S.785: Leading the Way to Comprehensive Mental Health Care and Suicide Prevention for Veterans

Chairman Moran, Ranking Member Tester, and distinguished members of the committee; On behalf of National Commander James W. "Bill" Oxford, and the nearly 2 million members of The American Legion, thank you for inviting The American Legion to submit the following testimony on S. 785 – Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019. This legislation is a vital step towards combatting veterans' suicide by reducing barriers to mental healthcare accessibility.

Suicide among veterans occurs twice as often as civilian suicides. This statistic is concerning on its own; however, it becomes especially concerning when the Department of Veterans Affairs (VA) notes that veterans make up 14 percent of all suicides in the United States, while only being 8 percent of the total population.

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In response to these alarming statistics, The American Legion instituted a nationwide program in an effort to take an active role in the fight against veteran suicide and destigmatize mental health issues. The Buddy Check program, established in May 2019, encourages dialogue on mental health and overall wellness by having members do informal wellness check-ins with their fellow veterans.

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However, this awareness is not enough to curb the alarming rate of veteran suicide. Programs like The American Legion’s Buddy Check program must be followed by data-driven policies that are designed to help those most in need.

BACKGROUND

The American Legion is a resolution-based organization that takes our legislative priorities and direction directly from our dues-paying members. Many Legionnaires have been personally impacted by suicide or have witnessed the impacts of suicide on close friends in the military and veteran community.

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Our support on these topics are personal and come from a place of particular concern.

TITLE I: IMPROVEMENT OF TRANSITION OF INDIVIDUALS TO SERVICES FOR DEPARTMENT OF VETERANS AFFAIRS

Transitioning from active service is a crucial and stressful phase in a new veteran’s life. It is imperative that this period is adequately understood to ensure that VA and Department of Defense (DoD) programs provide the support that veterans need during the transition process. Sec. 102 of this bill calls for a review of data and research relating to servicemembers and veterans who have completed suicide within one year of separation from the Armed Forces. Reviewing this data can allow VA and supporting organizations to create more data-conscious strategic plans to address suicide during the transition. Additionally, Sec. 103 requires VA to submit an impact assessment of the REACH-VET predictive model. Assessing the impacts of previously implemented programs is imperative to ensuring that VA allocates resources to places that will best assist veterans in their transition period.

The American Legion Resolution No. 77: Support for the Military Transition Program urges Congress to pass legislation which “can help alleviate the employment problems faced by many veterans.” Inconsistent and turbulent employment can cause additional stressors on a transitioning servicemembers’ mental health. Therefore, constant program evaluation yields an opportunity for continuous improvement to provide the best services possible.

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The American Legion supports these provisions, including the idea that transparency and quality assurance in public reports and regular research can improve mental healthcare.

TITLE II: SUICIDE PREVENTION

VA must conduct extensive research and ongoing studies to provide accurate data to formulate appropriate programs to provide informed programmatic change. No price tag can be placed on a veterans’ wellbeing. Through Sec. 203, Pilot program veterans access to complementary and integrative health programs thorough annual therapy, aromatherapy, sports and recreational therapy, art therapy and post-traumatic growth programs and Sec. 204, Department of Veterans Affairs study of all-cause mortality of veterans, including suicide, and review of staffing levels of mental health professionals, VA can introduce a data-driven environmental change in the mental health space.

The American Legion supports these measures through Resolution No. 20: Suicide Prevention Program. This resolution emphasizes the importance of discovering the best practices in veteran suicide that can be achieved by allowing pilot programs and promoting financial assistance when needed.

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Additionally, Resolution No. 116: Post-Traumatic Growth, encourages “VA to collaborate with nonprofit mental health organizations that implement programs designed to cultivate and facilitate post-traumatic growth.”

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  The American Legions strongly supports these provisions.

TITLE III: PROGRAMS, STUDIES, AND GUIDELINES ON MENTAL HEALTH

Further research and studies on suicide and mental health-related topics, such as how increased accessibility to VA services affects suicidal ideation, are necessary to provide data to identify how to best address veterans' suicide. The American Legion Resolution No. 20: Suicide Prevention Program encourages “analyzing best practices in veterans suicide prevention not currently used by the Department of Defense or the Department of Veterans Affairs.”

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The American Legion is supportive of all the provisions under this title. Specifically, reports from government agencies that provide information on the services, programs, and effectiveness of various training pieces within the VA healthcare system.

Additionally, we support the implementation of beneficial pilot programs derived from targeted research. VA must continue to be an innovative leader in the healthcare space and actively work to implement pilot programs to serve veterans mental health needs. As mentioned in Resolution No. 165: Traumatic Brain Injury and Post Traumatic Stress Disorder Programs, The American Legion supports the execution of various programs that ultimately support veterans' mental health journeys.  

TITLE IV: OVERSIGHT OF MENTAL HEALTH CARE AND RELATED SERVICES

VA has many excellent programs available to veterans; however, many of these programs are not being properly advertised. This problem often leads to underutilization, lack of participation, or decreases in program performance. With the implementation of oversight initiatives, VA programs would be able to identify their shortcomings. Additional oversight of mental healthcare services would be beneficial for the sustainability of all VA programs, restore utilization, increase participation, and improve program performance. If implemented, the following provisions would provide the space these programs to flourish with the proper oversight:

• Sec. 401. Study on effectiveness of suicide prevention and mental health outreach programs of Department of Veterans Affairs
• Sec. 402. Oversight of mental health and suicide prevention media outreach conducted by Department of Veterans Affairs
• Sec. 404. Comptroller General report on efforts of Department of Veterans Affairs to integrate mental healthcare into primary care clinics

We support oversight that evaluates the functionality and the quality of government agencies, healthcare facilities, and programs accessed by veterans. Resolution No. 142 – Department of Veterans Affairs Mental Health Services notes that VA must “ensure comprehensive mental health services are available to veterans” and that we “urge Congress to provide annual oversight of VA’s mental health services.”

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Frequent assessments of programs' efficiency, ambitious yet obtainable goals, and open lines of communication should be evaluated and fashioned to serve this unique population. The American Legion urges this provision's execution to ensure no veteran falls through the cracks.

TITLE V: IMPROVEMENT OF MENTAL HEALTH MEDICAL WORKFORCE

The quality of VA care is often impacted due to the many vacancies among its staff of healthcare professionals. While the hiring process was expedited during the initial stages of COVID-19 to respond to the significantly increased demand for healthcare professionals; the same urgency should be sustained to fill any remaining staff positions with specific emphasis on mental health professionals. Mental health is too important to be omitted due to hiring delays. The American Legion encourages VA staff diversity to allow cultural and gender representation in mental health settings as advocated by Sec. 502, Establishment of Department of Veterans Affairs Readjustment Counseling Service Scholarship Program.

The implementation of programs to improve VA employees' quality of life as offered in Sec. 501, Sec. 506, and Sec. 507 are crucial for these recruitment and retention goals. Through Resolution No. 115: Department of Veterans Affairs Recruitment and Retention, The American Legion believes VA must have the necessary resources to obtain the best-qualified individuals to care for our veterans.

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The effort to retain qualified healthcare professionals is of the utmost importance and financially driven retention efforts are a useful tool that VA should have at its disposal.

TITLE VI: IMPROVEMENT OF CARE AND SERVICES FOR WOMEN VETERANS

The American Legion is pleased to see that provisions specifically targeting women veterans are included in Sec. 601, Sec. 602, Sec. 603, and Sec. 604. There is a significant gap in gender-conscious care and outreach programs among VA’s programmatic offerings. The passing of this legislation is a step in the right direction.  Providing data on where women veterans are utilizing healthcare services will give an accurate needs assessment to ensure programs better serve this specific veteran population better.

Through Resolution No. 147: Women Veterans, we applaud the initiative to diversify the scope of VA services to include care for all of our nation's heroes and "ensure that the needs of the current and future women veteran populations are met.

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Women have served this nation honorably since the revolutionary war. It is time to create an inclusive environment for them in VA facilities and represent them in staffing positions, programmatic design, and research.

TITLE VII: OTHER MATTERS

Many veterans in rural areas struggle to make their appointments because the distance needed to travel to the nearest VA facility makes it inconvenient and unrealistic. To address this issue, The American Legion is working with VA to bring healthcare to veterans in a familiar setting – their local Legion posts. Through Project ATLAS (Accessing Telehealth through Local Area Stations), VA will install video communication technologies and medical devices in selected posts to enable remote examinations through a secure, high-speed internet line. Veterans will be examined and advised in real-time through face-to-face video sessions with VA medical professionals, who may be located hundreds or thousands of miles away. Sec. 701, Sec. 702, Sec. 703, Sec. 704, and Sec. 705 reiterate this widely held belief by The American Legion.

The ability to launch and participate in this excellent program was made possible by our Resolutions No. 20 – Suicide Prevention Program and No. 75 – Department of Veterans Affairs Rural Health Care Program.

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We are glad to see this legislation reaffirm our beliefs that all veterans, regardless of geographical location, should receive quality healthcare.

CONCLUSION

The American Legion, like many other VSOs, has a deep concern on the rate of suicide among servicemembers and veterans. It is unfortunately a number that has been consistent for years and it is time for it to decrease.

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We believe that a decrease in suicide midst servicemembers and veterans is achievable by implementing the legislation discussed today. We support S. 785 – Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 as currently written. However, we strongly urge that the committees in both chambers of Congress move expeditiously to reconcile their versions of the S. 785 to ensure that this critical legislation is passed before the end of the 116^th Congress. The American Legion is thankful for the invitation to submit this statement for the record and stand ready to assist when needed on these issues and any other issues. For additional information regarding this testimony, please contact Legislative Associate Ms. Alexandria Evers at (202) 263-2990 or aevers@legion.org.