S.Hrg.119-60

1[Senate Hearing 119-60]2[From the U.S. Government Publishing Office]34                                                         S. Hrg. 119-6056                BRIDGING THE GAP: ENHANCING OUTREACH TO7                    SUPPORT VETERANS' MENTAL HEALTH89=======================================================================1011                                HEARING1213                               BEFORE THE1415                     COMMITTEE ON VETERANS' AFFAIRS16                          UNITED STATES SENATE1718                    ONE HUNDRED NINETEENTH CONGRESS1920                             FIRST SESSION2122                               __________2324                             APRIL 29, 20252526                               __________2728       Printed for the use of the Committee on Veterans' Affairs2930[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3132        Available via the World Wide Web: http://www.govinfo.gov3334                                __________3536                   U.S. GOVERNMENT PUBLISHING OFFICE3760-293 PDF                  WASHINGTON : 20253839-----------------------------------------------------------------------------------4041                 SENATE COMMITTEE ON VETERANS' AFFAIRS4243                     Jerry Moran, Kansas, Chairman44John Boozman, Arkansas               Richard Blumenthal, Connecticut,45Bill Cassidy, Louisiana                  Ranking Member46Thom Tillis, North Carolina          Patty Murray, Washington47Dan Sullivan, Alaska                 Bernard Sanders, Vermont48Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii49Kevin Cramer, North Dakota           Margaret Wood Hassan, New50Tommy Tuberville, Alabama                Hampshire51Jim Banks, Indiana                   Angus S. King, Jr., Maine52Tim Sheehy, Montana                  Tammy Duckworth, Illinois53                                     Ruben Gallego, Arizona54                                     Elissa Slotkin, Michigan5556                     David Shearman, Staff Director57                Tony McClain, Democratic Staff Director5859                           C O N T E N T S6061                              ----------6263                             April 29, 20256465                                SENATORS6667                                                                   Page68Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     169Hon. Richard Blumenthal, Ranking Member, U.S. Senator from70  Connecticut....................................................     271Hon. Kevin Cramer, U.S. Senator from North Dakota................     972Hon. Patty Murray, U.S. Senator from Washington..................    1073Hon. Marsha Blackburn, U.S. Senator from Tennessee...............    1274Hon. Mazie K. Hirono, U.S. Senator from Hawaii...................    1375Hon. John Boozman, U.S. Senator from Arkansas....................    1576Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    1677Hon. Angus S. King, Jr., U.S. Senator from Maine.................    1878Hon. Tammy Duckworth, U.S. Senator from Illinois.................    1979Hon. Ruben Gallego, U.S. Senator from Arizona....................    2180Hon. Elissa Slotkin, U.S. Senator from Michigan..................    2481Hon. Tommy Tuberville, U.S. Senator from Alabama.................    368283                                 GUEST8485Hon. Mark R. Warner, U.S. Senator from Virginia..................     48687                               WITNESSES88                                Panel I8990Thomas O'Toole, MD, Acting Assistant Under Secretary of Health91  for Clinical Services and Deputy Chief Medical Officer,92  Veterans Health Administration, U.S. Department of Veterans93  Affairs accompanied by Michael Fisher, Chief Officer,94  Readjustment Counseling Service, Veterans Health Administration     59596                                Panel II9798Jim Lorraine, President and CEO, America's Warrior Partnership...    2699100Gilly Cantor, MPA, Director of Evaluation and Capacity Building,101  D'Aniello Institute for Veterans and Military Families (IVMF),102  Syracuse University............................................    27103104Steffen Crow, SSG Parker Gordon Fox Grant Program Manager,105  Oklahoma Veterans United.......................................    29106107Heather Barr, U.S. Marine Corps Veteran..........................    30108109Austin Lambright, U.S. Marine Corps Veteran......................    32110111Lindsay Church, Executive Director and Co-Founder, Minority112  Veterans of America............................................    34113114                                APPENDIX115                          Prepared Statements116117Thomas O'Toole, MD, Acting Assistant Under Secretary of Health118  for Clinical Services and Deputy Chief Medical Officer,119  Veterans Health Administration, U.S. Department of Veterans120  Affairs........................................................    47121122Jim Lorraine, President and CEO, America's Warrior Partnership...    67123124Gilly Cantor, MPA, Director of Evaluation and Capacity Building,125  D'Aniello Institute for Veterans and Military Families (IVMF),126  Syracuse University............................................    75127128Steffen Crow, SSG Parker Gordon Fox Grant Program Manager,129  Oklahoma Veterans United.......................................    80130131Heather Barr, U.S. Marine Corps Veteran..........................   102132133Austin Lambright, U.S. Marine Corps Veteran......................   104134135Lindsay Church, Executive Director and Co-Founder, Minority136  Veterans of America............................................   106137138                        Questions for the Record139140Department of Veterans Affairs response to questions submitted141  by:142143  Hon. Jerry Moran...............................................   143144145  Hon. Angus S. King, Jr.........................................   144146147  Hon. Marsha Blackburn..........................................   145148149                       Submissions for the Record150                  (From Minority Veterans of America)151152Memorandum to Interagency Task Force on Outdoor Recreation for153  Veterans.......................................................   151154155Minority Veterans of America resignation from Interagency Task156  Force on Outdoor Recreation for Veterans.......................   155157158Final Report by Interagency Task Force on Outdoor Recreation for159  Veterans, September 2024.......................................   156160161                       Statements for the Record162163Hon. Sheri Biggs, U.S. Representative from South Carolina........   191164165American Psychological Association Services, Inc., Katherine B.166  McGuire, MSc, Chief Advocacy Officer...........................   196167168AMVETS, Joseph R. Chenelly, Executive Director...................   201169170Blue Star Families, Brooke Blaalid, Associate Director of Policy.   203171172Boulder Crest Foundation, Josh Goldberg, CEO.....................   210173174Combined Arms, Mike Hutchings, CEO...............................   215175176Community Building Art Works, Seema Reza, Chief Executive Officer   216177178Disabled American Veterans, Naomi Mathis, Assistant National179  Legislative Director...........................................   219180181EveryMind, Ann Marie Mazur, CEO..................................   228182183Modern Military Association of America...........................   230184185Paralyzed Veterans of America....................................   232186187The American Legion, Sri Benson, Health Policy Analyst...........   237188189The American Legion, Mario A. Marquez, Executive Director,190  Government Affairs.............................................   248191192Tragedy Assistance Program for Survivors, Bonnie Carroll,193  President and Founder..........................................   249194195Veterans of Foreign Wars of the United States, Meggan Coleman,196  Associate Director, National Legislative Service...............   251197198BRIDGING THE GAP: ENHANCING OUTREACH TO SUPPORT VETERANS' MENTAL HEALTH199200                              ----------201202                        TUESDAY, APRIL 29, 2025203204                                       U.S. Senate,205                            Committee on Veterans' Affairs,206                                                    Washington, DC.207    The Committee met, pursuant to notice, at 10:36 a.m., in208Room SD-106, Dirksen Senate Office Building, Hon. Jerry Moran,209Chairman of the Committee, presiding.210211    Present: Senators Moran, Boozman, Cassidy, Tillis,212Blackburn, Cramer, Tuberville, Sheehy, Blumenthal, Murray,213Hirono, Hassan, King, Duckworth, Gallego, and Slotkin.214215    Also present: Senator Mark R. Warner.216217             OPENING STATEMENT OF HON. JERRY MORAN,218               CHAIRMAN, U.S. SENATOR FROM KANSAS219220    Chairman Moran. All right. Good morning, and welcome.221Before we begin the hearing, I want to highlight that today at2223 o'clock in Emancipation Hall, a Congressional Medal that was223authorized by the Senate and the House will be presented to The224Six Triple Eight, the African American women who in World War225II delivered the mail by the millions.226    And we would welcome you to participate, to attend, or at227least honor those women today who served our country, and in it228is a really touching story. I think a number of networks across229the country have carried this story about these women who230rolled up their sleeves and got the mail delivered to service231members during World War II.232    Today, we're on the topic of mental health and veterans'233well-being. Nearly 5 years ago, the Commander John Scott Hannon234Veterans Mental Health Care Improvement Act was signed into235law. I led the introduction of this legislation with the help236and support of many of the veterans and advocates that are here237today. I also would indicate that this was a piece of238legislation that Senator Tester was hugely engaged in.239    The Commander Hannon Act directed better collaboration240between the VA and the Department of Defense, and made241improvements to the VA's mental health workforce, and directed242cutting edge precision health research. This landmark243legislation also developed an authorized federal funding for244the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant245Program, which focuses on bolstering community organizations246providing nonclinical suicide prevention services to veterans.247    It was the goal of Congress, and this Committee,248specifically, for the VA to work more seamlessly with veterans249serving community organizations to provide veterans lifesaving250clinical care and nonclinical support services they deserve.251This morning, we are here to discuss the nonclinical suicide252prevention services and to hear directly what has worked well253and what needs to be altered, with the goal of reauthorizing254this impactful program.255    We will hear from the VA to receive the Department's256perspective on implementation of this grant program. We'll also257hear from advocates who represent grantee organizations from258their perspectives, and from veterans who have benefited from259the program.260    Additionally, we will be receiving input from the VA and261feedback from advocates on four bills, which include Helping262Optimize Prevention and Engagement, the HOPE Act, which is my263legislation, the Building Resources and Access for Veterans264Mental Health Engagement, the BRAVE Act, sponsored by the265Ranking Member Blumenthal, the bill to reauthorize and modify266Staff Sergeant Parker Gordon Fox Suicide Prevention Grant267Program, sponsored by Senator Boozman and Warner. And Every268State Counts for Vets Mental Health Act, sponsored by Senator269Cramer and Senator Coons.270    With that, I yield to the Ranking Member, Senator271Blumenthal for his opening remarks.272273         OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,274         RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT275276    Senator Blumenthal. Thank you, Mr. Chairman. Thank you for277convening this hearing on this critically important topic.278We're here today to discuss the issue of veterans' mental279health, including their access to care from a safe, reliable280provider. A safe, reliable provider who has the expertise and281trust to provide the best possible care for each individual282veteran.283    I welcome our colleague, Senator Warner, to testify on284behalf of the Staff Sergeant Parker Gordon Fox Grant Program.285It's been a game changer for so many veterans. It's geared286toward meeting veterans where they are, providing access to287services from trusted community partners and targeting288underserved communities. And my hope is we'll have bipartisan289support for reauthorizing the Fox Grant Program, and we will290have bipartisan consensus on a couple of really essential291points.292    The rate of veterans' suicide, 17.6 a day, is absolutely293intolerable. The level of services to veterans for mental294health is woefully lacking. The efforts underway to address the295lack of mental health are completely inadequate. And my bill on296today's agenda, the BRAVE Act, reauthorizes the Fox Program,297but it goes further, and I hope we'll have bipartisan support298to ensure, not only that this program, but others to address299these issues are fulfilled.300    The fact is the Veterans Crisis Line has seen a dramatic301impact in call volume, largely from veterans who are either302terminated from the federal workforce, or who are concerned303about losing their benefits, or both. And at a time when304veterans are uniquely anxious, and apprehensive, and need our305support the most, we're seeing the Trump/Musk/Collins306conglomerate slashing and trashing their way through the307Federal Government.308    Employee assistance programs and mental health support309contracts for the VA workforce have been canceled. Some have310been reinstated, but not before employees were left high and311dry, and forced to choose between paying out-of-pocket or312canceling their appointments due to contract cancellation.313World-class researchers studying mental health and substance314use disorders are among the ones who've been terminated. Makes315no sense. It's nonsensical, it is shameful, and disgraceful.316    On the issue of privacy, a recent memo obtained by NPR,317recommended VA mental health providers tell their patients,318``While I will do my utmost to maintain your privacy, I cannot319guarantee complete confidentiality.'' They're telling veterans320they can't maintain privacy or confidentiality due to space321limitations caused by a rushed and reckless return-to-office322mandate. Again, disgraceful, shameful. Concerns about privacy323will destroy the hard-won trust VA has spent decades building.324    After this memo was disclosed, VA backtracked to say it was325temporarily delaying its return-to-office requirements for326telemental health providers. I want to note these providers327haven't been exempted from the return-to-office mandate. The328facilities have simply been asked to confirm their return-to-329office spaces are private. This strategy of cut first-plan330later, fire first-analyze later, terminate, cut, freeze, ask331questions later apparently is continuing. And this failure of332leadership is at the expense of veterans. And we have yet to333hear in this Committee from the Secretary of the VA, despite my334repeated requests for him to tell us what the rationale and335reason is for these massive cuts and firings.336    So, we all know that even before the Trump administration's337crusade against veterans, the VA projected a 59 percent338increase in inpatient and outpatient mental healthcare demand339in the coming years--59 percent increase. The Department was340already suffering from critical mental health staffing341shortages. There were already 40,000 open positions in the VA,342some of them for mental health professionals.343    In his confirmation hearing, the Secretary claimed, he344claimed, suicide prevention was a priority. But instead of345bolstering access to life-saving mental health, he's fired346thousands of critical employees, including veterans crisis line347employees. Some have been reinstated, others have found new348employment. That's understandable because they have bills to349pay, they have lives to live and waiting for the administration350to correct yet another unforced error can't be their burden.351    We have to make sure that the administration answers our352question. Our responsibility is oversight, and scrutiny, and to353prevent the firing of another 83,000 VA employees over the354coming months. We know from this Committee, we've all been on355it for a while, that outreach is essential to bring veterans356into mental health. We can't rely only on veterans calling a357crisis line or coming to the VA facilities.358    There has to be outreach. 10 of those 17 per day average359veterans taking their own lives, 10 of them, have had no360contact with the VA. If we can reach more, we can save more. If361we fire the counselors and others who are doing outreach, it362will cripple efforts to save veterans from suicide, including363the Fox Program.364    So, while we're here today, I hope to hear from our365witnesses about the importance of outreach and how it can be366bolstered and strengthened. Thank you, Mr. Chairman.367    Chairman Moran. Ranking Member, thank you. We are now368delighted to have before the Veterans Committee, on a temporary369basis, the Senator from Virginia, Senator Warner, one of our370esteemed colleagues. And this is a rare occasion when other371Senators not on the Committee appear before us. But you are372welcome to be here, Senator Warner.373374               STATEMENT OF HON. MARK R. WARNER,375                   U.S. SENATOR FROM VIRGINIA376377    Senator Warner. Well, thank you, Mr. Chairman, and Ranking378Member Blumenthal. This is obviously a very important topic.379You've given me 4 minutes. I'll try to get it under 4 minutes,380so I actually get asked back. But very much appreciate the work381of this Committee. I know the issue of mental health of our382veterans is extraordinarily important.383    And this is something I think we all realize is part of a384core commitment. This is not a nice to do. This is an385obligation we owe to the men and women who've served us. It is386not charity. It is something that we must fulfill. And387unfortunately, as the Chair and the Ranking Member, and I know,388all the Committee members realize, veterans' suicide is a389scourge that has to be addressed.390    For the past several years, Staff Sergeant Fox Suicide391Prevention Grant Program, I think, has been an invaluable tool392for the VA to use. Senator Boozman and I came up with an393initial legislation back in 2019, a number of Members on this394Committee were firm supporters. That turned into an effort that395ultimately led to the Staff Sergeant Fox Grant Program.396    In that time, $150 million has gone out in my home State of397Virginia. $4.5 million of that has gone out to organizations398who are providing the kind of critical outreach to make sure399that veterans who are in duress know that the services are400available as Ranking member Blumenthal mentioned. We have a401huge concentration of veterans down in Hampton Roads, and the402fact that of these 17 suicides today, the fact that literally40310 of those never interact with the VA, is a challenge that we404have to overcome.405    This program was a temporary grant program. It is time for406its permanent reauthorization. I've joined again with Senator407Boozman on legislation to do that. I know the Chair, and the408Ranking Member, and others on this Committee have similar409legislation. I just want to add my voice that this is something410we have to get done. The sooner, the better. Literally,411veterans' lives depend upon it. And if any, in any way, I can,412as an off-Committee member helping these efforts, please count413me as one of your allies.414    I appreciate the opportunity, and I will note Mr. Chairman,415that I'm seating back a minute and 40 seconds.416    Chairman Moran. A message. It's an opportunity for Senators417to learn from Senator Warner. A message well delivered under418the time allowed.419    Senator Warner. Thank you, Mr. Chairman.420    Chairman Moran. Thank you, Senator Warner. Thank you for421joining us today. I remember the hard work that you and Senator422Boozman did early on to get this legislation in place.423    Testifying on today's first panel is Dr. Thomas O'Toole,424the Acting Assistant Under Secretary of Health for Clinical425Services of the Veterans Health Administration. He's426accompanied by Michael Fisher, Chief Officer of Readjustment427Counseling Service of the Veterans Health Administration. Thank428you both for being here.429    Dr. O'Toole, you're now recognized for your testimony.430431                            PANEL I432433                              ----------434435    STATEMENT OF THOMAS O'TOOLE, MD, ACTING ASSISTANT UNDER436  SECRETARY OF HEALTH FOR CLINICAL SERVICES AND DEPUTY CHIEF437    MEDICAL OFFICER, VETERANS' HEALTH ADMINISTRATION, U.S.438 DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED BY MICHAEL FISHER,439CHIEF OFFICER, READJUSTMENT COUNSELING SERVICE, VETERANS HEALTH440                         ADMINISTRATION441442    Dr. O'Toole. Thank you, Chairman Moran, Ranking Member443Blumenthal, and Members of the Committee. Thank you for444inviting us here today to present our views on several bills445that would affect VA programs and services, particularly the446Staff Sergeant Parker Gordon Fox Suicide Prevention Grant447Program. Joining me today is Mr. Mike Fisher, Chief Officer of448the Readjustment Counseling Service.449    The Staff Sergeant Parker Gordon Fox Suicide Prevention450Grant Program enables VA to provide resources toward community-451based suicide prevention efforts to meet the needs of veterans452and their families through outreach, suicide prevention453services, and connections to VA and community resources.454    In alignment with VA's National Strategy for Preventing455Veteran Suicide, this grant program assists in further456implementing a public health approach that blends community-457based prevention with evidence-based clinical strategies458through community efforts. The grant program is part of the459Commander John Scott Hannon Veteran Mental Health Care460Improvement Act of 2019, that was signed into law on October46117th, 2020.462    The Staff Sergeant Parker Gordon Fox Suicide Prevention463Grant Program began on September 19th, 2022 when VA awarded464$52.5 million to 80 community-based organizations in 43 states,465the District of Columbia, and America Samoa. Since its launch466in September '22, VA has awarded $157.5 million to 95467organizations across these 43 states, U.S. territories and468tribal lands.469    Early results show that 33 percent of participants are new470to VA services, and 75 percent of participants who complete471services show improvement in mental health status, well-being,472social supports, and financial stability, as well as a decrease473in suicide risk. All of the bills on today's agenda would hold,474or in part, mend the authority for the Staff Sergeant Parker475Gordon Fox Suicide Prevention Grant Program.476    VA strongly supports the reauthorization of this program as477it is critically important for sustaining and expanding the478progress we have made so far. The initial grants have already479shown promising results, and continued congressional support480will be essential for ensuring that we can reach even more481veterans in need.482    We greatly appreciate the Committee's interest in483continuing this program and stand ready to implement the484extension of this authority as soon as possible, because it's485important to continue this work in fiscal year 2026. We welcome486the opportunity to meet with the Committee to ensure that any487amendments to the terms of the grant do not interrupt488operations or delay these awards. The Department's position for489each bill is detailed in my written statement.490    This concludes my statement, and we are happy to answer any491questions you or other Members of the Committee may have.492493    [The prepared statement of Dr. O'Toole appears on page 47494of the Appendix.]495496    Chairman Moran. Doctor, we'll begin a round of questions by497the Members of the Committee. Let me start by asking you, as498Congress looks to reauthorize, it's really pleasing, I think499this has broad support in Congress and certainly strong support500from the Department. But as we do this process and work to501improve this program, what's the VA learned about grantee502performance and outcome data so far? And what are the lessons503that have been learned in shaping your approach to suicide504prevention?505    I would add before you answer that, one of the challenges506highlighted in the Hope for Heroes Act is a lack of awareness507among VA staff about the Fox Grant Program. And I would ask,508how is the VA working to make certain its own employees, and509especially those in high needs areas, are fully aware of the510program and collaborating with grantee organizations making511this program even better?512    Dr. O'Toole. Thank you, Senator. As noted, the 3-year513authorization for this grant program has really allowed us to514be on a learning curve to try to do a better job. As has been515noted, any suicide by a veteran is one too many. And so, we516very much view this grant as an important part for reaching517those veterans that we are not reaching.518    The lessons learned to date, and much of this is captured519in the MITRE report that provided a snapshot view of early520experiences, highlighted several areas that we need to continue521to improve on. Obviously, enhancing our outreach and522engagement, particularly for those disconnected veterans is523critical. And I think ensuring that our grantees have all of524the services they need as well as the expectations and skills525that they require to be able to effectively engage not only in526outreach, but in the services is critically important.527    The other area that I think is essential is making sure528that the VA is there, ready, and has capacity, and a clear path529for ensuring that mental health care is available to those530veterans who need it. And obviously, that incorporates several531different elements, but one of which you mentioned, which is an532awareness of the programs by the grantees. It's something that533we acknowledge, and I know it's addressed in several of the534bills going forward as well.535    Chairman Moran. Let me ask you. You used the word capacity,536clear path. So, how would you indicate that the Department of537Veterans Affairs is prepared and capable on a clear path to538reduce suicide by veterans in the country just more broadly539than this legislation? Tell me about the capacity and540capabilities.541    Dr. O'Toole. So, the capacity is we have a very robust542mental health services program within VA that incorporates543tiered levels of care, including screening throughout the544agency and in our healthcare settings, not only just in mental545health; integration of mental health care within our PACT or546primary care teams through the PHMI program, behavioral health547teams providing more intensive care as well as specialized548services for higher need, higher risk veterans, including549inpatient care and residential treatment programming.550    It's a continuum of care and continuum of services that,551you know, as noted in Senator Blumenthal's statement, requires552maintenance, requires an ongoing, you know, capacity to553effectively serve the veterans in need. But it is also, I554think, a more robust service than oftentimes we can find555elsewhere. And it's one that, you know, I think our veterans556benefit from greatly.557    Are there things we can do better? Absolutely. Are there558things we need to be improving on? Absolutely. And, you know,559I'm not here to try to defend things that aren't working, but560more importantly, you know, be here to commit to our ongoing561work with the Committee to do a better job.562    Chairman Moran. What would be those things that you could563do that you see you can do a better job aside from what we've564talked a lot about, which is outreach?565    Dr. O'Toole. Right. I think that, you know, the Veteran566Crisis Line, I think has been a lifeline for a lot of veterans.567We need to continue to be able to support that and do the best568we can. What's critically important is clearly making sure that569we have pathways to treatment and to ensuring safety for those570veterans who do screen positive. And we actually do well in571that capacity and support.572    Our ability to reach those veterans who are transitioning573from the military is a critically important focus and capacity574and interest. And I know it's one that our agency is working on575several different efforts to try to improve and enhance. That576becomes, I think, a critical piece, an element to it.577    It's also important to note that suicide risk extends578beyond strictly a mental health approach and status.579Oftentimes, there are economic drivers, there are social580drivers, and others. And taking a whole-health approach to the581veteran is critical to really ensuring that not only the582immediacy of a suicide risk is addressed, but sometimes the583underlying issues and drivers of that suicide are also being584considered.585    Chairman Moran. I would note that I have utilized Senator586Warner's extra minute and a half, and I now recognize Senator587Blumenthal.588    Senator Blumenthal. Thanks, Mr. Chairman. I want to begin589by thanking you both for being here, and for your service to590our country and to the veterans of America. I know that this591time in your professional careers is probably one of the most592challenging that you have encountered, not because of anything593you've done, but because the leadership at the VA is slashing594positions, and freezing hiring, and cutting funding that is595necessary for you to do your jobs and accomplish the mission596you've devoted your lives to doing. And to you and all of the597professionals at the VA, just offer my thanks for continuing to598persevere in this very difficult time.599    Dr. O'Toole, you would agree with me that outreach is600critical in preventing veteran suicide, and enabling them to601what you have called a pathway to treatment.602    Dr. O'Toole. Yes, sir.603    Senator Blumenthal. And that takes human beings on the604phone or in a meeting. It can't be done by an automated message605machine. Correct?606    Dr. O'Toole. Yes, sir.607    Senator Blumenthal. What rationale, what reason could there608be to cut those positions as is now happening?609    Dr. O'Toole. Well, thank you, Senator, and I appreciate610one, your kind words as well as the attention that you're611focusing on this issue. I am happy to report that, actually,612the Veteran Crisis Line staffing numbers have gone up and not613down since this last January. This is a, as you know, an614exempted position from both return-to-office and along with615300,000 other direct care positions exempt from any hiring616freeze, or any hiring, or any firings.617    Senator Blumenthal. Those returns or reinstatements were618done after vocal protest from myself, others on this Committee,619in Congress, and across the country. So, yes, that's good news,620but it's not just the crisis line, it's positions in the West621Haven facility outreach counseling. There already were 40,000622vacancies before this administration took over. Would you agree623with me that a lot of those positions in the field are open624now, and some people in those positions have been terminated?625    Dr. O'Toole. Thank you. And I'm just up the road from you626in Providence, Rhode Island. So, I can appreciate the627challenges of local staffing and local issues. Quite honestly,628our challenges in maintaining the workforce in healthcare629extend beyond this administration. The challenges that we're630facing now, a lot of them----631    Senator Blumenthal. Well, I'm going to interrupt because632I'm going to run out of time if I don't interrupt, so I633apologize. But the fact is there are challenges in recruitment.634Correct?635    Dr. O'Toole. Yes, sir.636    Senator Blumenthal. And those challenges in recruitment are637deeply and dramatically aggravated when the prospect of firing63883,000 employees is raised. Why I go to work for an institution639that's about to fire probationary employees, the newest among640them, when there are opportunities in the private sector where641you get paid more, I mean, duh, you know, I know you're not in642charge of personnel, but isn't that a recipe for disaster?643    Dr. O'Toole. Well, sir, I can't say that 300,000 positions,644which are the direct care positions, are exempted from any645hiring freeze. And this is a critically important element to646trying to ensure that we are retaining and ideally growing our647workforce as best we can.648    Senator Blumenthal. I am about to have my time expire, but649I just want to say that we know that there have been firings of650researchers, counselors, outreach personnel. There is simply no651way to save veterans. And I've heard nothing here that would652convince me otherwise if we engage in this slash and trash653approach to the VA. And again, my thanks to all the654professionals, to you, Mr. Fisher, and Dr. O'Toole, for what655you're doing. And I have not gone over my time.656    [Laughter.]657    Chairman Moran. Only by 3 seconds. Senator Cramer.658659                       HON. KEVIN CRAMER,660                 U.S. SENATOR FROM NORTH DAKOTA661662    Senator Cramer. Thank you, Mr. Chairman, Ranking Member,663for this important hearing. And thank you to our witnesses as664well for your service, and for being here.665    I'm going to get right to the specific point that's666addressed in legislation that I've introduced, an amendment to667the Act before we reauthorize it, that I've introduced with668Senator Coons. And to be clear, what resulted in this is the669fact that as important as this program is, and it is important,670and I strongly support it, neither North Dakota nor Delaware671received any of the funds despite a very, very good672application, particularly the one I'm most familiar with; the673State of North Dakota through the North Dakota Department of674Veterans Affairs. Important I stress the North Dakota675Department of Veterans Affairs because of the five criteria676that meets five of them, the five criteria for the grant.677    And so, we're a little disappointed, of course, that North678Dakota's application was rejected. I don't know if it was not679qualified, but at least wasn't prioritized. And so, I want to680I'd like to have you, you know, maybe explain to me a little681bit about why that happened. And then, also, you know, we682received the testimony yesterday that the VA is opposing my683language and my amendment, and I just want to give you an684opportunity to explain that before I try to explain my position685better.686    Dr. O'Toole. Thank you, Senator. And while I can't speak to687the specifics of that individual grant application and the688decision to it, I think it's important, first, thank you for689your support of this. It's support that we're very appreciative690of, and we share in our need, and want, and desire to really691grow this program and grow these efforts. I think our challenge692and our concern with an approach to increasing the number of693grantees, which we acknowledge is important, and it's an694essential aspect to being able to reach more veterans, engage695more veterans, and get more veterans into care and services, is696going to be--it's a shared objective.697    Having two potentially different or a prioritized pathway698would be difficult to logistically administer, if we have two699tiers. Our larger concern is that we want to make sure that all700of the projects and all of the grants that are being approved701are meeting the high-quality universal standard. And our702concern was we do not want to create two standards for how a703grant would be approved.704    Senator Cramer. And I appreciate all of that. I would705state, however, that in the case of states and just to be so706that people know what our bill does, Every State Counts Act, it707recognizes that a couple of states didn't receive funds from708the program, and we want to prioritize states that haven't709received funds previously. It's a one-time deal. We want to get710these other states in the loop, so to speak, and then clear the711deck, particularly very rural states.712    I mean, North Dakota's a big state, 350 by about 200 miles713rectangle in the middle of the North American continent,714literally, we have a monument to prove it. And a lot of miles715between veterans, but 55,000 of them that need this service. We716think that's pretty important criteria. I've done this before717with other bills that--Senator Heinrich and I did something718similar when the discretionary grant programs at the Department719of Transportation weren't reaching some rural states. We fixed720that, got them back in the loop, and it's worked out very well.721    I would just state that, particularly, again, I've read722that the objections, some of them reference, you know, multiple723applicants within the state, the competitive nature, all the724things that you've highlighted. But I think when it comes to an725entire state, regardless of the small population, it is after726all why there are two Senators from every one of them. Every727state does matter. Our Founders made sure that.728    I just think it's worth fixing in a way that prioritizes729states that have not received funding previously. And just730adding that as a--it's not complicated. I know that testimony731says it's complicated. It's not complicated. It's very simple.732And we want to make it simple. If we make it simpler, we would733like to do that.734    Dr. O'Toole. Thank you, Senator. And we agree we are very735interested in working with the Committee to figure out a good736way to approach it because we share that same----737    Senator Cramer. And I suspect more resources would be738helpful.739    Dr. O'Toole. Yes, sir.740    Senator Cramer. All right. I yield 10 seconds since we're741keeping track.742    [Laughter.]743    Chairman Moran. Senator Murray.744745                       HON. PATTY MURRAY,746                  U.S. SENATOR FROM WASHINGTON747748    Senator Murray. Thank you, Mr. Chairman, and thank you to749both of you for being here. I think it's really important that750in order to improve our mental health care outreach, we need to751hear, all of us Members of Congress, need to hear from both752veterans and VA providers about their experiences and the753issues that they face every day.754    However, last week, the Trump administration denied VA755Puget Sound in my state, the ability to both host and756participate in my women veterans roundtable. I held the757roundtable anyway at a local VFW, but VA would not participate.758And the conversation certainly lacked, in my opinion, a much-759needed perspective. I have never seen this sort of blatant760barrier to outreach before in my entire time of Congress.761    Dr. O'Toole, can you explain why having both the VA and762veterans together is important for a robust conversation?763    Dr. O'Toole. Well, thank you Senator, and I appreciate it.764I'm not familiar with the situation you're describing, so765unfortunately, I can't comment to that and to the specifics, or766to the approval, or lack of. But absolutely, we are informed by767our veterans. It helps us to be a better agency and a better768organization, and it's something we try to encourage in as many769capacities as we can.770    Senator Murray. Well, do you know if the new policy that771prevents elected officials from meeting with veterans at VA772facilities comes from within VHA, or does it come from773political leadership at VA central office?774    Dr. O'Toole. You know, I would have to defer that to our775leadership in terms of describing it better than I can myself.776    Senator Murray. Okay. Well, Mr. Chairman, this is really777important, and I really hope that Secretary Collins, who says778he is running the most transparent VA in history, decides that779VA can be transparent enough to let a Senator hold the780discussion about VA healthcare onsite at the local VA as I have781done for over 30 years, and I know other members have as well.782So, I am not done with this topic.783    Let me ask you, though, Dr. O'Toole, even though women are784more likely to seek care through VA, they're also more likely785to be dealing with depression, and anxiety, or sexual trauma.786In 2022, suicide rates for women veterans with histories of787military sexual trauma, were 75 percent higher than those788without. So, getting into contact with these veterans and789providing them the resources they need can truly be life or790death.791    However, in February, President Trump and Musk fired more792than 2,400 VA employees, including dedicated health793professionals who staff the phones at the VA's Center Veteran794Crisis Line. What steps is VA taking now to reach out to795survivors of military sexual trauma?796    Dr. O'Toole. Thank you, Senator. Well, first, in relation797to the Veteran Crisis Line, that decision was reversed and we798have actually seen a net increase in staff working in the799Veteran Crisis Line. And, you know, I'm happy to report that800outcome.801    The outreach and specific efforts for women who are victims802of military sexual trauma has been incorporated into our REACH803VET and REACH VET algorithm so that we are specifically804identifying and engaging those women to make sure that we are805providing better care. I'd like to defer to Mr. Fisher, who can806also speak specifically to some of the efforts at the veteran807resource centers as well.808    Mr. Fisher. And thank you, Senator, for the question. So,809Vet Centers have historically gone out and reached out to any810veteran cohort and service member cohort that's eligible for811Vet Center services. That includes women veterans, that812includes individuals who experience military sexual trauma.813We've continued to do this since the change of the814administration.815    Our outreach staff, as well as our counseling staff at Vet816Centers are exempted from any hiring freeze. And what we can817say specific to women veterans is that we every year see818increases in the number of women veterans that are coming into819Vet Centers. We also see high trust scores with women veterans820who received Vet Center services. Last year, it was at 93821percent.822    Senator Murray. Okay. And I'm running--almost out of time,823but I don't see how 80,000 more employees being removed will824help the VA provide services. I just wanted to ask about the825return-to-office policy. I have been talking to a number of VA826providers who tell us about VA's new rule that forces them to827work in person. Those providers have been working remotely828since before the pandemic, and now instead of being able to829take video calls in private offices, they're speaking with830veteran patients in open floor spaces where there's no privacy.831This is a violation of veterans' privacy. It's a violation of832HIPAA. It is leading doctors and counselors to look elsewhere833for work.834    I am almost out of time. I just want to say that the835elimination of telework agreements is really affecting our836veterans access to mental healthcare, and we need to have a837further conversation with you about how we can fix that.838    Chairman Moran. Senator Blackburn.839840                     HON. MARSHA BLACKBURN,841                  U.S. SENATOR FROM TENNESSEE842843    Senator Blackburn. Thank you, Mr. Chairman, and thank you844for being here and for approaching this subject today. This is845one--the veterans that are a part of our team talk with me846about this access to mental health services all the time, and847the grief that people experience when there is that loss of848life of someone that they have served with. And putting849attention on the mental health needs is something that, we,850each and every one should spend more time doing and making851these services available that our veterans need. This is852something that is also very important.853    Dr. O'Toole, I want to come to you because we've talked854about this, and thank you for your testimony. We've talked855about what you're doing to make services available. What you856have not addressed is the fact that there seems to be857inconsistency of access, and there seems to be gaps in this858service. So, if you would build that out a little bit. How are859you addressing those gaps in the inconsistencies and what is860the strategy for moving forward so that people know that at the861VA there is a standard of care that they can expect?862    Dr. O'Toole. Thank you, Senator. I appreciate that, and I863appreciate the way you framed it. I think this really864underscores the importance of the Fox Grants. And, you know, I865think it is important to put into context of the 17.6 veterans866that complete a suicide every day, 10 of them have no contact867with the VA, as has been noted earlier.868    We need to be doing a better job of engaging those veterans869in care. We need to be able to reach out to them. We need to be870able to meet them on their terms, in their homes, in their home871communities, to be able to provide those services. And this is872what the Fox Grants are providing for us. And this is what the873preliminary evidence of the Fox Grant grantees to date are874showing progress in.875    So, I think your question is spot on, but it very much876underscores the strategic public health approach we have to877really using these grants and these grantees to create that878connection. And use then those connections to facilitate the879trust that's needed to break down the barriers that individuals880may have to actually being able to engage in care, which the881Vet Centers are a great example of that occurring.882    Senator Blackburn. So, how do you simplify the ability for883individuals to access that care in their communities? Because884we know the telehealth is important. We know that easy access885is important when you're dealing with the mental health issues,886but if you've got to wait on the VA and a caseworker to make up887their mind, then it is something that delays you getting the888care. So, talk to me about simplification of that access.889    Dr. O'Toole. Well, I think one of the best examples of890the--there's two points, actually three points, I'd like to891bring up with that. The first, is the issue of outreach and892engagement, which again, is critical to those 10 veterans a day893who are committing suicide without having connections to the894VA. The second, is ensuring that we are effectively screening895those veterans that do receive care in the VA to make sure that896we are determining if they are at risk for suicide. And our897risk ID, you know, universal screening of all veterans is very898much that strategy.899    The third issue that is critically important is that when900veterans are in crisis, that we are able to effectively and901meaningfully respond. And this is where I would highlight the902successes of the Veteran Crisis Line that truly provide that903safety net for veterans in crisis.904    And, you know, both the uptake and increased utilization of905the Veteran Crisis Line and the responsiveness of the Veterans906Crisis Line to be able to engage individuals in care are great907examples. Is this saying that it's perfect? By no means. Can we908do better? We have to. But I'm saying those are our three909strategic approaches.910    Senator Blackburn. Well, I appreciate that. I also am911concerned, and I'll send you a question for the record on the912continuum of care from active duty to veteran status with those913EHRs. And Mr. Fisher, I'm certain you deal with this every914single day, and people trying to make certain they have access915to their records so that they can get the care that they need.916Thank you all for being here.917    Chairman Moran. Thank you Senator. Senator Hirono.918919                     HON. MAZIE K. HIRONO,920                    U.S. SENATOR FROM HAWAII921922    Senator Hirono. Thank you, Mr. Chairman. So, as you testify923about the need to reach out and provide the kind of services924that you need to--for that, you need workers and the VA has925always had thousands and thousands of positions that have been926needed to fill, to be filled then to the point where we enacted927legislation to make it easier for the VA to hire people faster.928    And so, my colleagues have pointed out several, and I'm929going to add to that because does it make sense to you, this is930for Dr. O'Toole, that at a time when there are some 300,000931positions that need to be filled, and you have 2,500 or so932already fired, another 83,000 to be fired. Does it make sense933to you that this is happening to the VA?934    Dr. O'Toole. Well, thank you, Senator. And just a935clarification, the 300,000 positions in the VA are positions936that are exempt from any hiring freeze.937    Senator Hirono. Well, then, can you tell me how many938positions are needing to be filled in the VA?939    Dr. O'Toole. I don't have that information readily940available.941    Senator Hirono. But we're talking about thousands and942thousands, I can tell you. So, does it make sense to you that943this is an environment that you have to live with to provide944the kind of services that you're talking about, which need945workers. Does it make sense to you that this is happening to946the VA? Yes, or no?947    Dr. O'Toole. Well, ma'am, we are trying to do the best that948we can with the resources that we have. The focus of the cuts949to date have been of administrative personnel and not direct950care providers.951    Senator Hirono. Let's face it. There's utter chaos going on952as far as I can see in the VA. So, we know that a lot of953veterans make up the workforce. We know that the slash and burn954of the federal workforce has also impacted veterans. We know955that the VA's 2024 annual report on veteran suicide identify956financial loss as a significant risk factor for suicide.957    Do you know which veterans have lost jobs in the Federal958Government, knowing that some 30 percent of federal employees959are veterans, and knowing that loss of a job is a risk factor960for suicide? Do you know the veterans who have lost their jobs961in this administration who have been fired?962    Dr. O'Toole. I do not, ma'am. And we can--I can defer that963to leadership that may.964    Senator Hirono. Well, it's amazing to me that how are you965supposed to help these veterans with a significant risk factor,966which is a loss of job, if you don't even know who they are.967So, it really concerns me that as you talk about the need to968outreach and suicide prevention, which is an ongoing issue that969with homelessness to the VA, that you don't have the kind of970information that, in my view, you should have to provide the971support that you need to provide.972    So, with everything that's going on, and with the tariffs,973and the impact on our communities of the fear that the tariffs974and the potential for tariffs and the impact, do you have a975sense of what the impact will be on the veteran community, of976which we have millions and over 100,000 just in Hawaii? Do you977know what kind of impact the tariffs situation is having on the978cost of everything for the veteran community?979    Dr. O'Toole. I do not have that information. No, ma'am.980    Senator Hirono. Well, you can see that this is the kind of981information that I would think that you would have to prepare982for this hearing.983    For again, for you Dr. O'Toole. So, as I mentioned, veteran984suicide and homelessness is an ongoing issue for the VA. And985knowing that the loss of economic security would increase986homelessness among the veteran community, do you think that987what is happening to the veterans in terms of loss of their988jobs, et cetera, that homelessness among veterans will989increase? And what are you doing about it?990    Dr. O'Toole. Well, thank you, ma'am. So, this obviously991shifts gears a bit to the Homeless Program Office. I'm happy to992speak to some of the different----993    Senator Hirono. Well, I would say the homelessness also has994an impact on veteran suicide.995    Dr. O'Toole. Absolutely, it does. And as a social996determinant of health and economic stability, it's critically997important. We do have several programs in place for those998veterans. I think our supportive services for veterans and999families, and the bridge support that provides our vocational1000rehab programming, and others are clearly intended to provide1001greater economic supports for those veterans who are at risk.1002And clearly there is an overlap between suicide risk and1003economic instabilities associated with homelessness.1004    Senator Hirono. Oh, the thing is, Mr. Chairman, with all1005the chaos that is going on, not just to the VA, but every1006single department, except for possibly the DOD, which is1007actually seeing increase in potential funds, there's going to1008be an increase in the risk factors that would lead to veteran1009suicides, I have to say so. So, there you have it. Thank you.1010    Chairman Moran. Senator, thank you. Senator Boozman.10111012                       HON. JOHN BOOZMAN,1013                   U.S. SENATOR FROM ARKANSAS10141015    Senator Boozman. Thank you, Mr. Chairman, and thank you,1016Senator Blumenthal, for calling this hearing. I was really1017proud to have partnered with Senator Warner years ago to1018introduce legislation that would eventually become the Staff1019Sergeant Fox Suicide Prevention Grant program. This program1020created out of a dire need to improve community-based resources1021to address the veteran suicide crisis.1022    While veteran suicide remains a critical issue, the VA's1023work and success with the Staff Sergeant Fox Suicide Prevention1024Program deserves recognition. Veterans who battle mental health1025challenges respond best to support from those that they know,1026and trust, and needs this program is critical in meeting. I1027look forward to discussing how we can reauthorize and update1028this support for veterans and communities across the country.1029    Dr. O'Toole, it's great to hear from VA how successful the1030program's been. In your testimony, you mentioned that VA1031supports increasing the authorized funding for the program.1032What kind of an impact would this funding increase have on the1033program, and what results should we hope to see?1034    Dr. O'Toole. Thank you, Senator, and thank you for your1035work and efforts to get this legislation passed. Initially, our1036hope with a reauthorization and appropriations is that we would1037be able to expand the number of grantees that that expansion of1038the grantees would both cover all of our states and geographic1039need areas, particularly those where access to care, access to1040VA care may be particularly thinned. And also, to ensure that1041the grantees are able to effectively engage specific population1042groups that may be at higher risk for suicide as well. And that1043is our hope and aspiration with the reauthorization and1044appropriations.1045    Senator Boozman. What aspects of the program do you think1046have made it such a success story, and where do you see the1047program going?1048    Dr. O'Toole. I think the fact that these are community1049groups that have credibility in the communities where veterans1050live. These are peers. These are also organizations that are1051engaging families of veterans are all critical to this. The1052wraparound and holistic approach to really supporting those1053veterans is complementary to what VA does, and it really,1054again, creates a public health strategy and complements a1055public health strategy for how we're looking at suicide in a1056way that reflects the complexity of all that goes into it.1057    Senator Boozman. The legislation that Senator Warner and I1058introduced included reporting requirements for VA. What metrics1059would VA likely identify as important to collect and share with1060Congress?1061    Dr. O'Toole. I think the measurement dynamic is obviously1062critical. We need to be good stewards of the resources that1063Congress provides to us, and make sure that the money is going1064where it needs to go and is having an effect.1065    The key as we see it, is not just in terms--it's obviously1066important that as many veterans are being reached as possible,1067but we also want to make sure that it's not just a throughput1068for lots of veterans, but without also looking at the quality1069of the care that they are getting, the comprehensiveness of the1070screening so that the care and the services they are getting is1071matched to the need. And also, that we are outcome driven.1072    We have to be focused on using this grant mechanism to be1073making a difference in these communities. How many of those1074veterans are doing better as a result? How many of those1075veterans are connecting in VA for VA services, or in the1076community for community services as healthcare would require?1077    But these are the accountabilities. These are the trackable1078metrics that we need to be really looking at.1079    Senator Boozman. Very good. Well, that's good to hear. I1080agree with you 100 percent, I think, as does to the rest of the1081Committee. Thank you, Mr. Chairman.1082    Chairman Moran. Senator Hassan.10831084                   HON. MARGARET WOOD HASSAN,1085                U.S. SENATOR FROM NEW HAMPSHIRE10861087    Senator Hassan. Well, thank you, Mr. Chairman, and Ranking1088Member Blumenthal for this hearing. And thank you, Dr. O'Toole,1089and Mr. Fisher for the work that you do to serve our veterans.1090    Dr. O'Toole, over the past few months, I've been asking VA1091officials and nominees if they can guarantee that the Trump1092administration's plan to fire 80,000 VA employees will not1093result in longer wait times for veterans to get appointments1094and receive care.1095    In response, the administration's nominees have told me1096that wait times at the VA have been increasing and reform is1097necessary, but they've never explained how firing 80,0001098employees will help solve that problem. That's indicative of1099the way the administration has approached things these past few1100months. They have been making drastic changes without, as far1101as any of us can tell, any analysis or plan.1102    Dr. O'Toole, you've worked at the VA for almost 20 years,1103and you're currently the VA's top doctor. Has anyone asked for1104your analysis on how firing 80,000 employees will affect1105veterans care?1106    Dr. O'Toole. Thank you, Senator. And I appreciate the1107question. I do not--I am not involved in that--those1108discussions. And it is--I will say that we actively monitor and1109track wait times. We actively monitor and track access.1110    Senator Hassan. I understand that. And, again, my time is1111short, but the answer to my question is no, they haven't asked1112you for your analysis. And, obviously, wait times is a piece of1113this, but affecting veterans care, you know, if somebody's been1114laid off who orders supplies, and a doc runs out of critical1115supplies, that affects veterans' care. Right? So, have you seen1116or been provided with any analysis as to how firing 80,000 VA1117employees might affect veterans care?1118    Dr. O'Toole. I have not, ma'am.1119    Senator Hassan. Have you been directed to perform or1120oversee any analysis as to how firing 80,000 VA employees might1121affect veterans care?1122    Dr. O'Toole. Well, again, ma'am, I will say, you know, I am1123prepared here to be able to speak to this grant. I don't have1124the information you're asking to that.1125    Senator Hassan. Right? But I'm taking that you would know1126if you have been directed to perform or oversee an analysis.1127So, I'm going to take that as a no as well.1128    Last year, the VA's Inspector General released a report on1129several occupational staffing shortages within the VA. These1130are jobs that the VA was having the hardest time filling. The1131IG's report stated that the top clinical job in the VA with a1132severe staffing shortage was psychology. A whopping 61 percent1133of Veterans Health Administration facilities reported having1134such a shortage. Psychiatry came in third place; 47 percent of1135Veterans Health Administration facilities reported psychiatry1136as a shortage.1137    As a career VA doctor, can you please discuss the role that1138mental health professionals, like psychologists and1139psychiatrists, play in supporting our veterans?1140    Dr. O'Toole. Thank you, ma'am. They are critical. I think1141that goes without saying. And the complex needs and care1142requirements of our veterans, obviously, require the engagement1143of a very robust mental health service.1144    Senator Hassan. Yes. I continue to be concerned then about1145the Trump administration's policies of hiring freezes, firings,1146and general disruption. You've talked about the exemption for1147about 300,000 employees, but it's really difficult to see how1148the chaos that is churning is going to help recruit and retain1149mental health professionals that our veterans really deserve1150access to. And you've just acknowledged, and Mr. Fisher, too,1151has, about how important they are to our veterans.1152    Last question Dr. O'Toole. You were the founding director1153of the VA's Homeless Patient Aligned Care Teams program, HPACT.1154This program utilizes clinics with co-located medical staff,1155social workers, mental health, and substance use counselors,1156nurses and homeless program staff that form a team to provide1157veterans with comprehensive individualized care. I really want1158to thank you for your leadership on this important work.1159    Can you please discuss the benefits of holistic wraparound1160care like this, and how this model utilizes expertise across a1161variety of fields within the VA?1162    Dr. O'Toole. Well, thank you, Senator. I appreciate those1163kind comments. And I think the hosting of that initiative in1164the VA speaks to a culture in the VA of trying to reach the1165veteran where they are, and meet them and their comprehensive1166needs on their terms, not necessarily our terms. And I think1167the HPACT successes in engaging those veterans, and really1168providing that stability that allowed them to move on with1169their lives, and engage more fully in programming reflects it.1170And it reflects, I think, a culture of the VA that I'm very1171proud to have been a part of.1172    Senator Hassan. And I think it does, too. And I think one1173of the things we could really work on with that culture in1174place with so many veterans being willing to do peer-to-peer1175outreach, is reaching those veterans who haven't engaged with1176the VA who we are especially concerned about as we look at the1177suicide statistics. So, thank you very much. Thank you, Ranking1178Member Blumenthal.1179    Senator Blumenthal [presiding]. Thanks, Senator Hassan.1180Senator King.11811182                    HON. ANGUS S. KING, JR.,1183                    U.S. SENATOR FROM MAINE11841185    Senator King. Thank you, Doctor O'Toole, and thank you for1186your long service, and your dedication to veterans. One of my1187mottoes in life is that implementation is as important a1188vision. And we're talking about the vision now of the Fox1189Program, but the question is, what are the implementation1190steps, and how is it working?1191    One of the things I've heard from the field is that the1192intake process is intrusive and burdensome, and we're losing1193veterans who are just basically dropping out of the process.1194For example, in Maine, we've had 311 veteran screened since1195they started the program. 96 of those 311 refused to1196participate because of burdensome paperwork or the required VA1197connection. Veterans who make it through the initial screening,11985 percent have stopped partway through because of the intrusive1199questions.1200    Here's a practical implementation. One of the feedback I've1201gotten is, don't ask all those questions at the first1202interview. Let the professional establish a relationship. And I1203understand the screening is important, but we're losing some1204very at-risk people through the implementation process. Can you1205discuss this problem?1206    Dr. O'Toole. Well, thank you, Senator, and I appreciate the1207perspective you bring to this, because obviously implementation1208is the--you know, a great vision. But if it can't be1209implemented, it doesn't do as much good. I think it's important1210to put in context these findings. You know, this program was1211established as a 3-year temporary grant program to really learn1212from this. And those types of observations are critical.1213    You know, we need to find that balance between ensuring1214that we are asking the right questions to determine risk, and1215to match those needs to the services, and be able to engage as1216much as possible. But being able to do so without scaring1217people away and without turning them off from those care and1218services is critically important.1219    And, you know, I would defer to my colleague, Mr. Fisher,1220because I think the Vet Centers have been working in that space1221for quite some time. But these are the lessons we have to be1222using to learn to get better and do better.1223    Senator King. That's my suggestion. We are talking about1224reauthorization. Let's talk about examining. And, I mean, this1225isn't a malicious process. It's to try to determine the risk1226factors and the qualification. But if that in itself ends up1227knocking somebody out of the process, that seems to me that's a1228problem, should be considered and addressed as we're talking1229about reauthorization, and then re-implementation.1230    I would suggest, and this has been discussed to some1231extent, outreach is critically important. If 10 out of the 171232suicides are people with no connection to the VA, that tells1233you something. And we need to connect those people, and we need1234to reach out to them. And for whatever reason, they're not1235reaching out themselves. So, again, it just hits me. That's a1236piece of data.1237    I want to turn to one other point. 74 percent of veteran1238suicides involve firearms. With female veterans, it's even1239higher. Senator Sheehy from Montana, and I, have a bill that1240basically would have the VA provide a free lockbox to veterans1241who ask for them. They don't have to be connected to the VA,1242they just have to be veterans.1243    It's a voluntary program. But the whole idea is, I'm sure1244you realize, is to have some space between the idea of suicide,1245and I almost said the execution, that's not the right word, but1246going through with it, and lockboxes are one way to do that. Is1247this something that makes sense to you?1248    Dr. O'Toole. It is, Senator, and I think anything we can do1249to create space between the idea and the action is critically1250important. And the literature and the data support that. I know1251that's not one of the bills that we're here to discuss today,1252but the notion of lethal means safety and strategies for how to1253best facilitate that, including the use of lockboxes, is1254something that the VA is very interested in working with the1255Committee to identify.1256    Senator King. I'm hoping to get that bill in the next, in1257the next round. But it just seems to me that the glaring1258number, 74 percent, involve firearms that gives us a place1259where we need to focus, it seems to me.1260    Dr. O'Toole. Fully agree.1261    Senator King. Thank you very much for your testimony, and1262for your hard work on behalf of America's veterans. Thank you.1263    Senator Blumenthal. Thank you, Senator King. Senator1264Duckworth.12651266                     HON. TAMMY DUCKWORTH,1267                   U.S. SENATOR FROM ILLINOIS12681269    Senator Duckworth. Thank you, Mr. Chairman, Ranking Member.1270Three months of unjust, unconstitutional attacks on our1271veterans and against critical services of the United States1272Department of Veterans Affairs have divided this traditionally1273bipartisan Committee, sadly. I hope that today's focus on a1274matter that should transcend Presidential loyalty; ensuring1275that our veterans have access to robust mental health and1276suicide prevention resources will reflect a new, renewed1277commitment that this Committee will once again faithfully1278fulfill its constitutional responsibility to serve as an1279independent check on any Presidential administration.1280    Under normal times, the renewal of the Fox Grants Program1281will be an important step in enabling the VA to continue1282providing critical community-based suicide prevention resources1283for veterans, and to reach even more veterans who need this1284lifesaving care. However, I am concerned that the Trump1285administration's policies continue to undermine the mental1286health and well-being of those patriotic Americans who have1287served our Nation honorably. For the mass reductions-in-force1288of federal workers, including veterans working on the crisis1289line, to canceled contracts, and continued attacks on veterans1290belonging to underserved communities, Donald Trump and Elon1291Musk are intentionally attacking morale and exacerbating the1292Department of Veterans Affairs mental health workforce1293shortages.1294    This threatens the ability of the VA to distribute the Fox1295grants rapidly. We're talking about real lives, someone's1296parents, child, sibling, aunt, or uncle, grandparent, friend.1297We cannot endure more chaos at the risk of delaying the1298provision of mental health care and suicide prevention1299services.1300    Dr. O'Toole, what specific steps are you taking to ensure1301that there are sufficient staff and resources on-hand to1302administer the Fox Grant Program and to provide timely care for1303veterans seeking Fox Grant resources?1304    Dr. O'Toole. Thank you, Senator. And thank you for your1305service, as well as for your advocacy for our veterans. It's1306much appreciated. You're absolutely right. This is about1307ensuring that we have resources in place and a commitment to1308making sure that the grantees are going to be as effective as1309possible.1310    The Suicide Prevention Program reports to me. I have a1311weekly meeting with their leadership team. These are some of1312the things that we discuss, and this is a priority for us. You1313know, if we're going to have to--if it's going to work, we have1314to make sure that we have people in place to work it.1315    Senator Duckworth. Well, what are you doing to ensure that1316they are there? I mean, my own office worked a case of several1317folks who work on the Veterans Crisis Hotline who were in that1318mass firing. Two of them have gotten their jobs back, but one1319of them still hasn't. And we're talking about people who, you1320know, may not be the ones answering the phones. We're talking1321about the trainers, the people who train the other folks, the1322supervisors, some of them still have not gotten their jobs1323back. What are you doing to make sure that there's enough1324people to work those hotlines and the suicide prevention1325programs?1326    Dr. O'Toole. Well, as I mentioned Senator, with the Veteran1327Crisis Line, that is exempt from any hiring freeze. And we've1328actually seen a growth in the numbers of employees on the1329Veteran Crisis Line, something though that we have to stay1330vigilant in ensuring that direct care is not impacted, and1331these programs are able to function at their highest1332capabilities.1333    Senator Duckworth. Will you commit to hiring some of those1334people back that were fired by Elon Musk?1335    Dr. O'Toole. Well, we're happy to follow up with you on any1336specifics, by all means, ma'am.1337    Senator Duckworth. Oh, I think it should be more than just1338the one people being handled by my office. There are many1339people across the country who have now been laid off, who've1340worked on veterans' mental health programs. Those people need1341to have their jobs back, especially if they themselves are1342veterans. Do you commit to safeguarding and strengthening VA1343mental health workforce, including making sure they have the1344appropriate resources and work spaces?1345    Dr. O'Toole. Yes, ma'am. I'd like to speak a little bit to1346that in more direct terms. It's been referenced several times1347in terms of the return-to-office and the impact on1348confidentiality. We are very committed, and our leadership1349within VHA, has been very committed to ensuring that privacy is1350maintained and confidentiality is maintained, including1351ensuring that if employees need dedicated private workspace for1352engaging in telemental healthcare services and other services1353that require confidentiality and HIPAA rules are being complied1354with.1355    When those are not being able to be met, we have processes1356in place to work with the facility to ensure that either space1357is found or that there are appropriate pauses to the return to1358office. This is critically important. We cannot let this1359compromise the care we provide to our veterans.1360    Senator Duckworth. Well, will you commit to advocating for1361protecting these mission-critical staff from adverse1362administrative actions, especially if they report that they're1363not getting the resources that they need?1364    Dr. O'Toole. Yes, ma'am. And we do that now.1365    Senator Duckworth. Okay. Because I, again, we've dealt with1366people who've had to take phone calls in their cars in the1367parking lot because there was no confidential space for them to1368do their work, their jobs.1369    Dr. O'Toole. And we have mechanisms in place to try to1370ensure that that is not happening. And if those are happening,1371you know, we need to know about it.1372    Senator Duckworth. Okay. Thank you, Mr. Chairman.1373    Senator Blumenthal. Thank you, Senator Duckworth. Senator1374Gallego.13751376                      HON. RUBEN GALLEGO,1377                   U.S. SENATOR FROM ARIZONA13781379    Senator Gallego. Thank you. I was just going to ask, moving1380on to Mr. O'Toole, following President Trump's executive order1381on the return to work, the VA issued its return-to-work mandate1382requiring most employees to return in-person work.1383    So, kind of following up on the therapists who are hired as1384remote workers and kind of what Senator Duckworth had just1385said. Have you heard of any instances where therapists have1386had, had awkward and/or, I would say, not professional settings1387when they're having their healthcare or when they're having1388their--the veterans are having the therapy sessions?1389    Dr. O'Toole. I have not heard specific situations where1390that may have occurred. I have obviously heard it second- or1391third-hand. We have a mechanism and process in place. Those1392work environments and work scenarios are not acceptable to us.1393That's not appropriate care standard for the VA. And if they do1394occur, we have mechanisms to ensure that they can be1395remediated.1396    Senator Gallego. Okay. And then just kind of along the1397lines, there's an 83,000-person cut of VA workers coming. Is1398there a standard of who is going to be in that cut? You know,1399how many will be therapists? How many are going to be different1400professions, because that will also obviously affect the1401healthcare outcomes?1402    You know, it's hard to get some of these therapists into1403this job. Some of them can be much better paid in the private1404sector. So, losing therapists to these arbitrary cuts, in my1405opinion, it's going to be very detrimental to the mental health1406of these men and women.1407    Dr. O'Toole. I do not have specifics on that information.1408It would have to defer. And we'll have to get back to you on1409that.1410    Senator Gallego. Yes. I mean, for example, my Phoenix VA,1411the VA that I've belonged to, has a memo out that they have to1412cut 15 percent. But what does that mean? You know, who is that1413that they're cutting?1414    Mr. Fisher, I'm sorry, I can barely see your name. I have1415bad eyesight. So, I placed a blanket hold on all President1416Trump's nominees to the VA, especially following the fact that1417they're cutting 83,000 jobs because I just don't see how it's1418possible for the VA to fire so many of their employees without1419it affecting care for veterans, especially in mental health1420care.1421    You lead the office of the VA in charge of helping veterans1422transition from military to civilian life, which is extremely1423important. Right? If we can make that transition, the1424likelihood of people falling into some bad times, you know,1425reduces tremendously. So, it's extremely important work.1426    Now, do these cuts, veterans can lose access to that mental1427healthcare and potentially, you know, creating and rising1428instances of suicide. What directions have you received1429specifically from the Trump administration in order to enact1430these cuts to the VA workforce when you commit to ensuring that1431the VA mental health providers are not among those fired or1432other positions that are very important in kind of keeping that1433network together of a very important job that you have and we1434all have here?1435    Mr. Fisher. Thank you Senator for the question. Similar to1436what Dr. O'Toole brought up, I have not received guidance. Our1437focus at Vet Centers has been the hiring of our counselors as1438well as our outreach staff. We continue to do that in locations1439where we have a hard time hiring those. We leverage all1440existing authorities, whether that's our scholarship program or1441other special incentives to be able to ensure we're bringing1442those staff into Vet Centers.1443    Senator Gallego. And just to be clear, you haven't received1444any directive and any orders from VA Collins or anyone else1445from the VA saying you have to cut X amount of people by X1446amount of date from the programs you guys oversee. Is that1447correct, Mr. O'Toole?1448    Dr. O'Toole. That that is correct.1449    Senator Gallego. Okay. And then, Mr. Fisher?1450    Mr. Fisher. Same answer. Yes.1451    Senator Gallego. Okay. And from your general understanding,1452what is the deadline that the VA has set for them to cut these145383,000, let's say, positions?1454    Dr. O'Toole. Sir, I don't know, and I would have to defer1455on that.1456    Senator Gallego. Mr. Fisher, do you know?1457    Mr. Fisher. I would have to defer as well, sir.1458    Senator Gallego. Okay. Well, my concern is because in1459Arizona, the memo that was laid out was that they wanted cuts1460to go into effect by July 1st, and were already in May. And,1461you know, such sudden cuts, especially when it comes to kind of1462mental health care clinics, VA clinics and suicide prevention,1463could be extremely damaging since you're trying to recruit1464people into this very hard work. And at the same time, they're1465hearing about these firings. It's going to be hard to recruit1466and retain.1467    And I don't know if you've had any conversations with some1468of these potential therapists that are asking questions about1469whether or not they can come on board with the assurances that1470they're not going to be fired or let go later? And Mr. O'Toole,1471have you heard anything from potential employees, please?1472    Dr. O'Toole. I have not. I will note, though, that the1473direct care providers of whom therapists are exempted currently1474from any of the hiring freezes that are taking place.1475    Senator Gallego. So, they're exempted from the hiring1476freeze, but not necessarily from the attrition or from the1477potential elimination?1478    Dr. O'Toole. I'm not--again, sir, I would have to defer on1479that because I'm not aware.1480    Senator Gallego. Okay. So, I yield back my time. Thank you.1481    Senator Blumenthal. Thanks Senator, Gallego. I have a few1482questions while we're waiting for the Chairman to return and1483start the second panel. And I don't know whether--I don't think1484anyone has asked about this fact, but the veteran suicide rates1485in Connecticut seem to have been highest among veterans who are1486over 75 years old, lowest in the age group, 18 to 54. Is that1487true nationally?1488    Dr. O'Toole. I don't know, sir. I'd have to look at that.1489There is a bimodal nature to the incidence of suicide. We see1490it very high in the 18 to 39 range for different reasons than1491we see it in the older populations where chronic disease,1492chronic pain, and other factors can play in a more active role.1493But I don't have the specific data that you're referencing. I1494would have to take it for the record.1495    Senator Blumenthal. Could you try to provide that data? I1496assume that if it's available for Connecticut, it's available1497elsewhere. And is there any explanation for disparities between1498different parts of the country or different states so far as1499you're aware?1500    Dr. O'Toole. Again, I'd have to defer that to our subject1501matter experts. It's an important questions. It has a lot to1502do, I think, with levels of engagement, lethal means1503availability, and so forth. But I would prefer deferring that1504and we can get that information to you.1505    Senator Blumenthal. I think it's an important question,1506both of those are important question. Because if there are1507lessons to be learned from some states and what they do in1508preventing veteran suicide, maybe they can be adopted more1509broadly.1510    And I want to just finally ask you to have a look at the1511BRAVE Act. You know, if we had a few hours more for this panel,1512I could go through each of the provisions. The standard1513response of the VA to many of these provisions was to oppose it1514because they said it was not necessary. Now, an example would1515be to give more priority to women's health, mental health care.1516And they're saying to me that, for example, the requirement for1517the Department of Veterans Affairs to modify the REACH VET1518program to incorporate risk factors weighted for women1519veterans, it's not necessary because we are already on top of1520it. We got that problem.1521    Well, I'm not so sure that's accurate. If it ever was1522correct, it certainly is not. Now, I would ask you, Dr. O'Toole1523to please go back and look at the BRAVE Act and perhaps speak1524with your colleagues about giving me some more, maybe1525different, and more constructive reactions to the BRAVE Act.1526    Senator Blumenthal. Thanks, Mr. Chairman.1527    Chairman Moran [presiding]. Thank you, Ranking Member.1528Senator Slotkin.15291530                      HON. ELISSA SLOTKIN,1531                   U.S. SENATOR FROM MICHIGAN15321533    Senator Slotkin. Thank you, Chairman. And thank you to our1534nominees for being here. I'm a former CIA officer. I did three1535tours in Iraq alongside the military. I've served very proudly1536both Democrat and Republican administrations as a civil servant1537before I was elected to Congress. And I think everyone on this1538panel, Democrat or Republican, believes that when we make the1539choice to send men and women into war, we have a responsibility1540when they return, and that veterans deserve the gold standard1541of care.1542    And as I've been on this Committee, and I was on the VA1543Committee in the House, it seems like every time there's a1544threat to veterans' care or we need to expand veterans care,1545it's veterans who are pushing and advocating for that change.1546It doesn't happen in a big bureaucratic system just by sitting1547there.1548    I'm concerned that mental health occupations are the ones1549where we have significant vacancies across the VA. Over 601550percent of VA facilities report shortages of psychologists, and1551nearly half reported shortages of psychiatrists. And I was just1552at the VA hospital in Saginaw this past week, and there's1553definitely shortages across the mental health architecture. And1554there's no way for me to square that with the threat of1555potentially cutting 70 to 80,000 VA employees. I don't1556understand how we can add by subtracting.1557    And while I keep hearing from the Secretary of the VA that1558we're not going to cut the hospitals and the nurses and all1559that kind of stuff, all those support steps, the suicide1560hotline, all the folks who process claims so that veterans can1561get care, they are quite literally seem to me to be on the1562chopping block.1563    So, tell me, what are you going to do Mr. O'Toole, in this1564moment of subtraction from the VA, to actually ensure that our1565veterans get the mental health care that they need?1566    Dr. O'Toole. Thank you, Senator, and I appreciate the1567comments and the observation. And it's shared. You know we have1568the healthcare workforce, not limited to the VA, is struggling1569to fill needed positions across the board. And, you know, long1570before this past year, we've actively tried and have been1571trying to continue to attract people to work at the VA, which1572is, I've been here for 20 years, you know, it's where I choose1573to work.1574    The commitment is to ensure that direct care is provided1575and not compromised by these cuts. I am not privy to the1576decisions, and the discussions, and would have to defer on the1577specifics to that. But just as I mentioned in relationship to1578telehealth care, our utmost and absolute commitment is to1579providing the best care possible and not compromising it by any1580means in the process of the changes underway.1581    Senator Slotkin. I do not doubt not for one minute your1582mission and your belief in this mission. It's my concern is1583that you could be overseeing a component of the VA when you say1584we don't want to compromise care. In fact, we have an1585obligation as a country not to compromise veterans' care. And1586yet, we're talking about cuts of potentially 80,000 people.1587    And the Secretary of the VA refused to dismiss those cuts1588when he came to Howell, Michigan a few weeks ago. He was asked1589directly and he said, ``well, difficult choices essentially are1590going to have to be made.'' So, I'm not seeing how the math is1591going to work out there.1592    I also want to note that in the 2024 National Veteran1593Suicide Prevention Annual Report, which you may have had a hand1594in it, said that most veteran deaths by suicide are among1595veterans who have not had access to VA care in the prior two1596years. Right? That if you're kind of in the system getting1597care, you have a better chance of being helped. But if you're1598out, you're not connected to the VA.1599    So, I would actually posit that we need to be getting to1600more veterans. We need to be doing better outreach. The VA1601needs to be talking to people when they separate and getting1602them in the routine of accessing all those services. So, in1603fact, on this mission, not only are we understaffed right now,1604but I think the mission is greater than what the VA is already1605doing. So, I would just note you are going to be the guy in the1606room when these cuts come down from on high.1607    Mr. Collins sat in your very seat and said, ``I'm not going1608to let anything compromise care,'' and then seems to be1609supportive of 80,000 cuts. I'd ask you to stand up for1610veterans. It's bigger than any one administration. We have a1611responsibility, and I know you care about that mission. So,1612appreciate that and appreciate you being here.1613    Chairman Moran. Thank you, Senator. Dr. O'Toole, let me1614just ask a quick question. It's a bit outside, I think, the1615realm, but there's been a lot of conversation about staffing at1616the VA from my colleagues and I, and I want to highlight the1617importance of community care. The MISSION Act, in the way I1618look at things, is a way that in fact choice came about in an1619effort to help further staff the VA, and particularly in mental1620health, where there's a shortage of mental health providers1621everywhere. It would be comforting to me for you to confirm the1622value of the MISSION Act and community care.1623    Dr. O'Toole. Thank you, Senator. And absolutely, community1624care provided in settings that are not VA for our veterans is1625very much part and parcel of the package of care that we1626provide, and needs to be considered because the bottom line is1627we want our veterans to get care.1628    Chairman Moran. Thank you. We'll dismiss Dr. O'Toole and1629Mr. Fisher. Thank you for your testimony. Thank you for your1630service to veterans, and for your appearance here today. And1631we'll call the second panel to the table.1632    Testifying on today's second panel is Jim Lorraine, the1633President and Chief Executive Officer of America's Warrior1634Partnership. Gilly Cantor, Director of Evaluation and Capacity1635Building, D'Aniello--there's no reason for me to make a fool of1636myself one more time, so, thank you for being here. She is with1637the Institute for Veterans and Military Families, Syracuse1638University.1639    Steffen Crow, Staff Sergeant Parker Gordon Fox Program1640Manager, Oklahoma Veterans United, Heather Barr, U.S. Marine1641Corps veteran, assisted by a grantee organization, and Austin1642Lambright, U.S. Marine Corps, a veterans assisted by a grantee1643organization, and Lindsay Church, Executive Director and co-1644founder, Minority Veterans of America. Thank you-all for being1645here. And Mr. Lorraine, let's begin with you.16461647                            PANEL II16481649                              ----------16501651STATEMENT OF JIM LORRAINE, PRESIDENT AND CEO, AMERICA'S WARRIOR1652                          PARTNERSHIP16531654    Mr. Lorraine. Chairman Moran, Ranking Member Blumenthal,1655and esteemed Members of the Committee, thank you for the1656opportunity to testify today on behalf of America's Warrior1657Partnership.1658    You're considering four important bills that impact the1659well-being of all veterans. I'll focus on the impact of the1660Staff Sergeant Parker Gordon Fox Suicide Prevention Grant1661Program, commonly known as the Fox Grant. At AWP, we view1662suicide and deaths of despair prevention, not as a single1663program, but as an outcome of veterans restored sense of1664purpose and improved quality of life. Our model is rooted in1665proactive outreach and engagement, trust building, and1666sustained relationships, which we do at scale. We strive to1667forge these connections before the crisis begins. That's where1668the Fox Grant has been essential.1669    Of the 545 veterans we've screened who reported suicide1670risk, 94 percent were not initially seeking mental health1671support. They face challenges such as economic insecurity,1672navigating the VA system, and fractured personal relationships.1673The importance of asking the right questions early and having1674someone listen cannot be overstated. Thanks to the Fox Grant,1675we've interviewed or we've intervened early, connected veterans1676to local resources and remained a consistent presence.1677    Just halfway through this grant year, AWP's screened 1,3001678veterans, with 10.8 percent disclosing suicide risk. Since the1679grant's inception, that number has totaled 2,100, with 251680percent of the people that are veterans that we talked with and1681screened, disclosing some level of risk. These are not just1682statistics. They are lives saved because someone cared enough1683to ask and listen. However, there is room for improvement.1684    While the HOPE Act makes great strides, outreach must be1685reestablished as the program's singular focus. We must get1686upstream and follow the data of who is at greatest risk. The1687who is so important. Our study, Operation Deep Dive in1688partnership with Duke University School of Medicine allows us1689to follow the data of the ``who'' is most at risk based on the1690community where they live in.1691    The pathway from community identification to VA must be1692more transparent, quicker, and less burdensome. Congress should1693require the VA to establish a simplified intake process for1694veterans already screened by grantees, one that avoids1695redundant questions in respects to the veteran's time in a1696critical situation.1697    We also support codifying the emergent suicide care1698section. In many cases, AWP uses the 988 Crisis Line for1699veterans for immediate need. Formalizing this connection1700enhances safety and saves lives.1701    Accountability is another key. AWP holds itself to the1702highest standards; routine audits, transparent reporting, and a1703sharp focus on Title 38 beneficiaries. Title 38 funding must1704focus on veterans and their families. We recommend that1705Congress require verifiable metrics from all grantees, and a1706regular reporting to ensure the taxpayer's trust is upheld, and1707that those not meeting the standard are reevaluated.1708    We support the use of the Columbia Protocol as the sole1709requirement screening tool. The current requirement of multiple1710follow up assessments is overwhelming and deters engagement.1711Let's reduce bureaucracy and focus on care. We strongly support1712the provisions in the HOPE Act, and that allow the Fox Grant1713funds to be used for transportation. We do a survey every year,1714and the lack of transportation is the top barrier veterans1715face, especially when those are in crisis.1716    Grantee funding is another consideration. AWP could double1717its outreach efforts if the funding ceiling was increased to1718$1.5 million. While this isn't necessary for every grantee,1719organizations that have proven outcomes and capacity should be1720empowered to do more provided the metrics and reporting1721structure are in place.1722    Regarding the BRAVE Act, we support a deeper analysis of1723veteran suicide and its risks factors. Still, discussions also1724must address the role of traumatic brain injury, a silent1725killer we are not doing enough to confront. Finally, we support1726the Every State Counts Act to expand the Fox Grant access to1727underserved states. In the meantime, AWP stands ready with our1728national network to assist when necessary.1729    Members of the Committee, thank you for your continued1730leadership, and support your efforts to saving lives. At AWP,1731we stand ready to keep doing our part to serve, to listen, and1732to ensure the vets are known. Together, we can do better.17331734    [The prepared statement of Mr. Lorraine appears on page 671735of the Appendix.]17361737    Chairman Moran. Mr. Lorraine, thank you. Ms. Cantor.17381739  STATEMENT OF GILLY CANTOR, MPA, DIRECTOR OF EVALUATION AND1740    CAPACITY BUILDING, D'ANIELLO INSTITUTE FOR VETERANS AND1741         MILITARY FAMILIES (IVMF), SYRACUSE UNIVERSITY17421743    Ms. Cantor. Mr. Chairman, Ranking Member, Members of the1744Committee, thank you for the opportunity to offer testimony on1745behalf of the D'Aniello Institute for Veterans and Military1746Families at Syracuse University.1747    The IVMF perspective is rooted in research, along with more1748than a decade of experience working with 26 communities across1749the country. These communities are connected by a common goal,1750improving coordination between organizations that provide1751clinical and non-clinical care. So, together, we can help1752veterans thrive.1753    So, what have we learned? As we know, the rate of suicide1754among veterans remains too high, higher than among civilians.1755Data has also shown that each additional non-clinical stressor,1756such as financial and housing instability, is linked to1757increases in the likelihood of suicidal ideation. States,1758counties, and community-based organizations can often best1759address these needs.1760    In a study we conducted with the VA, we found a majority of1761veterans served by our partners were also enrolled in VA1762healthcare. For these veterans, their stressors were most1763effectively addressed when communities and VA medical centers1764worked together. At the same time, the study demonstrated that1765communities are in fact reaching many veterans not connected to1766VA healthcare, a group that represents over half the veterans1767that died by suicide.1768    The Fox Grants Program recognizes and leverages the role1769communities play in suicide prevention. It creates new1770formalized avenues into clinical care, and it supplements that1771care with wraparound services so that we can address root1772causes, at the same time. We are grateful to this Committee for1773looking upstream as part of the Hannon Act to invest in this1774evidence-based coordinated approach.1775    The reauthorization currently under consideration is1776therefore critically important. Since the program's launch, the1777IVMF has offered ongoing support for 11 of our partners who1778have been awarded these grants. They have stress-tested this1779program and identified its strengths and challenges. While1780there's always more that can be done, many of the proposed1781changes directly respond to their feedback.1782    There are three main target areas that I'd like to address1783today. First, program coverage and expansion. Increased1784funding, both overall and for administrative and incidental1785costs, will enable grantees to scale and reach more veterans in1786a way that builds trust in non-clinical settings. These1787individualized peer-based approaches to outreach are both1788backed by evidence and just common sense.1789    A simple gathering over pizza or coffee can open the door1790for a veteran to reach out for help. Allowing reimbursement for1791transportation and ride-shares to appointments will also be1792beneficial. Whenever possible, the cost of an Uber ride should1793not be the barrier that stops a veteran from getting the1794critical care that might save their life.1795    Second, screening and eligibility. While some of our1796partners support the Columbia Protocol as the main required1797screening, others would prefer more nuance on when and how it's1798used. The proposed training on the tool will mitigate some of1799these difficulties. But overall, we hope that the intake1800process can balance evidence-based assessments with burden1801considerations for both veterans and program staff.1802    And third, VA collaboration and compliance. Most1803importantly, we strongly support the provisions designed to1804hold the VA accountable for their role in making this program1805successful. Our partners have routinely experienced1806inconsistencies in awareness and compliance by their local VA1807medical centers. Once a veteran has been deemed eligible for1808the program, VA enrollment must be streamlined with a dedicated1809process such as an automatic high priority group assignment.1810    We also appreciate the proposal to expand emergent suicide1811care coverage if the VA is not responsive. This provision will1812ensure grantees can effectively help veterans get the care they1813need.1814    In conclusion, the evidence for reauthorizing the Fox1815Grants Program is clear, and the proposed legislation aligns1816with many improvements sought by our partners. We deeply1817appreciate the Committee's steadfast commitment to increasing1818our investment in prevention so that this critical program can1819reach more veterans before they're in crisis. Thank you.18201821    [The prepared statement of Ms. Cantor appears on page 75 of1822the Appendix.]18231824    Chairman Moran. Thank you. Steffen Crow.18251826STATEMENT OF STEFFEN CROW, SSG PARKER GORDON FOX GRANT PROGRAM1827               MANAGER, OKLAHOMA VETERANS UNITED18281829    Chairman, Ranking Member, and Members of the Committee,1830thank you for the opportunity to testify today. My name is1831Steffen Crow, a retired gunnery sergeant of Marines with tours1832in Afghanistan, Asia, Africa, Europe, and Central America. I1833now serve as the Program Manager for the Staff Sergeant Parker1834Fox Suicide Prevention Grant at Oklahoma Veterans United.1835    Our program exists to prevent suicide among our Nation's1836veterans by removing barriers to care. The Fox Grant was1837created precisely because the system was not working for too1838many veterans. Through the Fox Grant, OKVU has built a1839statewide veteran-centric approach that reaches across rural1840and urban communities. Over the past three years, we have1841engaged over 5,000 veterans and supported or led more than 8001842outreach events.1843    We have formal collaborations with major veteran employers1844across the state, consistent engagement at Fort Sill, and we1845hosted the first multi-grantee veterans stand down in the1846country alongside the Cherokee and Choctaw Nations, drawing1847veterans from across Oklahoma and five other states.1848    At the core of our work is sustained trust and empowerment.1849Veterans who succeed often ask, how can they help others,1850proving that when we lift one, they turn to lift many. However,1851we face significant barriers. Chief among them, is the required1852use of the Columbia screening tool. Though well-intentioned, it1853often drives veterans away.1854    At a recent grantee conference, it was reported by one1855grantee that 13 veterans died by suicide after either refusing1856to complete the Columbia or answering no to every question1857despite the clear need these veterans were in. Worse, grantees1858are instructed not to track veterans deemed ineligible for the1859program, which creates a very dangerous survivorship bias.1860    Another persistent challenge is the absence of a national1861referral process between grantees and the VA. No two facilities1862operate the same way, and even within a single state, these can1863differ dramatically. Local VA staff often defer to central1864office guidance, which is not materialized into actionable1865support.1866    Veterans like Parker found solace in physical activity and1867music. Yet, grantees are restricted from funding low-cost gym1868memberships or instruments despite VA's own research supporting1869these therapies. VA guidance currently prevents us from1870delivering the very solutions their studies endorse.1871Transportation remains another major barrier. Guidance1872recommends Uber and Lyft. Yet, these services are non-existent1873in rural communities, and these are the areas that we primarily1874serve.1875    We currently need a national community of practice to unify1876efforts, and I can say Oklahoma Veterans United has already1877developed internal models for cross-county collaboration, and1878is ready to lead this initiative across the Nation. Another1879great benefit that would be a good add to this program would be1880the ability for grantees to hire an LPC or an LCSW to be that1881gap fill whenever there is a wait time for veterans to get care1882at their local VAs.1883    We think that in a 2-month period, four to six sessions1884with an LPC or LCSW in our direct team could be a very critical1885gap fill that would get someone into VA, and let them have the1886patience to wait for those appointments to materialize.1887    In the military, I was taught, if you see something, say1888something. For three years, we have raised these concerns to VA1889leadership without meaningful action. Veterans mistrust of the1890VA did not happen overnight, and winning it back requires a1891real tangible change. If the rate of 17.6 veteran suicides per1892day is accurate, then we have lost over 16,000 veterans since1893this grant started. Yet when a veteran stabilizes, the first1894thing they ask is, ``How can I pay it forward?'' Veterans want1895to be the champions of the system, and if the system works for1896them, I guarantee they will be.1897    The VA has good intentions, but they lack timely execution1898and consistent communication. We believe that with clear1899guidance, national coordination, and policies grounded in real-1900world realities, we can save lives and help veterans live lives1901worth living. We believe Parker's legacy must guide the future1902of this program. If he had access to these tools we propose, he1903might have remained with us longer. Let us not waste the1904opportunity to honor him through this meaningful change.1905    And thank you for your time, and your commitment to our1906Nation's heroes.19071908    [The prepared statement of Mr. Crow appears on page 80 of1909the Appendix.]19101911    Chairman Moran. Thank you. Ms. Barr.19121913                   STATEMENT OF HEATHER BARR,1914                   U.S. MARINE CORPS VETERAN19151916    Ms. Barr. Good afternoon, Mr. Chairman, good afternoon,1917Members of the Committee, thank you for this opportunity to1918share my story about this program and how it helped.1919    My name is Heather Barr. I was a sergeant in the Marine1920Corps, served for just over five years, did two deployments;1921one to the Middle East, one to the Indo-Pacific. I was1922honorably discharged from the Marine Corps in September 2023. I1923went on terminal leave a month before that. So, this was two1924months post-deployment. Turned from a deployment next week,1925transition seminar, and then was out in two months.1926    I had no plan, no idea what I was supposed to do. Just was1927moved back into my family's home in South Carolina. Felt like I1928was back at square one, basically. Living with my mother, no1929prospects for the future, and didn't know what I was doing.1930    I ended up reaching out to the local Vet Center to try to1931find counseling and a therapist for mental struggles that hit1932me during deployment, and then just were expedited and grown by1933transitioning out of the Marine Corps. They then pointed me to1934the Upstate Warrior Solutions who are in Greenville, veterans'1935organization who are partially funded by the Staff Sergeant Fox1936Program.1937    While I was there, I was screened, found at risk, and they1938set me up for success, basically. Made sure I was continuing to1939go to therapy and things like that at the Vet Center. Were able1940to actually provide a way for me to get a job. Showed me ways1941to do that. That was the first employment out of the military,1942thanks to Upstate Warrior Solutions.1943    Part of the big change in transitioning for me was being1944completely disconnected from the military lifestyle and people1945I had been around for the past five-plus years. Coming back1946from a deployment, trying to transition to just normal military1947life and then to civilian is what put me in just a tailspin. It1948felt like I was just drowning, and was pointless, and1949purposeless without any guidance.1950    So, Upstate Warrior Solutions Staff Sergeant Fox Program1951helped provide that to me. They helped me get a job, made sure1952that I was engaging with veterans in community where I could1953actually relate to, and I could realize that I wasn't actually1954completely alone, and there were other people who actually1955understood what I had was going through or had been through.1956So, I was extremely, extremely grateful for that.1957    My scenario is an ideal scenario. My family was available1958for me to move back in with. Financial struggles were there,1959but thankfully, within a few months of getting out of the1960military, I was set up with Upstate Warrior Solutions in the1961program.1962    That is not always the case. I know many people who have1963gotten out, they do not have families to go back to. They have1964either poor relationships, or they're just non-existent. So,1965mine is basically the best-case scenario. I had family to go1966back to, but not all do. And regardless of if you're an1967enlisted officer, female or male, you have dependents, don't1968have dependents, all these things add up. Both financial1969difficulties, and then some have PTSD, anxiety, stress-related1970things that just compound on the already trying time that1971transitioning out of the military is.1972    And the Upstate Warrior Solutions and the Staff Sergeant1973Fox Program was definitely a life ring that I was very, very1974fortunate to be provided. It did take a lot of searching, but I1975was very, very fortunate to be thrown that life ring that not1976all people are.1977    I finished--completed the Staff Sergeant Fox Program in1978August 2024. When I left the state, they reached out to me1979multiple times, even though I was out of the program, actually1980showing they cared, dependent or not, if I was relying on them1981for anything, they wanted to make sure that I was taken care of1982as a veteran. I'm very, very grateful for that.1983    Since 2022, UWS has also completed the Staff Sergeant Fox1984Program with 20 other veterans, and currently have 164 active1985members within their program. And it's just a great outreach1986for those who have struggles finding other outlets, or just1987need help when they need. So, thank you. I appreciate.19881989    [The prepared statement of Ms. Barr appears on page 102 of1990the Appendix.]19911992    Chairman Moran. Heather, thank you for your service to our1993country, and thank you for your testimony. Austin.19941995                 STATEMENT OF AUSTIN LAMBRIGHT,1996                   U.S. MARINE CORPS VETERAN19971998    Mr. Lambright. Good afternoon, Chairman Moran, and Members1999of the Committee. My name is Austin Lambright. I just want to2000start by thanking everyone for the opportunity to be here. I'm2001deeply humbled not only for the opportunity to serve my2002country, the greatest country in the world, but also to be here2003and speak on behalf of the veteran community, and offer some2004insight on support based on my experiences.2005    I'm here from South Carolina. In 2006, at the age of 18, I2006enlisted in the Marine Corps to serve as an infantry machine2007gunner. I did two deployments; to Iraq in 2007, and then 20082008and 2009, and I was honorably discharged from the Marine Corps2009in 2010 at the rank of corporal as a squad leader.2010    During my time in the Marine Corps, I completely engulfed2011myself with the mentality of going to combat during the peak of2012two wars in the harshest conditions possible that Marines are2013sent to. I earned my Combat Action Ribbon when I was 19 years2014old in Ramadi. I was just a kid and at the time, I felt about2015as close to invincible as I could possibly feel. Although2016foolish, that was my feeling.2017    I had a purpose and a driven focus for my life with the2018support from loved ones at home that projected me into being a2019successful Marine and squad leader on my second deployment.2020Both of my deployments were to combat zones. I'm very fortunate2021to have the family that I have at home. Very hardworking2022father. He's a deacon at church and a mother that's as close to2023an angel as any human that I've ever met.2024    When I transitioned out of the Marine Corps in 2010, I2025moved back to my hometown in Easley, South Carolina, bought my2026first house, and I was somewhat of a reckless wrecking ball at2027first. I was mad at the world from my experiences, the outcomes2028of how the war played out, and just the current state of2029Americans in my generation.2030    In those 18 months' time from my EAS, I had been arrested2031three times for driving under the influence. I went to jail a2032handful of times on violent-related charges, and I had an2033unexpected child who is now 12 years old; my son. During this2034time of those 18 months, one of my Marines had committed2035suicide. The first experience that I had with a Marine of mine2036committing suicide actually happened on my second deployment2037where Lance Corporal Robert Ulmer took his own life in our2038living quarters.2039    So, during this time when I was struggling really bad with2040some of the decisions that I was making, that 17.6 per day2041suicide number really started creeping in the back of my mind2042and became an option. In fact, five guys, five Marines that I2043deployed with to Iraq since we've gotten out, have committed2044suicide to this date.2045    Moving forward, you know, I said I had an unexpected child.2046So, my child, Jackson, he gave me a new purpose, and made2047suicide feel like it just couldn't be an option because I would2048leave my son alone in this world. My son's birth was a turning2049point in my life, and it's when I became connected with Upstate2050Warrior Solutions.2051    I began reaching out for help to better myself because I2052wanted to be the best father I could for my son. I quickly made2053common connections with other veterans at UWS, for example,2054Nate, back here, and another gentleman named Scott Hicks. Both2055of them I had strong connection to because of similar2056experiences, and they had been through some of the dark tunnels2057that I was going through at the time. However, they had made it2058through and were living very successful lives, good fathers,2059and they had something that I really wanted.2060    I found a commonality and mindset. I felt as if I was not2061just alienated in the general public. I was able to be real2062about my problems with these gentlemen and gain advice from2063them who have experiences similar to mine, but overcome the2064same struggles. I learned that I'm not invincible by any means.2065My choices and decisions moving forward directly influenced my2066way of life and leadership for my son.2067    This was the key period in my journey that really turned2068the course positive. I would've been suicidal or landed myself2069in prison or the grave. Surely enough, had I continued down the2070road I was on before my son was born, and I got connected with2071UWS. As time progressed, I went through a divorce, job changes2072that really got me in the dumps at times. And these times, I2073would reach out to UWS for support to keep my head on straight.2074I was invited to and participated in golf tournaments, dinners,2075hikes, other events that gave me a sense of positive community2076that I could take a pride in being a part of.2077    In October 2022, Upstate Warrior Solutions helped me get2078connected to the Vet Center for mental health counseling. I was2079in one of my darkest ruts at the time. I was suicidal for2080months. And in February 2023, I reached out to Upstate Warrior2081Solutions for help again, and agreed to participate in the2082Staff Sergeant Fox Program.2083    As a Staff Sergeant Fox participant, I received inpatient2084and outpatient care from both VA facilities and non-VA. I2085received care for PTSD and alcohol abuse, with a lot of time2086and focus spent on post-combat stress and my personal2087experiences. I also participated in Upstate Warrior Solutions's2088recreational programs, and received peer support from them.2089When I went to get inpatient mental health therapy, I missed my2090son's 10th birthday. However, the way I explained it to my son2091and the mentality I had was, I can either miss his 10th2092birthday, or I can miss all of them.2093    So, I took that opportunity and it was one of the best2094things I ever did. I also want to note that I've always claimed2095to be a Christian man since I was saved at 12 years old.2096However, I never truly followed the lifestyle and choices that2097Jesus had directed me by his actions and words in the Bible.2098Last year, in April 2024, I was rebaptized in the presence of2099my son, my mother and father, and my life drastically changed.2100    Seeking God's purpose for my life and putting all my focus2101and energy on that cause for myself has been life changing for2102the better. The care and help that I received through the Staff2103Sergeant Fox Program saved my life. I had been out of the2104Marine Corps for 12 years before I asked for help. It took me210512 years to get to rock bottom. And at rock bottom was the2106untouched trauma that I experienced while I was in the Marine2107Corps, and the losses I experienced since that time as well.2108Loss of veteran friends, loss of marriage, loss of purpose.2109    For over two years, my mental health and well-being were2110made a priority by the VA, Upstate Warrior Solutions, and my2111community, but most importantly, by me. I exited the Staff2112Sergeant Fox Program in April of this year. When families,2113friends, local organizations, and fellow veterans actively2114participate in creating a supportive environment, it helps2115build a strong network of care and understanding. This sense of2116connection and shared responsibility makes a profound2117difference in the lives of veterans, reminding veterans that2118they're not alone, and that our lives really do matter.2119    Completing the program gave me the tools not only to take2120better care of myself, but to be there for my brothers and2121sisters in arms. I'm proud to have taken that step because2122asking for help is a strength, not a weakness. I hope and pray2123that this program, the Staff Sergeant Fox program, will not2124only be continued, but also expanded to include other avenues2125of resources like legal assistance, financial literacy, that2126will also include veterans with eligibility limitations.2127    Thank you for your time, and God bless.21282129    [The prepared statement of Mr. Lambright appears on page2130104 of the Appendix.]21312132    Chairman Moran. Thank you for your presence here today,2133your ability to tell us your story, and thank you for your2134service to our country. Thank you.2135    I'm going to go vote. I'm going to call on Lindsay Church,2136and then I'm going to yield my time to Senator Tuberville, and2137then Senator Blumenthal will chair the meeting until I return2138from the vote. So, Lindsay Church.21392140STATEMENT OF LINDSAY CHURCH, EXECUTIVE DIRECTOR AND CO-FOUNDER,2141                  MINORITY VETERANS OF AMERICA21422143    Ms. Church. Thank you. Chairman Moran, Ranking Member2144Blumenthal, and Members of the Committee, thank you for the2145opportunity to testify today.2146    My name is Lindsay Church, and I'm the Executive Director2147of Minority Veterans of America. Our organization serves2148veterans who have been historically excluded and underserved;2149women, people of color, LGBTQ+ individuals, religious2150minorities, folks with disabilities, and those living in rural2151communities. We're not side stories in American military2152service, we're central to it. Yet, when we return home, we face2153systems not designed with us in mind.2154    Today's hearing acknowledges a crisis many of us have been2155warning about for years; the growing distance between service2156and survival, especially for those at the margins of2157visibility. Since October of last year, we know of at least 132158veterans who died by suicide on VA property. Another 13,2159transgender, non-binary, and intersex veterans have attempted2160suicide compared to just one last year. If this rate continues,2161we're on pace to exceed the highest number of veteran suicides2162recorded on VA campuses in a single year.2163    These aren't isolated incidents. They're a reflection of a2164system that is not only broken, but actively weakened by policy2165choices that erase the unique experiences and barriers faced by2166our Nation's most vulnerable veterans. Instead of fostering2167trust, transparency, and targeted services, we've watched as2168this administration has taken steps that endanger the veterans2169most in need.2170    In the past 100 days, VA rescinded VHA Directive 1341,2171eliminating protections for respectful, clinically informed2172care for transgender and intersex veterans, as well as access2173to crucial life-saving healthcare. Critical language,2174acknowledging race, gender, sexual orientation, disability2175status, and accessibility was stripped from the forthcoming2176congressionally mandated report of the Outdoor Recreation Task2177Force for Veterans, which we sit on, effectively erasing2178marginalized veterans from national policy recommendations.2179    Outreach materials, acknowledging LGBTQ+, veterans, women,2180veterans of color, and disabled veterans have been sanitized or2181eliminated altogether. Efforts to suppress data collection on2182sexual orientation, gender identity, race and ethnicity have2183intensified making disparities easier to ignore and harder to2184address. These aren't bureaucratic oversights. They're2185deliberate choices with deadly consequences.2186    When we erase identity, we erase risk. When we erase risk,2187we erase responsibility. When we erase responsibility, veterans2188die. We confront these realities every day. Not in theory, but2189in lived experience. That's why our organization provides2190transitional housing for LGBTQ+ veterans experiencing2191homelessness. We deliver flexible financial assistance to2192veterans in crisis. We train minority veteran leaders and2193providers in culturally competent care, and we create spaces,2194indoors and outdoors, where veterans can heal without hiding2195who they are.2196    These interventions are suicide prevention. We've learned2197that connection saves lives. That trust saves lives. That2198access to mental care, healthcare that affirms identity rather2199than denying it, saves lives. That's why the bills before you2200today matter. They offer opportunities to not just bridge gaps,2201but repair the foundation of trust that's been so badly2202damaged.2203    That opportunity will be lost if we fail to embed equity at2204every step. We must prioritize equity in grant funding, not as2205a bonus, but as a core requirement. Mandate cultural competency2206training for all providers serving veterans. Require2207disaggregated data collection so we can identify and address2208the disparities that put minority veterans at greatest risk.2209Invest in partnerships with trusted community-based2210organizations already doing this work.2211    Outreach without intention isn't outreach, it's optics.2212Access without safety isn't an access, it's abandonment. And2213visibility without action isn't progress, it's betrayal. We're2214not simply facing an outreach problem when veterans drive onto2215VA campuses and take their lives in their cars, or when2216transgender veterans struggle to walk into VA clinics because2217they're afraid to reveal their identities. It's not just an2218outreach problem when women veterans report being re-2219traumatized by providers who don't understand gender-based2220trauma.2221    We must acknowledge it that we're facing a systems design2222failure, one worsened by political decisions to erase the2223identities most in need of protection. We cannot afford half2224measures or sanitize language that hides disparities behind2225one-size-fits-all solutions. We cannot afford to lose another2226life to silence, indifference, or fear. This isn't just a2227matter of mental health policy, it's a test of whether our2228government is willing to see and serve all who have served.2229    Veterans deserve more than visibility. We deserve systems2230that are worthy of our trust, our lives, and our sacrifices.2231This is our chance, right now, to build these systems. To not2232only acknowledge veterans like me and those sitting behind me,2233but to fight for us regardless of our identities. Not with2234empty promises, but with bold action, bold enough to save our2235lives.2236    Thank you for the opportunity to testify. I look forward to2237your questions.22382239    [The prepared statement of Ms. Church appears on page 1062240of the Appendix.]22412242    Senator Blumenthal [presiding]. Thank you. Senator2243Tuberville.22442245                     HON. TOMMY TUBERVILLE,2246                   U.S. SENATOR FROM ALABAMA22472248    Senator Tuberville. Thanks Senator. Good morning everybody.2249Thanks for being here and thanks for those of you that have2250served this great country. Thanks for your service.2251    Since I've been on this Committee now going on five years,2252we have not improved prevention of suicides. Matter of fact, in2253a lot of areas it's gotten worse. I know in my State of2254Alabama, you know, you can throw all the money at it you want,2255but at the end of the day, it's about attitude. It's about the2256people that work in these hospitals and these care units that2257show care and humility for the veteran.2258    I've had friends that have committed suicide. I've had2259friends that have almost committed suicide. It's a sad state of2260affairs. But again, I think it's more about people. We have to2261have people that's going to do the right thing. Veterans,2262there's no area that we need to concentrate more in our2263country, other than obviously our economy and things that are2264going on, but the care of the people that have put their life2265on the line for our, for our country.2266    Mr. Lorraine, opportunity for oversight on these grants. Do2267we have enough oversight, in your eyes, for the grants that2268we're putting out of the Fox Grants?2269    Mr. Lorraine. Thank you, Senator. I think if there is2270oversight, it's not transparent. We do participate. America's2271Warrior Partnership participates in all the meetings that the2272VA holds. We provide our reports, we just don't know how we2273rack up against others, and we don't understand where we are,2274you know, how we can improve what we're doing.2275    So, if the outcome of oversight is to change the process2276and improve the process, we're seeing it a little bit. The2277technology system that the VA was using previously has improved2278greatly, but, I would say it's not exceeding expectations and2279oversight.2280    Senator Tuberville. How can this VA and this administration2281stop the bad actors from taking these grants away from people2282who actually need these grants?2283    Mr. Lorraine. Well, sir, you know, there's an example of a2284grantee in the Northeast who was prosecuted for taking $50,0002285from the grant. I think that type of oversight is needed. We2286just went through our audit. We did very well with it. But I2287think more audits--I hate to say that, but I mean--I think more2288audits for organizations with clear guidelines that don't just2289look at how many hours are you spending doing the work, but2290what are the outcomes of the work that you're doing?2291    Senator Tuberville. Yes. And the data that we get, a lot of2292it is not accurate. How can we overcome? How can we get better2293if we don't get accurate data? Are you seeing, any of you, are2294you seeing a better use of data that we're accumulating? Ms.2295Cantor? Anybody?2296    Ms. Cantor. Thank you. I think that the types of measures2297that we've historically looked at in similar models, but not2298necessarily only models connecting people to VA care, but ones2299making referrals to organizations for services, have also2300included things like timeliness and accuracy of those referrals2301and whether they were referred for the right thing. And then if2302they were treated successfully.2303    So, to me, it's on a continuum of how many people are you2304reaching through your outreach, converting to how many people2305are you screening, converting to how many people successfully2306get to VA, converting to how successful is their treatment? So,2307it's really following that path. I think it's possible with a2308lot of the systems that many of us have used. I just think it's2309not, to Jim's point, as transparent as it could be about what2310information is available, particularly as a nongrantee, we know2311very little about how things are going.2312    Senator Tuberville. Yes. I'll ask you this question. Do you2313think merit-based system of people that are showing better2314data, better accomplishments, you know, more positive2315outfluences and influences, do you think they should get more2316grants?2317    Ms. Cantor. You're asking that to a seasoned program2318evaluator. So, I'm going to say absolutely, yes. And I think2319some of the provisions account for that in the new legislation.2320Allowing for potential additional funds to people who, like2321Jim, who have demonstrated good performance or like Steffen's2322team that could serve more with more funds.2323    Senator Tuberville. You know, the grant program started2324what in 2020, set to expire this fiscal year if we don't re-up2325it. Any of you want to answer this question? Are there any2326other suicide methods that we've seen? I'll ask the veterans.2327Any other suicide methods that we've seen to help to prevent2328suicide? Anything that you'd like to suggest in your2329experiences? Any of you want to answer anything that you've2330seen?2331    I have personally offered up to this Committee about2332hyperbaric chambers. People say that helps in some areas with2333PTSD, some people say they don't. Well who cares. If they help2334anybody, if they help one person, we should use them. Anybody2335want answer that question through experience?2336    Mr. Lambright. There are a couple of non-conventional ways2337that I've experienced personally that have helped. I don't know2338if you're familiar with DMT or psychedelics, but those helped2339me quite a bit using those, personally, just to be able to get2340past the trauma and be able to--you know, it gives you a2341supernatural way to kind of look at yourself and get over the2342things that haunt you so bad. I think those work in general. I2343think anybody could use those to their advantage.2344    Senator Tuberville. Were they provided by the VA?2345    Mr. Lambright. No, sir. I don't think it was an option.2346    Senator Tuberville. Yes, probably not.2347    Mr. Lambright. While I'm here, I wanted to mention one2348thing. You know, there's been multiple comments from Senator2349Moran and others about the VA and funding, and the budget cuts2350due to the amount of funding. I just want to give you one2351example from me personally. When I went to Willingway Hospital2352that the VA sent me to in Statesboro, Georgia, I saw the bill2353that ended up getting sent to the VA from Willingway Hospital.2354It was $90,000 for a 30-day inpatient program. The exact same2355person who got the exact same care, but not billed through the2356VA, instead billed through their insurance, was $21,500.2357    So, I think there's a lot of irresponsible, maybe invoicing2358or spending. That's just one example. You know, if 50 guys go2359to the same program, you're talking about a substantial amount2360of money. So, there's--I feel like just the audits, like we2361were just talking about that was brought up, I think that'd be2362a really good situation just to mitigate all the unnecessary2363spending or maybe careless spending that that goes on. That way2364there's more funds available for veterans that need and could2365use it.2366    Senator Tuberville. Yes, I think our VA Secretary now is on2367top of that. We've got to stop the fraud and the theft. We2368don't do that. We don't have money for people that actually2369deserve that. Thank you, Senator.2370    Senator Blumenthal. Thanks Senator. I have a few questions2371for Ms. Barr and Mr. Lambright. Both of you as Marine Corps2372veterans went to Upstate Warrior Solutions. You didn't call the2373VA directly. You didn't call the Veterans Crisis Line. Could2374you talk about why you went there and not to the VA directly?2375    Ms. Barr. Thank you, Senator Blumenthal. So, I, myself,2376actually searched through the VA first to reach out to try to2377find any type of mental health, anything. Something I had been2378trying to get into through the VA while I was in. Just try to2379get it worked out prior to getting out, and kept getting phone2380numbers for people who were no longer in service, or no longer2381connected to the VA, or just stonewalled over and over again2382through them.2383    I thankfully found a Vet Center in town, and they were2384actually the ones who pointed me to Upstate Warrior Solutions.2385And the Upstate Warrior Solutions were the ones to keep working2386through that. I think part of it is partially just due to, like2387in our area there in Greenville, South Carolina, there's a very2388large veterans presence. And the VA does not reach out very2389much nor does it announce its capabilities as often. It's2390definitely very much up to the veteran to try to find2391resources.2392    Upstate Warrior Solutions is one that presents itself and2393puts itself out there more so than the VA and the Vet Centers2394do. So, I think that's most likely the reason most people have2395found Upstate Warrior Solutions before the VA, just because2396they're out there putting themselves out to help and present2397themselves instead of making it a chore or an extreme task to2398try to make their way through the VA process of getting help,2399so.2400    Senator Blumenthal. Thank you. Mr. Lambright?2401    Mr. Lambright. Thank you for your question, Senator2402Blumenthal. I think what you had asked was why did I go to2403Upstate Warrior Solutions and not the VA. I had in fact went to2404the VA first. In South Carolina, there's multiple outpatient2405clinics, but there is one main VA hospital in Columbia where2406the state capital is.2407    So, when I was first initially struggling with suicide, I2408went through divorce, and I drove myself to Columbia,2409unbeknownst to my family or anybody, and checked myself in2410where they have a mental health facility there in Columbia. So,2411they basically took my clothes, put me in a gown and some foam2412slippers. And for five days I played Scrabble, and it was2413basically a waste of time.2414    When I left, I was more upset and in a worse place than2415when I got there. I discussed that with Upstate Warrior2416Solutions, which provided me the insight and the direction to2417use another facility, like a civilian facility if the VA can2418direct me there, where I can get the care that I needed.2419    So, I did in fact, go to the VA first. However, I had a2420relationship with Nate and with Scott Hicks, that I mentioned,2421and they had experience with other veterans that were in a2422similar position that had gotten help from a civilian entity.2423So, I chose that route instead, and honestly, it was the best2424decision I ever made, and I owe my life to these guys.2425    Senator Blumenthal. Thank you. Thank you both for your2426service and for being here today. Mr. Lorraine, have you seen2427evidence yet of the VA cuts in staffing so far as it affects2428veterans?2429    Mr. Lorraine. No, sir, we haven't. We haven't seen any.2430    Senator Blumenthal. How about other members of the panel?2431Have you seen--and when I say evidence of the cuts, I don't2432mean only people leaving, I mean also the sense of anxiety,2433worry, and so forth.2434    Mr. Crow. I would say I have heard that just in phone2435conversations, following up, trying to build more program2436agreeances between us and VA, and just in general asking. I2437mean, they're our peers, we care about them as well, so we ask2438how they're doing and what's going on. And there's definitely2439some mixed anxieties and some fears. We just haven't seen2440personally any of that come to fruition yet.2441    Senator Blumenthal. Have you heard veterans discuss it?2442    Mr. Crow. It's definitely asked about, sir. I mean,2443veterans that come into our programs or that we talk to at2444events. They are curious. It's in the news, so they ask about2445it. With us just being a grantee, I don't really have the2446expertise to tell them anything. I may mainly just direct them2447over to like public affairs offices and things like that to2448field those questions. But it's discussed.2449    Ms. Church. Can I jump in, Chairman, or recommend--excuse2450me, Ranking Member?2451    Senator Blumenthal. Thank you.2452    Ms. Church. First, and anecdotally, you are seeing that the2453centralized services that VA relies on for things like their2454operator services, you can call--in order to reach the VA2455providers, you have to call them main central, like, operator.2456Took me seven and a half minutes to get to the operator the2457other day. It normally takes 12 seconds. Just sitting there2458waiting, on hold, trying to get a hold of anybody to get you to2459the dental clinic. You are trying, because that's the only way2460that you can call the actual hospital.2461    You have providers who are worried because their schedulers2462are getting cut and are getting riffed. You have providers who2463are worried because anybody that helps support them to deliver2464the services are starting to get those. While the providers2465themselves might be exempt, the people that support them, and2466the support staff, and the schedule of the billing, all of2467those things are now landing on the provider's desk.2468    And to the point that was made earlier today, VA does not2469pay well enough to make them do three or four jobs in support2470of delivering these services. So, there's a ton of anxiety, a2471lot of frustrations, people making impossible decisions about2472whether or not to take the deferred resignation, to take the2473early retirement, to take it and/or to chance whether or not2474they're going to have a job in a few months.2475    So, there's a lot of anxiety, which to the point earlier,2476talking about VA employees being veterans themselves, you've2477got a dual crisis happening here. You have veterans who in our2478community most of us are worried about what's going to happen2479with the future of this agency that provides most of our2480healthcare.2481    Then you turn to the actual side of people who work for VA.2482They're experiencing the mental health crisis of the VA maybe2483being dismantled, but also, they have to work for the agency,2484worry about their jobs. Many of them work in billets that are2485now outlawed in the agency themselves. You've got a surging2486crisis underneath the underbelly of the veteran community that2487we are going to see in next year's suicide report.2488    Senator Blumenthal. Thank you. I want to thank all of you2489for being here today. The Chairman, Senator Moran, has another2490obligation, so, I'm going to finish the hearing. Thank you for2491your participation. Been very meaningful and important to the2492Committee.2493    The hearing record will remain open for five legislative2494days should any Committee members want to submit additional2495statements or questions for the record. And I'm going to ask2496all of our witnesses if there are any questions, to please2497respond to them.2498    And once again, thank you all for being here. This hearing2499is adjourned. Thank you.2500    [Whereupon, at 12:54 p.m., the hearing was adjourned.]25012502                            A P P E N D I X25032504                          Prepared Statements25052506[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25072508                        Questions for the Record25092510[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25112512                       Submissions for the Record25132514                  (From Minority Veterans of America)25152516[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25172518                       Statements for the Record25192520[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]25212522                                  [all]