do not have that information.
▶ 1:07:47Sen. Hirono: This is the kind of information I would think you would have to prepare for this hearing. Again, for you, Dr. o'toole, veterans of suicide and homelessness is an ongoing issue for the v.a.
▶ 1:08:15Sen. Hirono: Knowing that the loss of economic security would increase homelessness among the veteran community, do you think that what is happening to veterans in terms of loss of their jobs, etc., that homelessness among veterans would increase? What are you doing about it?
▶ 1:08:32Dr. O'Toole: Thank you, ma'am. This shifts gears to the homelessness program office.
▶ 1:08:42Sen. Hirono: I would say homelessness has an impact on veterans of suicide.
▶ 1:08:46Dr. O'Toole: Absolutely it does. Economic stability, it is critically important. We have several programs in place for those veterans. I thinkour supportive services for veterans and the bridge support that provides are clearly intended to provide greater economic supports for those veterans who are at risk and clearly there is an overlap between suicide risk and
▶ 1:09:19Dr. O'Toole: Economic instabilities.
▶ 1:09:21Sen. Hirono: With all the chaos going on not just at the v.a. But every single department other than the dod, there will be an increase in the risk factors that would lead to veteran suicide. There you have it. Thank you.
▶ 1:09:40Chair Moran: Senator bozeman.
▶ 1:09:43Sen. Boozman: . Thank you, chairman and thank you senator blumenthal. I was proud to partner with senator warner years ago. The fox grant program. Addressing the veteran suicide crisis. Veteran suicide remains a critical issue.
▶ 1:10:20Sen. Boozman: The suicide prevention program deserves recognition. Veterans who battle mental health conditions respond best to those they know and trust. I look forward to discussing how we can reauthorize and update the support for veterans across the country. Dr. o'toole, it is great to hear from the v.a. How great it has been.
▶ 1:10:50Sen. Boozman: What kind of an impact with this funding increase have on the program? What results should we hope to see?
▶ 1:10:59Dr. O'Toole: Thank you, senator. Thank you for your work and efforts to get this legislation passed initially. Our hope with the reauthorization is we would be able to expand the number of grantees, that expansion of the grantees would both cover all of our states and geographic need areas, particularly those were
▶ 1:11:29Dr. O'Toole: Access to v.a. Care could be particularly thinned. And to ensure the grantees can effectively engage specific population groups that might be at higher risk for suicide, as well. That is our hope and aspiration with reauthorization and appropriations.
▶ 1:11:54Sen. Boozman: What aspects of the program has made it so successful?
▶ 1:12:01Dr. O'Toole: I think the fact that these are community groups that have credibility in the communities where veterans live, these are peers, these are also organizations that are engaging families of veterans and they are all critical to this. Supporting those veterans is complementary to what v.a. Does.
▶ 1:12:29Dr. O'Toole: It really creates a public health strategy and complements a public health strategy for how we are looking at suicide in a way that reflects the complexity of all that goes into it.
▶ 1:12:43Sen. Boozman: The legislation that senator warner and I introduced requirements for v.a., what metrics would v.a. Identify as collective -- . Which will coat the dynamic is critical.
▶ 1:13:05Sen. Boozman: We need to be good stewards of the resources that congress provides to us and make sure that money is going where it needs to go and is having an effect. The key as we see it is not just -- it is obviously important that as many veterans are being reached as possible but we also want to make sure that it is not just a throughput for lots of veterans but without also looking at the quality of the care they are getting, the comprehensiveness of the screenings so the care and
▶ 1:13:35Sen. Boozman: Services they are getting is matched to the need. And also we are outcome-driven. We have to be focused on using this grant mechanism to be making a difference in these communities. How many of those veterans are doing better as a result, how many are connecting in v.a. For v.a. Services or in the community for community service has health care would require? These are the accountabilities, the trackable metrics we need to be really looking at.
▶ 1:14:05Sen. Boozman: That is good to hear. I agree with you 100%. Thank you, Mr. chairman.
▶ 1:14:16Chair Moran: Centre haskin.
▶ 1:14:20Sen. Hassan: Thank you for this hearing and thank you, Dr. o'toole and Mr. fisher, for the work you do to serve our veterans. Dr. o'toole, over the past few months, I've been asking v.a. Officials and nominees if they can guarantee the trump administration's plan to fire 80,000 v.a. Employees will not result in longer weight times for veterans to get appointments and receive care. In response, the administration's nominees have told me wait times at the v.a.
▶ 1:14:51Sen. Hassan: Have been increasing and reform is necessary but they have never explained how firing 80,000 employees will help solve that problem. That is indicative of the way the past few months. They've been making drastic changes without as far as any of us can tell any analysis or plan. Dr. o'toole, you have worked at the v.a. For almost 20 years and you're currently the v.a.'s top doctor.
▶ 1:15:19Sen. Hassan: Has anyone asked for your analysis on how firing 80,000 employees will affect veterans care?
▶ 1:15:23Dr. O'Toole: Thank you, senator. I appreciate the question. I do not -- I'm not involved in those discussions and I will say that we actively monitor and track weight times. We actively monitor and track weight times.
▶ 1:15:48Sen. Hassan: I understand. The answer to my question is, no, they have not asked for your analysis. Obviously, weight -- weight times is a piece of this. If someone has been laid up that order supplies and a doctor runs out of critical supplies come that affects veterans care. Have you seen or been provided with any analysis as to how firing 80,000 v.a. Employees might affect veterans care?
▶ 1:16:14Dr. O'Toole: I have not.
▶ 1:16:17Sen. Hassan: ?
▶ 1:16:24Dr. O'Toole: I am prepared to be able to speak to this grant. I don't have the information you are asking to that. Several hassan you would know it -- suppleness on you would be no so I'm going to take that as I know as well. Last year the v.a.'s inspector general released a report on several occupational staff shortages within the v.a. And these are jobs that the v.a. Was having the hardest time filling.
▶ 1:16:51Dr. O'Toole: The ig's report stated the top clinical job in the v.a. With a severe staffing shortage was psychology. A whopping 61% of veterans health administration facilities reported having such a shortage. Psychiatry came in third place, 47%. As a career v.a.
▶ 1:17:14Dr. O'Toole: Doctor, can you please discuss the role that mental health professionals like psychologists and psychiatrists play in supporting our veterans?
▶ 1:17:22Dr. O'Toole: They are critical. I think that goes without saying. The complex needs and the care requirements of our veterans obviously require the engagement of a very robust mental health service.
▶ 1:17:38Sen. Hassan: On I continued to be concerned about the trump administration's policies of hiring freezes, firing, and general disruption. You have talked about the exemption for about 300,000 employees but it is really difficult to see how the chaos that is churning is going to help recruit and retain mental health professionals that are veterans really deserve access to and you have just acknowledged and Mr. fisher has about how important they are to our veterans.
▶ 1:18:08Sen. Hassan: Last question, you are the founding director of the v.a.'s homeless veterans patient aligned care team program. This program utilizes lenox with social workers, mental health and substance abuse counselors, nurses, homeless program staff to form a team to provide veterans with comprehensive individualized care. I want to thank you for your leadership on this important work.
▶ 1:18:36Sen. Hassan: Can you discuss the benefits of holistic wraparound care like this and how this model utilizes expertise across a variety of fields within the v.a.? Dr. o'toole thank you, I appreciate those kind comments. I think the hosting of that initiative in the v.a. Speaks to a culture in the v.a. Of trying to reach the veteran where they are and meet them and their companies have needs on their terms, not necessarily our terms.
▶ 1:19:05Sen. Hassan: I think the hvac successes in engaging those veterans in providing that stability that allowed them to move on with their lives and engage more fully and programming reflects it and reflects attic a culture of the v.a. That I'm very proud to have been a part of.
▶ 1:19:20Sen. Hassan: I think one of the things we can work on with that culture in place with so many veterans being willing to do peer to peer outreach is reaching those veterans who haven't engaged with the v.a. Who we are especially concerned about as we look at the suicide statistics. Thank you very much.
▶ 1:19:41Sen. Blumenthal: Senator king?
▶ 1:19:46Sen. King: Thank you. I thank you for your service and your dedication to veterans. One of my mottos and life is the implementation is as important a vision, tucking the division now of the fox program. The question is, what are the implementation stems and how's it working?
▶ 1:20:09Sen. King: One of the things I've heard from that field is that the intake process is intrusive and burdensome and we are losing veterans who just basically dropping out of the process. For example, in may, we had 311 veterans, 96 of those refused to participate because of burdensome paperwork or the required v.a. Connection.
▶ 1:20:38Sen. King: Veterans make it through the initial screening, 5% have stopped part way through because of the intrusive questions. Here's a practical implementation. One of the feedback I have gotten is don't ask all those questions at the first interview. Let the professional establish a relationship. I understand the screening is important, but we are losing some very at-risk people through the implementation process.
▶ 1:21:10Sen. King: Can you discuss this problem?
▶ 1:21:11Dr. O'Toole: I appreciate the perspective you bring to this because obviously implementation is -- great vision but if it cannot be implemented, it does not do us much good. I think it is important to put in context these findings. This program was established as a three year temporary grant program to really learn from this. Those types of observations are critical.
▶ 1:21:38Dr. O'Toole: We need to find that balance between ensuring that we are asking the right questions to determine risk and to match those needs to the services and be able to engage as much as possible. But being able to do so without scaring people away, without turning them off from those care and services is important. I would defer to my colleague Mr. fisher because I think the vet centers have been working in that space for quite some time. These are the lessons we have to be using to learn to get better and do better.
▶ 1:22:08Sen. King: Talking about reauthorization, let's talk about examining -- I mean, this is not a malicious process, it is to try to determine the risk factors in the qualification. But that in itself ends up knocking somebody out of the process, it seems that is a problem there should be considered and addressed as we are talking about reauthorization and then reimplementation.
▶ 1:22:36Sen. King: I would suggest, this has been discussed, outreach is critically important. If 10 out of the 17 suicides are people with no connection to the v.a., that tells you something. We need to connect those people. We need to reach out to them. For whatever reason, they are not reaching out themselves. It seems that is a piece of data. I want to turn to one other point.
▶ 1:23:08Sen. King: 74% of veteran suicides involve firearms. With female veterans it is even higher. Senator sheehy from montana and I have a bill that basically would have the v.a. Provide a free lockbox to veterans who ask for them create they don't have to be connected to the v.a., just had to be veterans. It is a voluntary program. The whole idea is to have some space between the idea of suicide and --, said the execution. That is not the right word.
▶ 1:23:39Sen. King: But going through with it read and lock boxes or one way to do that. Is this something that makes sense to you? Dr. o'toole: it is. I think anything we could do to create space between the idea and the action is critically important and the literature in the data support that.
▶ 1:24:01Sen. King: I know that is not one of the bills we are here to discuss today, but the notion of lethal means safety and strategies for how to best facilitate that, including the use of lockboxes, is something the v.a. Is very interested in working with the committee.
▶ 1:24:20Sen. King: I'm hoping to get the bill in the next round. It seems to me the glaring number, 74%, involving firearms, that gives us a place where we need to focus.
▶ 1:24:30Dr. O'Toole: I fully agree.
▶ 1:24:34Sen. King: Thank you for your hard work with americans veterans. >> senator duckworth.
▶ 1:24:41Sen. Duckworth: Thank you, ranking member. Attacks on her veterans and against critical services of the united states department of veterans affairs have divided this traditionally bipartisan committee, sadly.
▶ 1:24:58Sen. Duckworth: I hope today's focus on a matter that should transcend presidential loyalty ensuring our veterans have access to robust into health and suicide prevention resources will reflect a new -- renewed commitment this committee will once again be looking to fulfill its constitutional responsibility to serve as an independent check on any presidential administration. Under normal times, neural of the fox grant program would be an important step in enabling the v.a.
▶ 1:25:23Sen. Duckworth: To continue providing critical community-based suicide prevention resources for veterans and to reach even more veterans who need this lifesaving care. I am concerned the trump administration's policies continue to undermine the mental health and well-being of those patriotic americans who have served our nation honorably.
▶ 1:25:40Sen. Duckworth: From the mass reduction supports a federal federal workers including veterans working on the crisis line, to cancel contracts and continued attacks on veterans belonging to underserved communities, donald trump and elon musk are intentionally attacking morale and exacerbating the department of veterans affairs mental health workforce shortages. This threatens the ability of the v.a. To contribute -- distribute to fox grant's rapidly. We're talking that real lives, someone's parents, a child's sibling, aunt, uncle, grandparent, friend.
▶ 1:26:10Sen. Duckworth: We cannot endure more chaos at the risk of delaying the provision of mental help and suicide prevention services. Dr. o'toole, what specific steps are you taking to ensure there are sufficient staff and resources on hand to administer the fox grant program and to provide timely care for veterans seeking fox grant resources?
▶ 1:26:26Dr. O'Toole: Thank you for your service as well advocacy for our veterans. It is much appreciated. You are absolutely right. This is about ensuring that we have resources in place and a commitment to making sure the grantees are going to be as effective as possible. This suicide prevention program reports to me. I have a weekly meeting with their leadership team.
▶ 1:26:56Dr. O'Toole: These are some of the things we discussed and this is a priority for us. If we are going -- if it is going to work, we have to make sure we have people in place to work it.
▶ 1:27:07Sen. Duckworth: What are you doing to ensure they are there? My own office worked a case of several folks who work on veterans crisis hotline who are in the mass firing and two have gotten a job spec but one of them still has not. We are talking about people who may not be the ones answering the phones, training the trainers come those who -- some of them still have not gotten her job spec. What are you doing to ensure there are enough people to work those hotlines in the suicide prevention programs?
▶ 1:27:34Dr. O'Toole: As I mentioned with the veteran crisis line, that is exempt from any hiring freeze and we have actually seen a growth in the numbers of employees on the veteran crisis line. Something we have to stay vigilant in ensuring direct care is not impacted and these programs are able to function at their highest capabilities.
▶ 1:28:02Sen. Duckworth: Will you commit to hiring some of those people back that were fired by elon musk?
▶ 1:28:05Dr. O'Toole: We are happy to follow-up with you in specific spinal means.
▶ 1:28:11Sen. Duckworth: I think it should be more than just the people being handled -- there many people across the country who have been laid off who have worked on the veteran's mental health programs. Those people need their jobs back, especially if they themselves are veterans. Do you commit to safeguarding the mental health workforce including making sure they have the appropriate resources and work spaces?
▶ 1:28:30Dr. O'Toole: Yes, ma'am. I would like to speak a little bit to that in more direct terms . It has been referenced several times in terms of the return to office and the impact on confidentiality.
▶ 1:28:45Dr. O'Toole: We are very committed and our leadership within vha is been committed to ensuring that privacy is maintained and confidentially -- confidentiality is maintained, including ensuring that if employees need dedicated private workspace for engaging in tele-mental health services and other confidential -- services that require confidentiality and
▶ 1:29:16Dr. O'Toole: Hipaa rules are being complied with. When those are not able to be met, we have processes in place to work with the facility to ensure that either a space is found or there are positives -- appropriate pauses to the return to office. This is critically important. We cannot let this compromise the care we provide to our veterans.
▶ 1:29:38Sen. Duckworth: Will you commit to advocating to protect his mission critical staff from adverse diminished rate of actions, especially if they report they are not getting the resources they need?
▶ 1:29:45Dr. O'Toole: Yes, ma'am, and we do that now.
▶ 1:29:50Sen. Duckworth: We have dealt with people who had to take phone calls in their cars in the parking lot because there was no confidential space for them to do their work, their jobs.
▶ 1:29:57Dr. O'Toole: We have mechanisms in place to try to ensure that is not happening and if those are happening, we need to know about it.
▶ 1:30:05Sen. Duckworth: Thank you.
▶ 1:30:07Sen. Blumenthal: Thank you. Moving on to Mr. o'toole, the return door, the v.a.
▶ 1:30:23Sen. Blumenthal: Returned work mandate requiring most in place to return in person work so following up on the therapists who were hired workers, what senator duckworth has just said, have you heard of any instances where therapists have had to have awkward and/or I would say nonprofessional settings when they're having their health care or veterans are having therapy sessions?
▶ 1:30:49Dr. O'Toole: I have not heard specific situations where that may have occurred. I obviously have heard it second or third hand. We have a mechanism and process in place. Those work environments and work scenarios are not acceptable to us. That is not appropriate care standard for the v.a. If they do occur, we have mechanisms to ensure they can be remediated.
▶ 1:31:13Sen. Gallego: On the lines, there is an 83,000 person cut of v.a. Workers, is their standard of who is going to be in that cut? How many will be therapists? Different professions? That will obviously affect the health care outcomes. It is hard to get some of these therapists into this job. Can be better paid in the private sector.
▶ 1:31:40Sen. Gallego: So losing therapists to these arbitrary cuts in my opinion will be detrimental to the mental health of these men and women.
▶ 1:31:45Dr. O'Toole: I do not have specifics on that information. I would have to defer -- get back to you.
▶ 1:31:52Sen. Gallego: For example, my phoenix v.a. That I've gone to has a memo out they have to cut 15%. What does that mean? Who is that they are cutting? Mr. fisher, I placed a blanket hold on all president trump's nominees to the v.a., especially following the fact they are cutting 82,000 jobs posted I don't see how it is possible for the vhf are so many employees without it affecting care for
▶ 1:32:22Sen. Gallego: Veterans, especially health care. You leave the office of helping transition from military to civilian life which is extremely important. Reducing tremendously -- extremely important work. Due to these cuts come they can lose access to that and create a rise in suicide. What directives have you received from the trump administration in order to enact these cuts to the v.a.
▶ 1:32:51Sen. Gallego: Workforce and we commit to ensuring the v.a. Mental health providers are not among those fired or other positions that are very important to keeping that network together of a very important job that I think you have an we have here?
▶ 1:33:07Mr. Fisher: Thank you for the question. Similar to what Dr. o'toole brought up, I've not received guidance. Our focus at vet centers has been the hiring of our counselors as well as our outreach staff. We continue to do that in locations where we have a hard time hiring those we leverage all existing authorities whether that is our scholarship program or other special incentives to be able to ensure we are bringing those staff into that centers.
▶ 1:33:34Sen. Gallego: You have not received any directive in any orders from v.a. Saying you have to cut x amount of people by x amount of dates from the programs you guys -- is that correct, Mr. o'toole?
▶ 1:33:48Dr. O'Toole: That is correct.
▶ 1:33:55Mr. Fisher: Same answer, yes.
▶ 1:33:58Sen. Gallego: From your general understanding, what is the deadline that the v.a. Has said for them to cut these 83,000 let's say positions?
▶ 1:34:12Dr. O'Toole: I don't know.
▶ 1:34:16Mr. Fisher: I would have to differ as well.
▶ 1:34:19Sen. Gallego: My concern is because a narrow zone memo laid out was they wanted cuts to go into effect by july 1. We are already in may. Sudden cuts, especially when it comes to a mental health care clinic, v.a. Clinics, suicide prevention, could be extremely damaging since you are to recruit people into this very hard work and at the same time they are hearing about these firings, it is going to be hard to recruit and retain.
▶ 1:34:49Sen. Gallego: I don't know if you have -- have you had any conversations with some of the potential therapists asking questions about whether or not they can come on board with assurances they will not be fired or let go later? Have you hurting thing from potential employees?
▶ 1:35:02Dr. O'Toole: I have not. I will note that the direct care providers, therapists, are exempted currently from any of the hiring freezes that are taking place.
▶ 1:35:15Sen. Gallego: Exempted but not necessarily from the attrition? From the potential elimination?
▶ 1:35:23Dr. O'Toole: Again, I would have to differ on that because I'm not aware.
▶ 1:35:29Sen. Gallego: I yield back.
▶ 1:35:36Sen. Blumenthal: Thank you. I have a few questions while we are waiting for the chairman to return and start the second panel. I don't know -- I don't think anyone has asked about this fact but the veteran suicide rates in connecticut seem to have been highest among veterans who are
▶ 1:36:10Sen. Blumenthal: Over 75 years old, lowest in the age group 18-54. Is that true nationally?
▶ 1:36:20Dr. O'Toole: I don't know, sir. I would have to look at that. There is a bimodal nature to the incidence of suicide. We see it very high in the 18-39 range. For different reasons then we sit in the older populations. Where chronic disease, chronic pain, and other factors play a more active role. I don't have the specific data you're referencing.
▶ 1:36:50Sen. Blumenthal: Could you try to provide that data? I assume if it is available -- it is available elsewhere? Is there any explanation for disparities between different parts of the country or different states so far as you are aware?
▶ 1:37:14Dr. O'Toole: Again, I would have to differ that to our subject matter experts. It is an important question that has a lot to do I think with levels of engagement, lethal means, availability, and so forth. I would prefer differing that. We can get that information to you.
▶ 1:37:31Sen. Blumenthal: I think it is important -- both are important questions because if there are lessons to be learned from some states and what they do in preventing veteran suicide, maybe they can be adopted more broadly. I want to ask you to have a look at the brave act. If we had a few hours more for this panel, I could go through each of the provisions.
▶ 1:38:05Sen. Blumenthal: The standard response of the v.a. To many of these provisions was to oppose it because they said it was not necessary. Now, an example would be to give more priority to women's health mental health care.
▶ 1:38:28Sen. Blumenthal: They are saying to me that, for example, the requirement for the department of veterans affairs to modify to reach that program to incorporate risk factors waiting for women veterans is not necessary but we are already on top of it. We've got that problem. Well, I'm not so sure that is accurate if it ever was correct, it certainly is not now.
▶ 1:38:59Sen. Blumenthal: I would ask you, Dr. o'toole, to please go back and look at the brave act and perhaps speak with your colleagues about giving me some more maybe different and more constructive reactions to the brave act. Thank you, Mr. chairman.
▶ 1:39:20Chair Moran: Thank you. Senator slotkin.
▶ 1:39:24Sen. Slotkin: Thank you to our nominees for being here. I'm a former c.I.a. Officer. I did three tours in iraq alongside the military. I answered proudly democrat and republican administrations as a civil servant before I was elected to congress. I think everyone on this panel, democrat and republican, believes when we make the choice to send men and women into war, we have a responsibility when they return and that veterans deserve the gold standard of care.
▶ 1:39:55Sen. Slotkin: As I've been on this committee and I was on the v.a. Committee in the house, it seems like every time there is a threat to veterans care or we need to expand veterans care, it is veterans who are pushing and advocating for that change. It doesn't happen in big bureaucratic system just by sitting there. I am concerned that mental health occupations are the ones where we have significant vacancies across the v.a.
▶ 1:40:25Sen. Slotkin: Over 60% of the a facilities report shortages of psychologists and nearly half reported shortages of psychiatrists. I was just at the va hospital in saginaw this past week and there is definitely shortages across the mental health architecture. There is no way for me to swear that with the threat of potentially cutting 70,000 to 80,000 v.a. Employees. I don't understand how we can add by subtracting.
▶ 1:40:54Sen. Slotkin: And while I keep hearing from the secretary of the v.a. Were not going to cut the hospitals and nurses and all that kind of stuff, all of those support staff -- the suicide hotline, all the folks who process claims so that veterans can get care, they are quite literally seemed to me to be on the chopping block. So tell me what you're going to do, Mr. o'toole, in this moment of subtraction from the v.a. To actually ensure that our veterans get the mental health care that they need.
▶ 1:41:23Dr O'Toole: Thank you, senator. I appreciate the comments in the observation and it is shared. We have a health care -- health care workforce not limited to the v.a. Struggling to fill two positions across the board. And long before this past year we actively tried and have been trying to continue to attract people to work in the v.a.
▶ 1:41:50Dr O'Toole: Which I've been here for 20 years, it is where I choose to work. The commitment is to ensure that direct care is provided and not compromised by these cuts. I am not privy to the decisions and the discussions and would have to defer on this -- on the specifics to that.
▶ 1:42:18Dr O'Toole: Just as I mentioned in relationship to telehealth care, are at most absolute commitment is to providing the best care possible and not compromising it by any means in the process of the changes underway.
▶ 1:42:33Sen. Slotkin: I do not doubt for one minute permission and your belief in this mission. My concern is that you could be overseeing a component of the v.a. When you say what we don't want to compromise care, in fact we have an obligation as a country not to compromise veterans care and yet we are talking about cuts of potentially 80,000 people. The secretary of the v.a. Refused to dismiss those cuts when it came to howell, michigan, a few weeks ago.
▶ 1:43:02Sen. Slotkin: He was asked directly and said, well, difficult choices essentially will have to be made. I am not saying how the math is going to work out. I also want to note in the 2024 national veteran suicide prevention annual report, which you may have had a hand in, it said most veteran deaths by suicide are among veterans who have not had access to v.a. Care in the prior two years.
▶ 1:43:29Sen. Slotkin: If you are in the system, getting care, of a better chance of being helped but if you're out and not connected to the v.a. -- I would pause eight we need to be getting two more veterans, we need to be doing better outreach, the veteran needs to be talking to people when they separate and getting them in the routine of accessing those services so in fact on this mission, not only are we understaffed right now, but I think the mission is greater than what the v.a. Is already doing. I would note you are going to be the guy in the room when these cuts come down from on high.
▶ 1:44:01Sen. Slotkin: Mr. collins sat in your very seat and said, "I'm not going to let anything compromise care was quit and then seems to be supportive of 80,000 cuts. I would ask you to stand up for veterans. It is bigger than any one administration. We have a responsibility. I know you care about that mission. I appreciate you being here.
▶ 1:44:18Chair Moran: Thank you, senator. Dr. o'toole, let me ask you a quick question. It is a bit outside I think the realm but there's been a lot of conversation about staffing at the v.a. From my colleagues and I. I want to highlight that the importance of community care, the mission act in the way I look at things is the way -- choice came about in an effort to help further staff the v.a.
▶ 1:44:51Chair Moran: And particularly in mental health where there is a shortage of dental health providers everywhere, it would be comforting to me for you to confirm the value of the mission act and care.
▶ 1:45:03Dr. O'Toole: Thank you. Community care, care provided in settings that are not v.a. For our veterans is very much part and parcel of the package of care we provide. And needs to be considered because the bottom line is we want our veterans to get care.
▶ 1:45:22Chair Moran: Thank you. We will dismiss Dr. o'toole and Mr. fisher. Thank you for your testimony. Thank you for your service to veterans and for your appearance here today. We will call the second panel to the table.
▶ 1:46:16Chair Moran: Testifying on today's second panel is jim lorraine, president chief executive officer of american warriors partnership. Julie can tour -- gilly cantor. There is no reason for me to make a full of myself one more time. Thank you for being here. She is with the institute for veterans and military families syracuse university.
▶ 1:46:46Chair Moran: Steffen crow, heather barr, austin lambright, and lindsay church. Thank you all for being here. Mr. lorraine, let's begin with you.
▶ 1:47:16Mr. Lorraine: Thank you for the opportunity to testify today on behalf of an americas warrior partnership. Considering four important bills involving veterans. I will focus on the impact of the staff sergeant parker gordon fox suicide prevention grant program commonly known as the fox grant.
▶ 1:47:40Mr. Lorraine: At awp, we have used -- we view suicide and debts prepares prevention not as a single program but as an outcome of veterans restored since our purpose and improve quality of life. Our model is rooted in proactive outreach and engagement. Trust building and sustain relationships which we do at scale. We strive to forge these connections before the crisis begins. That is where the fox grant has been essential.
▶ 1:48:08Mr. Lorraine: Of the 545 veterans we have screened reported suicide risk, 94% were initially seeking -- were not initially seeking mental health support. They faced challenges such as economic insecurity, navigating the v.a. System come and fracture personal relationships most of the importance of asking the right questions early and having someone listen cannot be overstated.
▶ 1:48:32Mr. Lorraine: Thank you to the fox grant we've interviewed -- intervene early, connected veterans to local resources, and remained consistent presence. Just halfway through this grant year awp screen 1300 veterans with 10.8% disclosing suicide risk.
▶ 1:48:50Mr. Lorraine: Since the grant's inception, that number has totaled 2100 with 25% of the people that veterans we talked with and screened disclosing at some level of risk. These are not just statistics, they are lives saved because someone cared enough to ask and listen. There is room for improvement. While the hope act makes a great -- makes great strides come outreach must be reestablished as the program singular focus.
▶ 1:49:20Mr. Lorraine: We must get upstream and follow the data of who is at greatest risk. He who is so important. Deep dive in partnership with duke university school of medicine allows us to follow on -- follow the date of the who is most at risk. Based on the community where they live in. The pathway from community identification to v.a. Must be more transparent. Wicker and less burdensome. Hunger should require the v.a.
▶ 1:49:51Mr. Lorraine: To establish a simplified intake process for veterans already screened by the grantees that avoids redundant questions and respects the veterans time and critical situation. We support codifying the emergent suicide care section and in many cases awp uses the 988 crisis line for veterans for immediate needs. Accountability is key.
▶ 1:50:39Mr. Lorraine: A regular reporting to ensure the taxpayers trust is upheld and that those not winning the standard are reevaluated. We support the use of the columbia protocol as the sole requirement screening tool. The current requirement of multiple follow-up assessments is overwhelming and deters engagement. Let's reduce bureaucracy and focus on care. We are strongly support the provisions in the hope act that allow the fox grant funds to be used for transportation.
▶ 1:51:14Mr. Lorraine: The lack of transportation is a top barrier veterans face, especially when those are in crisis. Grantee funding is another consideration. Awp could double its outreach efforts if the funding ceiling was increased to 1.5 million. While this is not necessary for every grantee, organizations that have proven outcomes, capacity should be empowered to do more, provided the metrics and reporting structure in place. Regarding the brave act.
▶ 1:51:43Mr. Lorraine: We support a deeper analysis of veteran suicide and its risks factors. Still discussions also must address the role of traumatic brain injury as a were not doing enough to confront. -- traumatic brain injury, a silent killer were not doing enough to confront. Awp stands ready with our national network to assist when necessary. Members of the committee, thank you for your continued leadership and support.
▶ 1:52:14Mr. Lorraine: Your efforts to saving lives at awp we stand ready to keep doing our part to serve, listen, and ensure that vets are known. Together we can do better.
▶ 1:52:22Chair Moran: Mr. lorraine, thank you. Ms. cantor.
▶ 1:52:31Ms. Cantor: Thank you for the opportunity to off testimony. Our perspective is rooted in research along with more than a decade of experience working with 26 communities across the country. These communities are connected by a common goal. Improving coordination between organizations that provide clinical and nonclinical care, so together we can help veterans thrive. What if we learn?
▶ 1:53:01Ms. Cantor: As we know, the rate of suicide among veterans remains too high, higher than among civilians. That has also shown that each additional nonclinical stressor such as financial and housing instability is linked to increases in the likelihood of suicidal ideation. States, counties, community-based organizations can often best address these needs. In a study was conducted with the v.a., we found a majority of veteran served by our partners are also enrolled in v.a. Health care.
▶ 1:53:31Ms. Cantor: For these veterans, their stressors were most effectively addressed when communities in v.a. Medical centers worked together. At the same time, the study demonstrated communities are in fact reaching many veterans not connected to v.a. Health care. A group that represents over have to veterans died by suicide. The fox grant's recognize and leverage the role communities plate in suicide prevention.
▶ 1:53:53Ms. Cantor: It creates new formalized avenues into clinical care and it supplements that care with wraparound services so that we can address root causes at the same time. We are grateful to this committee for looking upstream as part of the hannon act to invest in this evidence-based coordinated approach. The reauthorization currently under consideration is therefore critically important.
▶ 1:54:17Ms. Cantor: Since our programs launch, the ivmf has offered support for 11 of our partners who have been awarded these grants. They have stress tested this program and identified his strengths and challenges. While there is always more that can be done, many of their proposed changes directly respond to their feedback. There are three main target areas I would like to address today. First, program coverage and expansion.
▶ 1:54:41Ms. Cantor: Increased funding both overall and for a minute straight of -- incidental costs will enable grantees to scale and reach more veterans in a way that builds trust and nonclinical settings. These individualized peer based approaches to outreach are both backed by evidence and just common sense. A simple gathering over pizza or coffee can open the door for a veteran to reach out for help. Unknowing reimbursement for transportation and rideshare is two appointments will also be beneficial.
▶ 1:55:09Ms. Cantor: Whenever possible, and the cost of an override should not be the barrier that stops veteran from getting the critical care that my savior life. Second, screening and eligibility. While some of our partners support the colombia protocol is the main required screening, others would prefer more nuance and how it is used. The proposed training on the tool will mitigate some of these difficulties. But overall, we hope intake process can balance evidence-based assessments with burn considerations for both veterans and program staff. Third, v.a.
▶ 1:55:36Ms. Cantor: Collaboration and compliance. This important, we strongly support the provisions designed to hold the v.a. Accountable for their role in making this program successful. Our partners have routinely experienced inconsistencies and awareness compliance by their v.a. Medical centers. Once a veteran has been deemed eligible for the program, v.a. Enrollment must be streamlined with a dedicated process such as an automatic high-priority group site.
▶ 1:56:05Ms. Cantor: We appreciate the proposal to expand emergent suicide care coverage if the v.a. Is not responsive. This provision will ensure grantees can effectively help veterans get the care they need. In conclusion, the evidence for reauthorization -- reauthorizing the program is clear and proposed legislation aligns with many improvements sought by our partners. We deeply appreciate the committees steadfast commitment to increasing our investment in prevention so this critical program can reach more veterans before they are in crisis.
▶ 1:56:35Chair Moran: Thank you. Mr. crow.
▶ 1:56:41Mr. Crow: Thank you for the opportunity to testify today. My name is steffen crow, retired gunnery sergeant marines with tours in afghanistan, asia, africa, europe from central america. I now serve as the program manager for the staff sergeant parker fox suicide prevention grant and obama veterans united. Our program exists to prevent suicide among our nation's veterans by removing barriers to care. The fox grant was created precisely because of the system not working for too many veterans.
▶ 1:57:11Mr. Crow: The fox grant, ok view is built statewide veteran centric approach that reaches across rural and urban communities. Over the past three years, have engaged and supported her lead more than 800 outreach events. We have former collaborations with major veteran employers across the state, consistent engagement at fort seal, and we hosted the first multi-grantee veteran standdown in the country alongside the cherokee and choctaw nations, drawing
▶ 1:57:41Mr. Crow: Veterans from across oklahoma and five other states. At the core of our work is sustained trust and empowerment. Veterans who succeed often ask how can they help others? Proving when we lift one, they turn to lift many. However, we face significant barriers. Chief among them is the required use of the colombia screening tool. Though well-intentioned, it often drives veterans away.
▶ 1:58:06Mr. Crow: At a recent grantee conference, it was reported by one grantee that 13 veterans died by suicide after either refusing to complete the colombia are answering note to every answer despite the clear need these veterans were in. First, grantees are instructed not to detract veterans deemed ineligible for the program which creates a very dangerous survivorship bias. Another persistent challenge is the absence of a national referral process between grantees and the v.a.
▶ 1:58:34Mr. Crow: No two facilities operate the same way and even within a single state, these can differ dramatically. Local v.a. Staff often differ to central office guidance which is not materialized into actionable support. Veterans like parker found solace in physical activity and music. Yet grantees are restricted from funding low-cost gym memberships or instruments despite v.a.'s own research supporting these therapies. V.a.
▶ 1:59:03Mr. Crow: Guidance currently prevents us from delivering the very solutions their studies endorse. Transportation remains another major barrier we had guidance recommends uber and left yet these services are nonexistent in rural communities and these are the areas that we primarily serve. We currently need a national community of practice to unify efforts and I can say oh, veterans united is already developed internal models for crosscutting collaboration and is ready to lead this initiative across the nation.
▶ 1:59:35Mr. Crow: Another great benefit that would be a good add to this program would be the ability for grantees to hire an lpc or csw to be that cap fill whenever there is a wait time for veterans to get character local v.a.'s we think in a two-month period, four to six sessions with an lpc or lcsw in our direct team could be a very critical gap filled that would get some into v.a. And let them have the patience to wait for those appointments to materialize.
▶ 2:00:05Mr. Crow: In the military, I was taught if you see something, say something. For three years, we have raised these concerns to v.a. Leadership without meaningful action. Veterans mistrust of the v.a. Did not happen overnight and winning it back requires real tangible change. If the rate of 17.6 veteran suicides per day is accurate, we have lost over 16,000 veterans since this grant started. Yet when a veteran stabilizes, the first thing they ask us how can I pay it forward?
▶ 2:00:34Mr. Crow: Veterans want to be the champions of the system and if the system works for them, I guarantee they will be. The v.a. Has good intentions but they lack timely execution and consistent communication. We believe with clear guidance, national coordination and policies grounded in real world realities we can save lives and help veterans live lives worth living. We believe parker's legacy must guide the future of this program. If he had access to these tools we proposed, he might've remained with us longer.
▶ 2:01:03Mr. Crow: Let us not waste the opportunity to honor him through this meaningful change. Thank you for your time and your commitment to our nation's heroes.
▶ 2:01:09Chair Moran: Thank you. Ms. barr?
▶ 2:01:14Ms. Barr: Thank you for this opportunity to share my story about this program and how it helped. My name is heather barr. I was a sergeant in the marine corps, served for just over five years, did two deployments, one to the middle east and went to the indo-pacific. I was honorably discharged from the marine corps in september 2023.
▶ 2:01:43Ms. Barr: I went on terminal leave month before that so this was two months post deployment, transition seminar, there was out in two months. I had no plan. No idea what I was supposed to do. Just was moved back into my family's home in south carolina. I felt like I was back at square one, basically. Living with my mother, no prospects for the future, did not know what I was doing.
▶ 2:02:13Ms. Barr: I ended up reaching out to the local vet center to try to find counseling, a therapist for mental struggles that hit me during deployment and then just were expedited and grown by transitioning out of the marine corps. They pointed me to a -- the upstate solutions, greenville veterans organization. They are partially funded by the staff sergeant fox program.
▶ 2:02:42Ms. Barr: While I was there, I was screened I found at risk, and they set me up for success, basically. Make I was continuing to go to therapy and things like that at the vet center. Were able to actually provide a way for me to get a job, showed me ways to do that. First employment out of the military.
▶ 2:03:09Ms. Barr: Part of the big change in transitioning for me was being completely disconnected from the military lifestyle and people I have been around for the past five plus years. Coming back from a deployment, try to transition to just normal military life, and then civilian put me in a tailspin. It felt like I was drowning.
▶ 2:03:36Ms. Barr: And was pointless and purposeless without any guidance. The staff sergeant fox program helped provide that to me. They help me get a job, made sure I was engaging with veterans and community where I could actually relate to and I could realize I wasn't actually completely alone and there other people who understood what I was going through or had been through.
▶ 2:04:10Ms. Barr: I was extremely, extremely grateful for that. My scenario is an ideal scenario. My family was available for me to move back in with. Financial struggles were there, but thankfully, within a few months of getting out of the military, I was set up with upstate solutions program.
▶ 2:04:40Ms. Barr: That is not always the case for you and I know many people who have gotten out and do not have families to go back to. They have either poor relationships or they are nonexistent. So mine is basically the best case scenario. I had family to go back to but not all do.
▶ 2:04:56Ms. Barr: Regardless of if you are enlisted officer, female, male, dependents, no dependents -- all of these things add up both financial difficulties and then some have ptsd, anxiety, stress related things that just compound on the already trying time that transitioning out of the military is.
▶ 2:05:26Ms. Barr: And the upstate warrior solutions was in the staff sergeant fox program was definitely a life ring. I was very, very fortunate to be provided. It did take a lot of searching. But I was very fortunate to be thrown that life ring that not all people are created -- that not all people are.
▶ 2:05:51Ms. Barr: Since 2022 -- excuse me, I finished the staff sergeant fox program in august 2024 when I left the state. They reached out to me multiple times even though I was out of the program, actually showing they cared. They wanted to make sure that I was taken care of as a veteran. I am very grateful for that.
▶ 2:06:21Ms. Barr: Since 2022, uws has also completed the staff sergeant fox program with 20 other veterans who currently have 164 active members within their program. It is a great outreach for those who have struggles finding other outlets or just need help. Thank you for your service and for your testimony.
▶ 2:06:51Ms. Barr: Austin?
▶ 2:06:55Mr. Lambright: Thank you. My name is austin lambright. I want to start by thanking everyone for the opportunity to be here. I'm deeply humbled not only for the opportunity to serve my country, the greatest country in the world, but also to be here and speak on behalf of the veteran community and offer some insight on support based on my experience. I'm here from south carolina.
▶ 2:07:21Mr. Lambright: In 20 -- 2006, at 18, I enlisted in the marine corps to serve as an infantry machine gunner. I did two deployments to iraq. 2007 and 2008 and nine and was honorably discharged from the marine corps in 2010 at the rank of corporal is a squad leader. During my time in the marine corps, I completely engulfed myself with the mentality of going to combat.
▶ 2:07:47Mr. Lambright: During the peak of two wars in the harshest conditions possible that marines are sent to, iron my combat action ribbon when I was 19 years old. I was just a kid. At the time I felt about as close to invincible as I could possibly feel, although foolish. That was my feeling. I had a purpose and driven focus with support from loved ones at home have rejected me into being a successful marine and squad leader on my second deployment.
▶ 2:08:19Mr. Lambright: Both my deployments were two combat zones. I'm fortunate to have the family I have at home. Very hard-working father, a deacon at church and a mother that is as close to as any human that I've ever met. When I transitioned out of the marine corps in 2010, I moved back to my hometown and bought my first house. I was somewhat of a wrecking ball at first.
▶ 2:08:45Mr. Lambright: I was met at the world from my experience has come of the outcomes of how the war played out. And just the current state of americans in my generation. In those 18 months time for my eas, I been arrested three times for driving under the influence, I went to jail a handful of times on violent-related charges, and an unexpected child who is now 12 years old, my son. During this time, those 18 months, one of my marines committed suicide.
▶ 2:09:16Mr. Lambright: The first experience I had with a marine of mine committing suicide happened on my second deployment were lance corporal robert ulmer took his own life in our living quarters. During this time when I was struggling really bad with some of the decisions I was making, that 17.6 per day suicide number really started creeping in the back of my mind, became an option.
▶ 2:09:43Mr. Lambright: Five guys -- primaries are deployed with to iraq -- five marines are deployed with to iraq have committed suicide to the state. Moving forward, I said I had an unexpected child. My child jackson, he gave me a new purpose and made suicide feel like it could not be an option because I would leave my son alone in this world.
▶ 2:10:11Mr. Lambright: My sense birth was the turning point in my life and when I became connected with upstate warrior solution. I began reaching out for help to better myself because I wanted to be the best father I could for my son. I quickly made, connections with other veterans at uws for example. Nate back here and another gentleman named scott hicks. Both of them had strong connection to because similar experiences and they had been through some of the dark tunnels I was going through at the time.
▶ 2:10:42Mr. Lambright: However, they had made it through and were living very successful lives, good fathers. They had something I wanted. I found a commonality and mindset. I felt as if I was not not just alienated in the general public, I was able to be real about my problems with these gentlemen and gain advice from them who had experiences similar to my but overcome the same struggles. I'm going to run over if that is ok. Is that ok? Thank you. I will try to be quick.
▶ 2:11:14Mr. Lambright: Thank you, sir. Moving quickly, I learned I'm not invincible by any means and my choices and decisions moving forward directly influence my way of life and leadership for my son. This is a key period in my journey that really turned the course positive. I would have been suicidal orlanda myself in prison or grave truly enough had I continued on the road I was on before my son was born and I got connected to uws.
▶ 2:11:39Mr. Lambright: As time progressed, I went through a divorce, job changes that got me in the dumps at times, in these times I would reach out to uws for support to keep my head on straight. I was invited to participate in golf tournaments, dinners, hikes and other events that gave me a sense of positive community I could take pride in being a part of. In october 2022, upstate warrior solution help me get connected to the vet center for mental health counseling.
▶ 2:12:06Mr. Lambright: I was in one of my darkest rights at the time, suicidal for months. February 2023, I reached out to upstate warrior solution for help again and agreed to participate in the program. As a staff sergeant fox participant, received inpatient and outpatient care from v.a.'s facilities and non-ba and received care for ptsd and alcohol abuse with a lot of time and focus spent on post-combat stress and more personal experiences.
▶ 2:12:35Mr. Lambright: I participated in upstate were solution recreational programs and I also participated in recreational programs and received support from them. In therapy, I miss my son's 10th birthday. However, the way I explained it to my son and the mentality I had was I could either miss his 10th birthday or I could miss all of them. So I took that opportunity, and it was one of the best things I ever did.
▶ 2:13:03Mr. Lambright: I always claimed to be a christian man since I was saved at 12 years old. However, I never truly followed the lifestyle and choices that jesus had directed me by his actions and words in the bible. Last year in april 2024 I was baptized again in the presence of my son, mother, father, and my life drastically changed. Seeking god's purpose for my life and putting my focus and energy on that caused himself some life changing for the better.
▶ 2:13:29Mr. Lambright: The care and help I received from the staff sergeant fox program saved my life. I -- excuse me -- I had been out of the marine corps for 12 years before I asked for help. It took me 12 years to get to rock bottom. Rock bottom was untouched trauma I experience while in the marine corps. The losses I experience since that time, as well, of veteran friends, parents, of purpose. For over two years, my mental health and well-being were made a priority I the v.a.
▶ 2:13:59Mr. Lambright: In my community that most importantly by me. I exited the program in april of this year. When familie friends, local organizations, and fed -- fellow veterans actively create a supportive environment, they build a strong network of care and understanding. This sense of connection and shared responsibility makes a profound difference in the lives of veterans, reminding them they are not alone and that our lives really do matter.
▶ 2:14:30Mr. Lambright: Completing the program gave me the tools to take better care of myself and be there for my brothers and sisters in arms. I am proud of taking that step because asking for help is a strength, not weakness. I hope and pray this program, staff sergeant fox program, will be continued and expanded to include other avenues and resources like legal assistance, financial literacy, eligibility limitations information for veterans or thank you for your time, and god bless.
▶ 2:14:57Chair Moran: Thank you for being here today and your ability to tell us your story and for your service to the country. I am going to go vote. I will call on lindsay church. Then I will give my time to senator tuberville and senator blumenthal will chair the meeting until I return. Lindsay church.
▶ 2:15:17Ms. Church: Thank you chairman, ranking member, and members, thank you for the opportunity to testify today. I am lindsay church, executive director of minority veterans of america. Our organization serves veterans who have been historically excluded and underserved. People of color, lgbtq, religious minorities, folks with disabilities, and those in rural communities. There are outside stories and american military service.
▶ 2:15:47Ms. Church: When we return home and face systems not designed with us in mind, today's hearing and knowledge is a crisis many of us have been warning about for years, the growing distance between service and survival. Especially for those at the margins of visibility. Since october of last year, we have had at least 13 veterans die by suicide on v.a. Property. Another 13 non-binary and intersection -- intersex veterans attempted suicide.
▶ 2:16:17Ms. Church: There is a highs number of veteran suicides on v.a. Campuses in a single year. They are not isolated incidents, they are the reflection of a system not only broken but actively weakened by policy choices that erase unique experiences and barriers faced by the most vulnerable veterans. Instead of fostering trust, transparency, and targeted services, we have watched as this administration has taken steps that endanger the veterans most in need. In the past 100 days, the v.a.
▶ 2:16:49Ms. Church: Rescinded 1341, eliminating protections for respectful, clinically informed care for transgender and intersex veterans and access to crucial life-saving health care. Critical language acknowledging race, gender, sexual orientation, disability status, and accessibility was stripped from the forthcoming congressionally mandated report for veterans. Effectively erasing marginalized veterans from national policy recommendations.
▶ 2:17:18Ms. Church: Outreach materials acknowledging lgbt veterans, women, veterans of color, and disabled veterans have been sanitized or eliminated. The suppressed data to auction on sexual orientation, gender identity, race, were making disparities easier to ignore and harder to address. These are not bureaucratic oversights, their deliberate choices with deadly consequences. We erase identity, we erase risk.
▶ 2:17:45Ms. Church: When we erase risk, we erase responsibility. When we erase responsibility, veterans die. We confront these realities everyday, not in theory but in lived experience.
▶ 2:17:59Ms. Church: That is why we provide transitional housing for lgbt veterans in homelessness, we help veterans in crisis, train minority veteran leaders and providers and culturally competent care, and we create spaces, indoors and outdoors, where veterans can go without hiding who they are. These interventions are suicide prevention and we have learned that connection saves lives. That trust saves lives.
▶ 2:18:25Ms. Church: That access to mental health care that affirms identity, rather than denying it, saves lives. That is why the bills before you today matter. They offer opportunities to not just bridge gaps but repair the foundation of trust which has been so badly damaged. That opportunity will be lost if we fail to embed equity at every step. We must prioritize equity in grant funding, not as a bonus but a core requirement.
▶ 2:18:52Ms. Church: Mandated cultural competencies and training for all providers serving veterans. Required disaggregated data collection to identify and address disparities that put minority veterans at greatest risk. Invest in partnerships with trusted community-based organizations already doing this work. Outreach without intention is not outreach. Access without safety is not access, it is abandonment. Visibility without action is not progress, it is betrayal.
▶ 2:19:22Ms. Church: We are not simply facing an outreach problem when veterans drive onto v.a. Campuses and take their lives in their cars or when transgender veterans struggle to walk into v.a. Clinics because they are afraid to reveal their identities. It is not just an outreach problem when women veterans report being re-traumatized by providers who do not understand gender-based trauma. We must acknowledge we are facing a systems design failure, one worsened by political decisions to erase identities most in need of protection.
▶ 2:19:51Ms. Church: We cannot afford half measures or sanitized language that hides disparities behind one-size-fits-all solutions. We cannot afford to lose another life to silence, indifference, or fear. This is not just a matter of mental policy. It is a test of whether our government is willing to see and survival have served. Veterans deserve more than visibility. We deserve systems that are worthy of our trust, our lives, and our sacrifices.
▶ 2:20:20Ms. Church: This is our chance, right now, to build these systems to not only acknowledge veterans like me and those sitting behind me but to fight for us, regardless of our identities. Not with empty promises but with bold action, bold enough to save our lives. Thank you for the opportunity to testify and I look forward to your questions. >> thank you. Senator tuberville.
▶ 2:20:49Sen. Tuberville: . Good morning, everybody, thank you for being here. Thank you for those who have served this great country. Inks for your service here to have been on the committee going five years, and we have not improved prevention of suicide. A lot of areas have gotten worse.
▶ 2:21:04Sen. Tuberville: In alabama, you can throw all the money at it you want, but end of the day, and deposit -- it is about the attitudes and the people that work in these hospitals and care units that show care and ability for the veteran. I have had friends commit suicide or almost. It is a sad state of affairs.
▶ 2:21:35Sen. Tuberville: Veterans, there's no area we need to concentrate more in our country other than, obviously, our economy, but the care of people that have put their life on the line for our country. Opportunity for oversight on these grants, Ms. lorraine, do we have enough oversight in your eyes for the grants we are putting out, the fox grants? Thank you, senator.
▶ 2:22:05Sen. Tuberville: If there is oversight, it is not transparent. We do participate in our partnership participates in all the meetings at the v.a. Holds. We provide reports, we just do not know how we rack up against others and we do not understand where we are, how we can improve what we are doing. So if the outcome of oversight is to change the process and approve it, we are seeing it a little bit. The technology system that the v.a.
▶ 2:22:34Sen. Tuberville: Was using previously has improved greatly. But I would say it is not exceeding expectations on oversight.
▶ 2:22:44Sen. Tuberville: How can the v.a. And this administration stop the bad actors from taking the grants away from people who actually need these grants?
▶ 2:22:55Mr. Lorraine: Sir, I think there is an example of a grantee in the northeast was prosecuted for 50,000 dollars, taking $50,000 from the grant. I think that type of oversight is needed. We just went through our audit and did very well with it.
▶ 2:23:13Mr. Lorraine: But I think more audits -- I hate to say that, but I think more audits for organizations, with clear guidelines, that do not just look at how many hours you are spending doing the work but whether the outcomes -- but the outcomes of the work you are doing.
▶ 2:23:32Sen. Tuberville: And the data we get, a lot of it is not accurate. How can we get better if we do not get accurate data? Any of you, are you seeing a better use of data that we are accumulating? Anybody?
▶ 2:23:54Sen. Tuberville: >> I think that the types of measures that we historically looked at in similar models but not necessarily only connecting people to v.a. Care making referrals to organizations for services have included things like timeliness and accuracy of those referrals, saying the veteran for the right thing.
▶ 2:24:18Sen. Tuberville: To me, it is on a continuum of how many people you are reaching for your outreach and how many people you are screening come converting to how many people successfully get to v.a. Come converting to how successful is the treatment.
▶ 2:24:35Sen. Tuberville: I think it is possible, I just think it is not as transparent as it could be about what information is available, particularly as I non-grantee, we know very little.
▶ 2:24:51Sen. Tuberville: I will ask you this question, do you think merit system of people showing better data, better accomplishments, more positive out fluence's and influences, do you think they should get more grants?
▶ 2:25:10Ms. Cantor: You're asking that to a seasoned program evaluator, so I will say absolutely yes. I think some of the provisions account for that in the legislation allowing for potential additional help to people who have demonstrated good performance. That could serve more with more funds.
▶ 2:25:31Sen. Tuberville: The grant program started back in 2020, set to expire this physical year if we do not re-up it. Any of you want to answer this question, are there any other suicide methods that we have seen? I will ask the veterans, any other suicide methods we have seen to help to prevent suicide?
▶ 2:25:58Sen. Tuberville: Anything you would like to suggest in your experiences, and if you want to answer anything you have seen? I have personally offered up to this committee about hyperbaric chambers. People say it helps in some areas with ptsd, some say they do not. Who cares? If they help anybody, one person, we should use them. Anybody want to answer that through experience?
▶ 2:26:28Sen. Tuberville: >> there's a couple nonconventional ways I have experienced personally that have helped. I do not know if you are familiar with dmt or psychedelics, but those have helped me quite a bit, using those personally just to get past the trauma. It gives you a supernatural way to kind of look at yourself and get over the things that haunt you so bad. I think those work in general. I think anybody could use those to their advantage.
▶ 2:26:55Sen. Tuberville: Were they provided by the v.a.?
▶ 2:27:00Mr. Lambright: No, sir. I do not think it was an option. While I am here, I wanted to mention one thing, there's been multiple comments from senator moran and others about the v.a. And funding in the budget cuts due to the amount of funding. I want to give one example for me personally. When I went to the hospital the v.a.
▶ 2:27:23Mr. Lambright: Sent me to in statesboro, georgia, I saw the bill that ended up getting sent to the v.a. From that hospital, it was $90,000 for a 30-day inpatient program. The exact same person who got the exact same care but not billed through the v.a. But build through their insurance was $21,500. So I think there is a lot of irresponsible maybe invoicing or spending. That is just one example.
▶ 2:27:54Mr. Lambright: If 50 guys go to the same program, you are talking a substantial amount of money. So I feel like the audits, like we were just talking about, I think that would be a really good situation to mitigate all the unnecessary spending or maybe careless spending that goes on, that way there's more funds available for veterans that need and could use it.
▶ 2:28:18Sen. Tuberville: Yet, I think our v.a. Secretary is on top of that. We have to stop the fraud and theft. We need the money for people that actually deserve that. Thank you.
▶ 2:28:30Sen. Blumenthal: Thanks, senator. I have a few questions for Ms. barr and Mr. lambright. Both of you, as marine corps veterans, went to upstate warriors solutions. You did not call the v.a. Directly. You did not call the veterans crisis line. Could you talk about why you went there and not to the v.a.?
▶ 2:29:01Sen. Blumenthal: Directly.
▶ 2:29:04Ms. Barr: Thank you, senator. I, myself, actually searched through the v.a. First to reach out to try and find any type of mental health, anything. I had been trying to get into that through the v.a. While I was in, just trying to get it worked out prior to getting out, and kept getting phone numbers for people who were no longer in service or no longer connected to the v.a.
▶ 2:29:31Ms. Barr: Or just stonewalled over and over again through them. Thankfully, I found a vet center in town and they were the ones who pointed me to upstate warriors solutions. An upstate warriors solutions were the ones to keep working through that.
▶ 2:29:50Ms. Barr: I think part of it is partially just do to -- in our area, in greenville, south carolina, the v.a. Does not reach out very much, nor does it announce its capabilities often. It is definitely very much up to the veteran to try to find resources.
▶ 2:30:17Ms. Barr: Upstate warriors solutions is one that presents itself and puts itself out there more so than the v.a. And vet centers do. So I think that is most likely the reason most people have found upstate warriors solutions before the v.a. Just because they are out there putting themselves out to help in present themselves, instead of making it a chore or an extreme task to try to make their way through the v.a.
▶ 2:30:48Ms. Barr: Process of getting help. Thank you.
▶ 2:30:52Mr. Lambright: Thank you for your question, senator. I think what you asked was, why did I go to upstate where your solution and not the v.a.? I into the v.a. First, in fact. In south carolina, there's multiple outpatient clinics but one main va hospital in columbia .
▶ 2:31:12Mr. Lambright: So when I was first initially struggling with suicide, I drove myself to columbia, unbeknownst to my family or anybody, and checked myself in where they have a mental health facility there in columbia. They took my clothes, but me in a gown and foam slippers, and for five days I played scrabble and it was basically a waste of time.
▶ 2:31:38Mr. Lambright: When I left, I was more upset and in a worse place than when I got there. I discuss that with upstate warriors solution, which provided me the insight and direction to use another facility, like a civilian facility, at the v.a. Could direct me there to get the care I needed. So I did, in fact, go to the v.a.
▶ 2:32:00Mr. Lambright: First, but I had a relationship with nate and with scott hicks that I mentioned, and they had experience with other veterans that were in a similar position and had gotten help from a civilian entity. So I chose that route instead, and it was honestly the best decision I ever made. I owe my life to these guys.
▶ 2:32:24Sen. Blumenthal: Thank you. Thank you both for your service and for being here today. Mr. lang, have you seen evidence yet of the v.a. Staffing so far as it affects veterans?
▶ 2:32:40Mr. Lorraine: No, sir, we have not seen any.
▶ 2:32:46Sen. Blumenthal: How about other members of the panel, have you seen -- when I say evidence of the cuts, I don't mean only people leaving, I also mean the sense of anxiety, worry, and so forth. >> I would say I have heard that in phone conversations, following up, trying to build more program agreements with the v.a. And in general asking.
▶ 2:33:12Sen. Blumenthal: They are our peers and we care about them as well and as cap they are doing. There is definitely mixed anxieties and some fears. We just have not seen personally any of that come to fruition yet.
▶ 2:33:25Sen. Blumenthal: Have you heard veterans discuss it?
▶ 2:33:31Mr. Crow: It is definitely asked about, sir. Veterans who come into our programs are that we talked to at events, they are curious, it is in the news, so they ask about it. With us just being a grantee, I do not have the expertise to tell them anything. I mainly direct them to public affairs offices and things like that to field those questions. But it is discussed.
▶ 2:34:03Ms. Cantor: And it -- Ms.
▶ 2:34:05Church: You see the centralized services of the v.a. Relies on like operator services that you call to reach v.a. Providers, you call the central operator. Took me seven and a half minutes to get to the operator the other day and normally takes 12 seconds. Just waiting on hold, trying to get a hold of anybody to get you to the clinic, because that is the only way you can call the actual hospital.
▶ 2:34:33Church: We have providers worried because their schedulers are getting cut and getting rif'ed, and anybody who help support them to deliver the services are starting -- some may be exempt, but the support staff and scheduling and billing, all of those things are now landing on the providers desk. V.a. Does not pay well enough to have them do three or four jobs in support of delivering these services.
▶ 2:34:59Church: So there is a ton of anxiety, a lot of frustrations, people making impossible decisions about whether to take deferred resignation, take retirement, to take it or chance whether or not they will have a job in a few months. So there is a lot of anxiety. So you talk about v.a. Employees being veterans themselves, you have a crisis. Most of us are worried about the future of this agency in our health care.
▶ 2:35:29Church: Then you turn to the side of people who work for v.a., they are experiencing the mental health rices at the v.a. Maybe being dismantled but they also have to work for the agency, worry about their jobs. Many work in areas now outlined -- outlawed in the agency themselves. So it is a crisis in the underbelly of the veteran community that we will see in next year suicide report.
▶ 2:35:54Sen. Blumenthal: Thank you. I want to thank all of you for being here today. Chairman, senator moran, has another obligation, so I am going to finish the hearing. Thank you for your participation, very meaningful and important to this committee. The hearing record will remain open for five legislative days.
▶ 2:36:20Sen. Blumenthal: Should any committee members want to submit edges no statements or questions for the record -- submit additional statement or questions for the record and I will ask all of our witnesses, if there are questions, please respond to them. And once again, thank you all for being here. This hearing is adjourned. Thank you. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]