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39–647 2008

STOPPING SUICIDES: 

MENTAL HEALTH CHALLENGES WITHIN 

THE U.S. DEPARTMENT OF VETERANS AFFAIRS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

DECEMBER 12, 2007 

Serial No. 110–61 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

MALCOM A. SHORTER, Staff Director 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

December 12, 2007 

Page 

Stopping Suicides: Mental Health Challenges Within the U.S. Department 

of Veterans Affairs ............................................................................................... 1 

OPENING STATEMENTS 

Chairman Bob Filner ............................................................................................... 1 

Prepared statement of Chairman Filner ........................................................ 66 

Hon. Steve Buyer, Ranking Republican Member .................................................. 3 

Hon. Stephanie Herseth Sandlin, prepared statement of .................................... 66 

Hon. Harry E. Mitchell, prepared statement of .................................................... 67 

Hon. Cliff Stearns, prepared statement of ............................................................. 67 

Hon. Leonard L. Boswell ......................................................................................... 5 

Hon. Donald A. Manzullo ........................................................................................ 6 

WITNESSES 

U.S. Department of Veterans Affairs, Ira Katz, M.D., Ph.D., Deputy Chief 

Patient Care Services Officer for Mental Health, Veterans Health Administration ................................................................................................................... 48 

Prepared statement of Dr. Katz ...................................................................... 84 

Bowman, Mike and Kim, Forreston, IL ................................................................. 6 

Prepared statement of Mike and Kim Bowman ............................................. 68 

Coleman, Penny, Rosendale, NY, Author, Flashback: Posttraumatic Stress 

Disorder, Suicide, and the Lessons of War ......................................................... 33 

Prepared statement of Ms. Coleman ............................................................... 69 

Meagher, Ilona, Caledonia, IL, Author, Moving a Nation to Care: Post-Traumatic Stress Disorder and America’s Returning Troops ................................... 35 

Prepared statement of Ms. Meagher ............................................................... 76 

Zivin, Kara, Ph.D., Research Health Scientist, Health Services Research and 

Development, Veterans Health Administration, U.S. Department of Veterans Affairs ......................................................................................................... 54 

Prepared statement of Dr. Zivin ..................................................................... 86 

SUBMISSIONS FOR THE RECORD 

U.S. Department of Veterans Affairs, Michael Shepherd, M.D., Physician, 

Office of Healthcare Inspections, Office of Inspector General, statement ....... 87 

American Legion, Joseph L. Wilson, Deputy Director, Veterans Affairs and 

Rehabilitation Commission, statement .............................................................. 91 

Disabled American Veterans, Joy J. Ilem, Assistant National Legislative Director, statement .................................................................................................. 93 

Iraq and Afghanistan Veterans of America, Todd Bowers, Director of Government Relations, statement .................................................................................. 98 

National Coalition for Homeless Veterans, statement ......................................... 99 

Vietnam Veterans of America, Richard F. Weidman, Executive Director for 

Policy and Government Affairs, statement ........................................................ 103 


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MATERIAL SUBMITTED FOR THE RECORD 

Additional Hearing Material: 

Hon. Michael J. Kussman, M.D., M.S., MACP, Under Secretary for 

Health, U.S. Department of Veterans Affairs, sample of letter sent 

to veterans, informing veterans of the National Suicide Prevention 

toll-free hotline number, 1–800–273–TALK (8255), and pocket-sized 

card with VA Suicide Crisis Hotline phone number/information, as 

well as a Crisis Response Plan .................................................................... 107 

U.S. Department of Veterans Affairs Pamphlet, entitled ‘‘Suicide Prevention, Men and Women Veterans, Knowing the Warning Signs of Suicide,’’ dated September 2007 ........................................................................ 108 

Post-Hearing Questions and Responses for the Record: 

Hon. Bob Filner, Chairman, Committee on Veterans’ Affairs, to Hon. 

Gordon H. Mansfield, Acting Secretary, U.S. Department of Veterans 

Affairs, letter dated December 14, 2007, and VA responses ..................... 110 

Hon. Harry E. Mitchell, Member of Congress, U.S. House of Representatives, to Hon. James B. Peake, M.D., Secretary, U.S. Department of 

Veterans Affairs, letter dated February 8, 2008, and response letter 

dated February 27, 2008, following up to request additional information 

not supplied in earlier VA responses to questions for the record ............. 115 

Hon. Bob Filner, Chairman, Committee on Veterans’ Affairs, to John D. 

Daigh, Jr., M.D., CPA, Assistant Inspector General, Office of Healthcare Inspections, U.S. Department of Veterans Affairs, letter dated 

December 14, 2007, and response letter dated January 24, 2008 ............ 117 

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican 

Member, Committee on Veterans’ Affairs, to Hon. James B. Peake, 

M.D., Secretary, U.S. Department of Veterans Affairs, letter dated 

December 21, 2007, and response letter dated February 5, 2008, requesting additional data on suicide rates among veterans ....................... 121 

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican 

Member, Committee on Veterans’ Affairs, to Rick Kaplan, Executive 

Producer, CBS Evening News With Katie Couric, letter dated December 

21, 2007, and response letter dated May 16, 2008, from Linda Mason, 

Senior Vice President, Standards and Special Projects, CBS News ......... 128 


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STOPPING SUICIDES: 

MENTAL HEALTH CHALLENGES WITHIN 

THE U.S. DEPARTMENT OF VETERANS AFFAIRS 

WEDNESDAY, DECEMBER 12, 2007 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 10:10 a.m., in Room 

345, Cannon House Office Building, Hon. Bob Filner [Chairman of 

the Committee] presiding. 

Present: Representatives Filner, Snyder, Michaud, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Rodriguez, McNerney, Space, Walz, 

Buyer, Stearns, Boozman, Brown-Waite, Bilirakis, and Buchanan. 

Also Present: Representatives Boswell, Manzullo, and Kennedy. 

OPENING STATEMENT OF CHAIRMAN FILNER 

The CHAIRMAN. This meeting of the House Committee on Veterans’ Affairs is called to order. 

I appreciate your attendance, and I appreciate your interest in 

this very important issue of mental illness, particularly of the suicides that have occurred in our veterans’ population, especially 

those involved in combat situations. 

So this is going to be a very tough hearing, an emotional hearing. 

It is an issue the military, the U.S. Department of Veterans Affairs 

(VA) and the American public does not like to talk about. Yet, we 

owe it to our fighting men and women. We owe it to their families. 

We owe it to our future mental health as a Nation to explore this 

issue in as much depth as possible. 

This year, as we try to deal with the influx of veterans who are 

coming from Iraq and Afghanistan, plus the needs of our older veterans, which continue, it has been a great challenge for this Committee and for this Congress and for this Nation. 

Earlier in the year, and in a series of articles since, The Washington Post reporters dealt with the terrible scandal at Walter Reed 

which had the effect, as other local newspapers around the country 

did stories on their military and veterans’ hospitals, of a wake-up 

call for all of America. Their veterans, their troops coming back 

from the current war were not getting the treatment, the care, the 

respect, the honor and the dignity that Americans thought they deserved. 

Because of that awareness that really spread throughout America, this Congress was able to add almost $13 billion of new money 

for healthcare for veterans, an unprecedented increase of 30 perVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 E:\HR\OC\39647.XXX 39647

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cent or more, based on the public perception that we had to do 

more. 

The injuries that come from this war are very great, both physically and mentally, and yet, America has not really come to grips 

with it. 

One of the television networks, ABC, whose reporter Bob Woodruff had suffered a blast injury and traumatic brain injury (TBI) 

in Iraq, opened up that subject to millions of Americans. And we 

know more now about TBI and how to treat it. 

Recently, the CBS network opened up again to millions of Americans the issue of suicides amongst our veterans. They had a great 

deal of difficulty getting information from the authorities or from 

the U.S. Department of Defense (DoD) or from the Department of 

Veterans Affairs. That is one of the issues we are going to explore 

today, the issue of information and the tracking of these issues. 

But they had to spend 5 or 6 months tracking down statistics in 

different States because nobody seemed to be interested in Washington, of understanding the statistics. 

Their report of several weeks ago again opened the eyes of millions of Americans to statistics, which went way beyond what people had thought or imagined as to the number of suicides, not only 

amongst our returning vets but amongst veterans from previous 

wars. I think it is now recognized that as many Vietnam veterans 

have now committed suicide as had died in the original war. That 

is a terrible, terrible statistic and says we have to do more. 

So what we are going to do today is try to open up this subject 

which is very difficult for the families involved and for our government. We want to talk about the statistics. Why doesn’t the VA do 

more about trying to understand the nature of the issue? We leave 

it to citizens like Ilona Meagher, who will be testifying later, to 

keep a Website for tracking suicides, of which she is one person 

with limited resources. This is what our government should be 

doing. 

We want to talk about the stigma of mental illness and how we 

try to deal with this as a Nation. We want to talk about the apparent inability of the military to look at mental illness and people’s 

honest attempts to deal with it as something to be recognized, promoted, encouraged. It is denied. Anybody who admits mental illness is threatened with no promotions or no jobs in law enforcement when they leave the military. 

It is an issue for all of us in America but particularly for those 

in the military, and we have to face it honestly and come to grips 

with it. That is what we hope to do today. 

We have a brave mother and father who have decided that their 

son’s suicide must be talked about and understood to help others, 

and other families, prevent that. We have citizens, authors who 

have dealt very directly with this issue and, of course, the professionals within the VA system and those in the veterans service organizations (VSOs) who try to help their members deal with these 

issues. 

So we will have a very tough hearing, as I said earlier, but it is 

an important hearing. America must look at these issues. We have 

to decide that we have to deal with them in a far more open and 

dedicated manner, and that is our objective today. 


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I would yield for an opening statement of the Ranking Member, 

Mr. Buyer. 

[The prepared statement of Chairman Filner appears on p. 66.] 

OPENING STATEMENT OF HON. STEVE BUYER 

Mr. BUYER. Thank you, Mr. Chairman. 

Some in this room today, including several of our witnesses, have 

been personally devastated by the loss of a loved one who has chosen to take their own life. Before I begin, I want to personally 

thank you for testifying about your extremely personal and painful 

experiences. While I know nothing can compensate you for the loss 

of your loved ones, we can hopefully find ways to help deter another soldier from succumbing to such tragedy. 

I hope that, as we delve into these sensitive matters, we do not 

lose sight of the fact that every case that we will discuss here today 

represents a human life, a veteran, a family, and a tragedy. Discussing the tragic circumstances surrounding a suicide of one who 

has worn the uniform should be done with great respect and in recognizing also their service to our country. We must search for answers and solutions to veteran suicide. 

As most of our witnesses will attest this morning, tracking suicide rates nationwide is very difficult, and it is clear to me that the 

data we currently have does not give us a definitive understanding 

nor a scope of the problem. There seems to be significant variations 

among the data provided by CBS News, the VSOs, the DoD and the 

VA. These veterans’ lives were important, and it would be a dishonor to them and to their service if information is not accurately 

portrayed. Accurate information is crucial to identifying risk factors, to providing better prevention and treatment protocols. 

Therefore, it is imperative that the VA have a better method to 

systematically collect and to track suicides so we can get a true understanding and scope of our challenge. It is my understanding 

that the VA is beginning to work with the DoD to do this, and I 

applaud them. But, again, I cannot overstate the urgent need to do 

it quickly. When decision makers do not have accurate data, we 

must rely on anecdotal evidence. While this can raise awareness, 

it does not help us make informed decisions on how best to develop 

strategies to diminish the risk and to prevent the events of suicide. 

Notwithstanding the tragic stories that surround this hearing, I 

believe we can point to the steps that the VA and the DoD have 

taken to help veterans and servicemembers deal with mental 

health challenges. 

The VA has already formulated a comprehensive strategy for suicide prevention, focusing on the needs of both new veterans from 

Operation Iraqi Freedom (OIF) and Operation Enduring Freedom 

(OEF) and on those of prior conflicts. The specific program for suicide prevention is based on public health and clinical models and 

activities both within the VA facilities and the civilian medical 

community. 

The cornerstone of this program is the VA’s new 24-hour veteran 

suicide prevention hotline, which opened its lines in July of 2007. 

Since its inception, the VA reports that they have made more than 

1,300 referrals to suicide prevention coordinators and have rescued 


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317 veteran callers. Veterans experiencing thoughts of suicide can 

call 1–800–273–TALK for help. 

We have seen clearly that early intervention and treatment has 

a significant and demonstrated impact and is crucial to preventing 

suicide. It is important to recognize the warning signs and to ensure that servicemembers receive the treatment they need right 

away. 

This starts with DoD. I am very encouraged that a new training 

program called BattleMind, developed at the Walter Reed Army Institute of Research, is being developed and is working to help soldiers transition from the combat zone to the home front. 

Mr. Chairman, I would sum this up with this. VA and DoD have 

made strides in the treatment of mental health disorders that can 

lead to suicide. However, until families like the Bowmans no longer 

bear such pain, not enough is being done. I welcome their testimony here today, and I hope this hearing can help us gain a better 

understanding of how to offer more effective and timely assistance 

for those troubled servicemembers to prevent them from turning to 

such a tragic option. 

On a personal note, as I see the parents sitting in front of me, 

your quest for answers will never end, and probably on your last 

breath there will still be the thoughts of your son. At the age of 

16, my best friend committed suicide. His baseball cap sits in my 

office. I think people walk in, and they think it is my baseball cap, 

but it is that of a very dear friend. I constantly search for answers 

because none of us knew, even as close as we were to him. And, 

of course, the parents would drill us all the time about the signs. 

What were they? And there were no signs. There were no risk factors. It was just one of these bizarre strikes of the mind that just— 

I do not have an answer. I just want you to know I carry the pain 

of suicide, and I am in constant search of answers. And I am 

haunted, haunted by suicide. Even among my colleagues—if you 

want to talk about something that is not discussed, in the 15 years 

I have been in Congress, it is the number of suicides of sons and 

daughters of Members of the Senate or of the House, and it is not 

discussed—or the attempts. It is that dark side. 

So you know what? It is not just us, and it is not just those in 

the military. You can touch any sector of our society. So, as we 

delve into this issue, we have to also be very sensitive, because I 

recognize there are anti-war advocates who also want to say that 

these individuals who then commit suicide and who have worn the 

uniform are somehow victims, and that is not right either, as we 

are trying to find out actually how can we prevent and how can we 

be helpful to someone who thinks that suicide is some form of option that can help them. 

So, on a personal note, I thank you for your bravery to come here 

and to talk about your son, and I know you are doing this because 

you absolutely believe that your testimony here today can help 

someone else. 

Thank you. I yield back. 

The CHAIRMAN. Thank you, Mr. Buyer. 

Our first panel will be Mr. and Mrs. Mike Bowman, whose son, 

Tim, an Army specialist in the Illinois National Guard from Bravo 

Troop, 106th Cavalry, committed suicide. 


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Before that, if you will allow me, Mr. and Mrs. Bowman, to ask 

our colleague Mr. Boswell if he would just step forward for 2 minutes. He is the author of Public Law 110–110, the Joshua Omvig 

Veterans Suicide Prevention Act, named after a young man in his 

own district, whose parents have now become friends with the 

Bowmans. 

The Bowmans are being introduced by our other colleague from 

Illinois, Mr. Manzullo. 

Mr. Boswell, please. 

OPENING STATEMENT OF HON. LEONARD L. BOSWELL 

Mr. BOSWELL. Thank you, Mr. Chairman, Ranking Member 

Buyer and Members of the Committee. I appreciate your holding 

this hearing and your leadership on this issue. 

To Mike and Kim, we extend our hand in friendship, our concern 

and sympathy for the loss of your son, Tim, and we pledge to do 

our best to stop this. 

As we all know, suicide is sweeping through our veteran population, and the Committee has shown leadership in addressing the 

issues our veterans face today. I want to thank you again for allowing me to speak on this important issue. 

Suicide is an epidemic which is encompassing much of our veteran population. For too long, suicide among veterans has been ignored, and now is the time to act. We can no longer be afraid to 

look at the facts, and the sad fact is we are missing adequate information on the number of veterans who commit suicide each year. 

I was shocked, and I am sure all were, when we saw the CBS 

Evening News report focusing on veteran suicides. They found that 

in 2005, over 6,200 veterans committed suicide—120 per week. The 

report also found that veterans were twice as likely to commit suicide as nonveterans. These statistics are devastating. 

As a result of this report, I immediately introduced H.R. 4204, 

the ‘‘Veterans Suicide Study Act,’’ which several Members of the 

Committee have co-sponsored. If time had permitted, there would 

be many, many more, because no one—no one—who I approached 

chose not to sign on. 

This legislation will direct the VA to conduct a study to get the 

real facts on the rate of suicide among veterans. It is just one step 

that we must do to ensure that we have adequate information so 

we can treat our veterans as they return from combat. 

I would also like to personally thank the Chairman and the 

Ranking Member of the full Committee for their action in support 

of the Joshua Omvig Veterans Suicide Prevention Act earlier this 

year. Now that this crucial piece of legislation has been signed into 

law, I am confident our veterans will begin to receive more of the 

vital care they need. 

While the Joshua Omvig bill puts in place a comprehensive approach in treating high-risk veterans, we still need to know the 

facts. So I implore the Committee, and the Congress, to act swiftly 

on H.R. 4204 so we can ensure we have the data we need to treat 

our Nation’s heroes. Our veterans have dedicated their lives to 

keep our great Nation safe, and it is now our duty and our time 

to protect them. 


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So I want to thank you again for allowing me to share this time 

with you, Mr. Chairman, and I am sorry I have to go to a markup. 

Thank you very much. 

The CHAIRMAN. Thank you, Mr. Boswell, for your leadership on 

this issue. 

Mr. Manzullo, if you want to introduce your constituents. 

Thank you for being here with us. 

OPENING STATEMENT OF HON. DONALD A. MANZULLO 

Mr. MANZULLO. Thank you, Mr. Chairman. I have the honor 

today of introducing, three constituents who are testifying before 

the Committee today. 

In inverse order, on the second panel is Ilona Meagher. Ilona’s 

father was a Hungarian freedom fighter and also became a member 

of the United States Armed Forces, so he is a veteran of both the 

Hungarian and the American Armed Forces. Ilona is a tremendous 

campaigner, a seeker of truth, and she wrote this book, ‘‘Moving a 

Nation to Care,’’ about the very subject of which we are discussing 

this morning. 

The other two constituents really exemplify the people about 

whom Ilona Meagher is concerned, and they are the Bowmans from 

Forreston, Illinois. Kim and Mike live about 10 miles from my farm 

in the same county in northern Illinois. Their testimony is nothing 

less than startling and compelling. They would rather be anywhere 

in the world than here today to talk about what happened in their 

lives and to their precious son. 

I encourage the Members of this Committee to continue their 

leadership, to draft legislation or whatever is necessary, in order to 

make sure that the Bowman’s testimony is not in vain and that 

their son’s life is not in vain and that the lives of other young men 

and women who have taken their lives, will be used in order to prevent those situations from occurring in the future. 

The CHAIRMAN. Thank you, Mr. Manzullo. 

Mr. and Mrs. Bowman, you are recognized for your testimony. I 

had a chance to talk to you yesterday and to understand a little 

bit more about Tim, about the incredible job he was doing overseas, 

about the soldier that he was, about the close relationship you had 

with him, about your patriotism and his. So, again, I cannot say 

I am looking forward to your testimony, but I just thank you for 

having the courage to be here and for making sure that Tim’s life 

and death will be used to help other people. 

Please, Mr. Bowman. 

STATEMENTS OF MIKE AND KIM BOWMAN, FORRESTON, IL 

(PARENTS OF SPECIALIST TIM BOWMAN, U.S. ARMY, ILLINOIS NATIONAL GUARD, BRAVO TROOP, 106TH CAVALRY) 

Mr. BOWMAN. Mr. Chairman and Members of the Committee, my 

wife and I are honored to be speaking before you today, representing just one of the families who lost a veteran to suicide in 2005. 

As my family was preparing for our 2005 Thanksgiving meal, our 

son Timothy was lying on the floor of my shop office, slowly bleeding to death from a self-inflicted gunshot wound. His war was now 

over; his demons were gone. Tim was laid to rest in a combination 

military-firefighter funeral that was a tribute to the man that he 

was. 


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Tim was a life-of-the-party, happy-go-lucky, young man who 

joined the National Guard in 2003 to earn money for college and 

to get a little structure in his life. On March 19th of 2005, when 

Specialist Timothy Noble Bowman got off the bus with the other 

National Guard soldiers of Foxtrot 202 who were returning from 

Iraq, he was a different man. He had a glaze in his eyes and a 

1,000-yard stare, always looking for an insurgent. 

Family members of F202 were given a 10-minute briefing on post 

traumatic stress disorder (PTSD) before the soldiers returned, and 

the soldiers were given even less. The commander of F202 had 

asked the Illinois Guard Command to change their demobilization 

practices to be more like the regular Army, only to have his questions rebuffed. He knew that our boys had been shot up, had been 

blown up by improvised explosive devices, had extinguished fires 

on soldiers so their parents would have something to bury, and had 

extinguished fires on their own to save their lives. They were hardened combat veterans now, but were being treated like they had 

been at an extended training mission. 

You see, our National Guardsmen from the F202 were not filling 

sandbags. They departed in October of 2003 for 6 months of training at Fort Hood and Fort Polk. On Tim’s 22nd birthday, March 

4th of 2004, Foxtrot left for Iraq, where they were stationed at 

Camp Victory. Their tour took them directly into combat, including 

4 months on the most dangerous road in the world, the highway 

from the airport to the Green Zone in Baghdad, where Tim was a 

top gunner in a Humvee. Tim, as well as many other soldiers at 

F202, earned their Purple Hearts on that stretch of road known as 

‘‘Route Irish.’’ We are still waiting for Tim’s Purple Heart from various military paperwork shuffles. 

My wife and I are not here today as anti-war protesters, and let 

me make that very clear. Our son truly believed that what his unit 

did in Iraq helped that country and helped many people that they 

dealt with on a daily basis. Because of his beliefs, I have to believe 

in the cause that he fought and died for. That does not mean I do 

not feel that we lost track of our overall mission in Iraq. 

When CBS News broke the story about veterans suicides, the VA 

took the approach of criticizing the way the numbers were created 

instead of embracing it and using it to help increase mental healthcare within their system. Regardless of how perfectly accurate the 

numbers are, they obviously show a trend that desperately needs 

attention. 

CBS News did what no Government agency would do. They tabulated the veterans suicide numbers to shed light on this hidden 

epidemic and to make the American people aware of this situation. 

The VA should have taken those numbers to Capitol Hill, asking 

for more people, funding and anything else they need to combat 

this epidemic. They should embrace this study, as it reveals the 

scope of a huge problem, rather than complain about its accuracy. 

If all that is going to be done with the study is to argue about 

how the numbers were compiled, then an average of 120 veterans 

will die every week by their own hand until the VA recognizes this 

fact and does something about it. The VA mental health system is 

broken in function and understaffed in operation. There are many 

cases of soldiers coming to the VA for help and being turned away 


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or misdiagnosed for PTSD and then losing their battle with their 

demons. 

Those soldiers, as well as our son Timothy, can never be brought 

back. No one can change that fact. But you can change the system 

so that this trend can be slowed down dramatically or even stopped. 

Our son was just one of thousands of veterans that this country 

has lost to suicide. I see every day the pain and grief that our family and extended family go through in trying to deal with his loss. 

Every one of those at-risk veterans also has a family that will suffer if that soldier finds the only way to take battlefield pain away 

is by taking his or her own life. 

Their ravished and broken spirits are then passed on to their 

families as they try to justify what has happened. I now suffer from 

the same mental illness that claimed my son’s life—PTSD from the 

images and sounds of finding him and hearing his life fade away, 

and depression from a loss that I would not wish on anyone. 

If the veterans suicide rate is not classified as an epidemic that 

needs immediate and drastic attention, then the American fighting 

soldier needs someone in Washington who thinks it is. I challenge 

you to do for the American soldier what that soldier did for each 

of you and for his country: take care of them and help preserve 

their American dream as they did yours. To quote President Calvin 

Coolidge, ‘‘The Nation which forgets its defenders will itself be forgotten.’’ 

Today, you are going to hear a lot of statistical information about 

suicides, veterans and the VA, but keep one thing in mind. Our 

son, Specialist Timothy Noble Bowman, was not counted in any VA 

statistic of any kind. Let me repeat that. Our son is not included 

in any VA count. Now, why, you ask? He had not made it into the 

VA system because of the stigma of reporting mental problems. He 

was National Guard, and he was not on a drill weekend when he 

took his life. Therefore, he was not counted as active duty. The only 

statistical study that he was counted in was the CBS News study. 

And there are many more just like him. We call them KBAs, killed 

because of action, the unknown fallen. 

I challenge you to make the VA an organization to be proud of 

instead of the last place that a veteran wants to go for help. It is 

the obligation of each and every one of you and all Americans to 

channel the energies, the resources and the intelligence and wisdom of this Nation’s best and brightest to create the most effective, 

efficient and meaningful healthcare system for our men and women 

who have served. 

We must all remove the stigma that goes with the soldier’s admitting that he or she has a mental issue. Let those soldiers know 

that admitting they have a problem with doing the most unnatural 

thing that a human being can do is all right. Mental health issues 

from combat are a natural part of the process of war and have been 

around for thousands of years, but we categorize that as a problem. 

Take that soldier who admits a head and mental health injury 

from combat and embrace him as a model for others to look up to. 

Let the rank-and-file know by example that it is okay to work 

through your issues instead of burying them until it is too late. 

Grab that soldier and thank him for saying, ‘‘I am not okay,’’ and 

promote him. A soldier who admits a mental injury should be the 


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first guy you want to have in your unit, because he may be the only 

one who really has a grasp on reality. But instead, he is punished 

and shunned, and by that example, he has become the model for 

PTSD and suicide. 

While we are at it, why do we call it a disorder? That title, in 

itself, implies ramifications that last forever. It is an injury, a combat injury, just like getting shot. And with proper care and treatment, soldiers can heal from this injury and can be as productive 

and as healthy as before. 

We, as a country, have the technology to create the most highly 

advanced military system in the world, but when these veterans 

come home, they find an understaffed, underfunded, underequipped 

VA mental health system that has so many challenges to get 

through it that many just give up trying. The result is the current 

suicide epidemic among our Nation’s defenders, one of which was 

our son, Specialist Timothy Noble Bowman, a 23-year-old soldier 

and our hero. Our veterans should and must not be left behind in 

the ravished, horrific battlefields of their broken spirits and minds. 

Our veterans deserve better. 

Thank you, Mr. Chairman. 

[Applause.] 

[The prepared statement of Mr. and Mrs. Bowman appears on 

p. 68.] 

The CHAIRMAN. Mrs. Bowman, do you have anything to add? 

Thank you for being here with Mike. And, again, thank you for 

your courage in being here. 

Mr. Michaud, you are recognized. 

Mr. MICHAUD. Thank you very much, Mr. Chairman and Mr. 

Ranking Member, for having this very important and timely hearing today. 

And it is going to be a tough day going through all of the testimonies, but I appreciate your remarks, Mr. Bowman. 

Thank you, Mrs. Bowman, for coming. 

Our soldiers, as you know, put their lives in harm’s way to protect our country. Not all wounds are physical. The memories of the 

war do not disappear when they take off the uniform. A lot of us 

have seen the casualties of war. Maine recently lost one of its sons 

to suicide. Kyle Curtis, who served in Iraq, took his own life, like 

your son. 

My question is: When your son came back, did he try to get some 

assistance from the VA? Did either one of you notice any changes 

in the way your son was acting? Did you try to see or to encourage 

him to get help? 

Mr. BOWMAN. Timothy was a very smart kid, for one thing, and 

that gave him the ability to—as soon as he would start to open up 

in a situation where he thought his anger or his drinking problem 

or any sign that he was having trouble was going to be visible by 

us, he would immediately change the subject, or if we were sitting 

around our patio, he would go home. He would find a way to leave 

that situation that was putting him in that position, so that he 

could close that door in the back of his mind again and go on to 

something else. 

He had shown us small signs but not enough to trigger anything, 

because we did not know what we were looking for. And we, as NaVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 E:\HR\OC\39647.XXX 39647

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tional Guard families, are never educated on what to look for, because it is volunteer. You know, you show up at a readiness group 

meeting, and there is somebody there who gives us a 10-minute 

briefing. That was 2 months before the guys got home. Then you 

go through the process of the homecoming, and you realize that 

they are going to be changed when they come out of combat. That 

is fact. So then they hit your back door, and sure, there are some 

issues that you see, yet they think it is normal, and they portray 

it as being normal, and they tell you that it is normal. ‘‘This is just 

the way I am now.’’ 

Now, he showed us one little sign. He showed certain friends 

other little signs. If we had all gotten together, we would have seen 

a larger picture, and we would have known he was in more trouble. 

But he was so good at hiding that that nobody knew for sure. 

And he was a model employee. He worked for me in the family 

business. We have an electrical contracting business. He would 

have been the third generation in 40 years. He was an absolute 

model employee. He went to work every morning regardless of 

what happened the night before or anything else. So, you know, 

you would discount any problem he was having at night because 

he did such a good job during the day. 

So trying to read the picture was very, very tough for him, especially with our not being educated on what the signs should be. 

Mr. MICHAUD. Not knowing where you live in relationship to the 

VA hospital, other than providing resources to the VA so they can 

hire staff to take care of the need that is out there, as well as to 

provide additional resources so if you live in a rural area, they 

could contract with providers in a rural area, do you think it would 

be helpful if the VA established a program for those individuals 

who might not want to go to the VA facility to have counseling online, on a computer? 

With technology today, a lot of individuals, particularly our 

younger individuals, are on the computer all of the time. Do you 

think it would be helpful if the VA established a program where 

someone could actually access help from home, whether it is to a 

clinic or to the VA hospital? 

Mr. BOWMAN. I would say, yes, definitely. As in the case with 

Tim and with a lot of his unit buddies, they are very well-computer-connected. They stay connected with us now via e-mail and 

by all kinds of ways through the computer. 

I would think that would be an easy way, especially as long as 

they can enter it anonymously, because you have the stigma of, if 

you walk into a VA clinic, somehow that information is going to get 

back to your commanding officer. And until that stigma is removed, 

that you have just admitted to having a mental health issue, they 

have to be able to find help in some way so it is not going to come 

back to haunt them in their careers. 

A lot of these guys who come home from Iraq, a lot of the guys 

in Tim’s unit are 10-years-plus in the National Guard. They want 

to get to their 20 years. They do not want to get out. So they do 

not want to have a problem with their careers down the road, 

which means they also do not want to have a problem with promotions. And it is a known fact that if you voluntarily admit that 


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you have a mental health issue that your chance of progression in 

the military ranks at that point is pretty well shot. 

So, with the computer, it is if you can make it anonymous and 

can make it helpful. By ‘‘helpful,’’ I mean it is peer-to-peer counseling. 

We had a discussion this morning about this very issue. The Vet 

Centers were a wonderful idea, but then all of a sudden, the VA 

comes along and they decide they have to have a guy with a title 

and a suit as a counselor at the Vet Center. Now, what did that 

do? That took that soldier who was walking in with that issue and 

made him on the defensive right off the bat. He was not talking 

to his peer anymore. He was talking to somebody who was sitting 

at another level above him. 

If you take a Vet Center and you make it a room with a couch 

and a pop machine and you put guys in there who are not in uniform and who are not in a suit or anything else and they just sit 

and talk, you will have veterans opening up. But if you take a guy 

with PTSD and you shove him in a room with a doctor in a suit, 

he is going to shut that door. 

Mr. MICHAUD. Thank you very much. It has been very helpful. 

Once again, I am sorry for the loss of your son, but I really appreciate both of you and your willingness to come forward to talk 

about your tragedy in order to help others who have not taken 

their lives. Hopefully, we will be able to move forward in a positive, 

productive manner. 

So, once again, thank you very much for coming here today. 

Mrs. BOWMAN. Thank you. 

Mr. MICHAUD. Thank you, Mr. Chairman. 

The CHAIRMAN. Ms. Brown-Waite, you are recognized. 

Ms. BROWN-WAITE. Thank you very much, Mr. Chairman. 

Mr. and Mrs. Bowman, all of us here who are parents can only 

imagine what it is like to lose a child. It is the toughest thing that 

a parent ever does. 

One of the questions that I was just asking counsel was—I do not 

believe, in many of the Community-Based Outpatient Clinics 

(CBOCs) where they offer mental healthcare, that that information 

gets back to the commanding officer. And I think we need to look 

at that. I know the CBOCs in my district consider anyone who 

seeks mental health or any kind of care as a VA case, and it is not 

reported to the National Guard commanding officer or to the Reserves or even if the person is ready reserve call-up. 

Tell me why you believe that—tell me why veterans who have 

served believe that the information gets back to the commanding 

officer. 

Mr. BOWMAN. The 118 soldiers who were in F202 have basically 

all—they have all adopted us. We are their adoptive parents now, 

and they are all our adopted sons. I talk with these boys all the 

time, and they open up to me because they know that I will understand about their mental status. They ask me questions about Tim. 

I have a list as long as my arm of soldiers in that unit who are 

all seeking counseling of some form or another privately, all away 

from the military, away from the VA, some as far as 100 miles 

away from home, to make sure that that information does not get 

back to their unit. 


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Now, you say that that information should be kept anonymously 

by the VA and should never make it back. If that is true, then you 

are not—I am sorry, not ‘‘you’’—then they are not educating the 

rank-and-file soldiers to let them know that it is safe to go to the 

VA. You have to change that stigma. 

And I know for a fact that I can call four or five guys right now 

who will tell you the same thing. They are all active-duty National 

Guard. They will not go to a VA center for this because they are 

going back. My son’s unit is going to Afghanistan in the spring, and 

they do not want to risk a redeployment opportunity by having a 

mental health issue all of a sudden show up on their records. 

Ms. BROWN-WAITE. Please do not misunderstand me. I am not 

questioning it. I am just saying what I believe is the policy. I will 

certainly check on that, as to if someone goes to a VA hospital or 

to a CBOC, that that information is kept private. Certainly, under 

Health Insurance Portability and Accountability Act (HIPAA), for 

example, which covers the privacy of medical records, that would 

be absolutely prohibited unless the patient releases any information. 

So what I am saying is, believe me, I do not think there is a person on this panel on either side of the aisle who would ever stand 

for, if that is the policy, its continuing. If it is not the policy, I 

agree with you, it needs to be out there loud and clear, absolutely 

loud and clear, to our military. 

The last casualty in my district happened to have been someone 

who was active-duty who committed suicide. I do not believe that 

the people who are active-duty even are properly informed. In this 

case, the young man was crying, and one of his buddies came up 

to him and said, ‘‘Can I help you? Do you need to talk to someone?’’ 

He said, ‘‘Yes.’’ So the buddy left to go get the chaplain, and in the 

meantime, this young soldier committed suicide. What should have 

happened was, if it were just the two of them, he should have 

stayed there with him and should have gotten, called, you know, 

just perhaps gone outside the door and called for help. So there are 

certainly ways that we could do a better job at suicide prevention. 

Again, thank you very much for coming and for sharing your 

story. And I will follow up on that issue. 

Mrs. BOWMAN. Thank you. 

Ms. BROWN-WAITE. Thank you. 

The CHAIRMAN. Thank you, Ms. Brown-Waite. 

By the way, I would not just concentrate on the official records, 

on whether they are sealed or not. It is the knowledge of when 

someone walks into a clinic. People talk; their buddies talk. The information is there even if the exact record may not be held. It is 

that information and that sense that seeking help is itself the problem for the military. 

So, you know, when you are in a small community like this, everybody knows what everybody is doing. I would think that that is 

more of the sense than someone’s individual record being given. 

Would you agree, Mr. Bowman? 

Mr. BOWMAN. Yes, it very true, especially in a National Guard 

unit because, traditionally, those men are closer than a regular 

military unit because they all live in the same neighborhood also. 


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The CHAIRMAN. Mr. Hare, I know the Bowmans live near your 

district. 

Mr. HARE. Thank you, Mr. Chairman. 

I want to thank the Bowmans for their courage in coming today 

and for telling the story, the chilling story, about your son, Tim. 

I had the opportunity to sit with both of you this morning with my 

friend, Representative Manzullo. I cannot begin to express my sorrow for your loss. My son is about the age of your son. 

I find it appalling that you have not received the Purple Heart 

for your son, and I want you to know, this morning, Representative 

Manzullo and I will work very hard, and we promise you that we 

will get this situation taken care of quickly. I cannot imagine that 

that is something that has not already been done, but we will work 

on that. 

Your son was a brave young man. He served this country honorably. We talked a lot about some of the things, about Iraqi veterans 

and Afghanistan veterans coming back. One of the things that you 

talked about, Mr. Bowman, too, was about how on a Monday you 

are in Iraq and on a Thursday you are home. You may be playing 

soccer or watching your kid’s soccer game or doing things, but it 

is a very different war, and it has put tremendous stress upon people. 

I just want to ask a couple of things of both of you. We talked 

about this this morning, but I think, for the record, it is important. 

You know, the Chairman has a wonderful idea, and that is to 

screen every person who comes back for PTSD. You know, Representative Murtha said if you are in combat for more than 6 

months you are a prime candidate. For those particularly in the 

Guard and in the Reserves who have to come out and say, ‘‘Hey, 

I think I have a problem here,’’ they are really setting themselves 

up, as you said, for a possible loss of employment, a possible loss 

of being redeployed again in their units. So I wonder if you think 

that makes sense, from a perspective of testing everybody. 

But also, I was amazed when you said you only had a 10-minute 

briefing prior to your son’s coming home. A lot of parents—I know 

Mrs. Bowman this morning was obviously very upset. You do not 

know what to look for. This is not just an individual problem. It 

seems to me, Mr. Chairman, this is a problem that affects the entire family. How do you know what to look for if you do not know 

what to look for or know what the signs are? 

So it puts you at a handicap, and then the parents and the family end up feeling like somehow they could have intervened or 

should have intervened, but if you do not know what you are looking for, you are relying upon bits and pieces. Like you said, Mr. 

Bowman, different groups of people had to come up and say, hey, 

Tim said this or Tim said that. 

So I don’t know. If you would spend maybe just a couple of minutes talking about the need—and I thoroughly agree with the 

Chairman that every person coming back should be screened. I 

think we should look farther down the road, because it does not 

necessarily manifest itself within 30 days of coming home. It could 

be 4 or 5 years. We have seen this. 

Then also, maybe, just how little knowledge you had or the families had before your sons and daughters were coming back from 

this war to know even what to look for. 


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Mr. BOWMAN. The redeployment process, basically reintegrating 

back into society—we were talking with Chairman Filner last night 

about the unboot camp, the reverse boot camp. It is something that 

we have lobbied with the Illinois National Guard for a long time. 

You cannot just educate the soldier; you have to educate the family. 

Now, obviously, I am speaking from the standpoint of a National 

Guard parent, but Army Reserves and Marine Reserves would 

pretty well fall into the same category. I have a young Marine Reservist who lives right up the road from me who is going through 

the same type of scenario right now. 

You cannot make it optional. Our education meeting from the 

State Family Readiness Group was optional. You did not have to 

be there as a family member. So, out of 118 families, we might 

have had half of them there, so there were 50 families who were 

there. The meeting was about an hour long. 

We spent, I would say, about 10 minutes with a brochure on 

PTSD, and then the rest of the time dealt with the health insurance, because, see, a lot of these guys have families. They need to 

know when the health insurance runs out, their last check. They 

need to know all of the financial aspects. When does my husband 

have to go back to work? When does my son come off of Federal 

title and go back onto State title? 

It is all of these questions because, at that point, those are much 

higher on the priority list than PTSD. So you start out the meeting 

talking about health issues, and that gets shoved off to the side. 

Then they hand you a magnet with a bunch of phone numbers on 

it that says, ‘‘Here is where you call for help.’’ 

It does not work because the excitement of the moment, the excitement of the homecoming overtakes everything. So you have to 

come back to the issue after they are home. There is a 2-week period of coming home. Let them be with their families for a couple 

of weeks, and then bring them back. It has been a long-talkedabout idea through a lot of families. Bring the families with them, 

and do not make it optional. Yes, you are going to have to pay for 

it because a lot of these guys have kids, but what would you rather 

pay for, a couple of weeks in a camp where you can educate the 

family and the soldier or looking at another statistic and another 

news report where you have lost another veteran to suicide who 

took his own life? 

You have to make it appealing to people. You cannot make it 

something that is so absurd or grueling that nobody is going to pay 

any attention. 

Mrs. BOWMAN. It is one more battle. 

Mr. BOWMAN. Yes, it suddenly becomes another battle, exactly. 

There are ways to do that. You know, you get the right people 

involved in the situation. You look at how you can educate kids 

with cartoons and video games and how they excel with that type 

of training because they relate to it. And that is the kind of re-education that not only the soldier needs but the families need and all 

of the family. 

Mr. HARE. Just one final thing. I know I am out of time. 

With regard to the price, the price that your family has had to 

pay, and particularly for those people who have lost their lives because they did not know where to go, I do not think we even ought 


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to be quibbling over whether or not we can afford to do this. This 

is something that I think we have a moral obligation to do for the 

men and women who serve this country. 

So, with that, I yield back. 

The CHAIRMAN. Thank you, Mr. Hare. 

Mr. Stearns. 

Mr. STEARNS. Thank you, Mr. Chairman. Thank you for holding 

this hearing. 

Let me echo sincerely the comments of my colleagues, in which 

we are very sorry for this tragedy. Having three boys, I think anybody who has children certainly identifies with the grief that you 

are going through. 

But I would say to you, in all candidness, that your coming here 

is good for us, but it is probably good for you to talk about it and 

to tell us, in the ways that you are doing, so that we better understand. As to the actual telling of it to us by you, I think and hope 

and pray that it helps you too, as you mentioned that you have 

post traumatic stress symptoms yourself. Obviously, every death is 

a tragedy, but losing those who fought so bravely to protect us in 

this room, and in this country, is something that we cannot discount and that we cannot brush aside. 

In hearing from your testimony that he was one of those who 

spent 4 months on the most dangerous road in Iraq, going from the 

airport to the Green Zone, Members of Congress go to Iraq, but we 

fly by helicopters from the airport to the Green Zone, so we are not 

in that dangerous zone. 

I read also that you indicated that his Purple Heart has still not 

arrived. Is that true? 

Mr. BOWMAN. That is correct. 

Mr. STEARNS. That is something that we will look into, too. 

The thing that struck me about this is—and Members will talk 

about this. Mrs. Bowman, is it possible I could ask you a question 

and get your feeling too? I notice your husband is doing all of the 

talking. 

When you look back at it, do you think the Veterans Administration, if they sent people to your home—I know I asked the staff 

here, does the Veterans Administration have counseling? It says 

they provide readjustment counseling and outreach services to all 

veterans who serve in any combat zone. Services are also available 

for their family members for military-related issues. Veterans have 

earned these benefits, and these services are provided to them, but, 

I mean, that means you have to go to the Vet Center to get it. 

So, Mrs. Bowman, in retrospect, is there something that the Veterans Administration could have told you or something that you 

could have done, where you felt that you just did not have the psychological skills or that you did not have the education? I mean, 

is there a void there that we, as Members of Congress, could legislate and could tell the Veterans Administration that we are not 

going to wait for the families to come to the Vet Centers and that 

we are going to send the people to you once we identify those individuals coming back? 

Mrs. BOWMAN. Right. It is just like my husband said. If we would 

have been included with Tim in some kind of a program where we 

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ing or a one-on-one with all three of us or with the two of us, as 

far as what we have seen or have not seen, and Tim on his own, 

so that we could, you know, get together and realize there is an 

issue here and that they could now help us deal with this and give 

us the tools to do that. 

Mr. STEARNS. I have been in hearings for something like this, 

and I chaired a Subcommittee on Commerce, Consumer Protection 

and Trade, and we dealt with families who had children who took 

steroids and who committed suicide. So I have looked at this. 

What I found is that, if there is employment for the individual, 

that is a big step—but Timothy had employment—and if he is adequately compensated and has enough cash flow or something so 

that he at least is not on the edge there. Secondly, it is that he has 

significant counseling by folks, and if necessary, he is provided 

medication. 

Was he provided medication? 

Mrs. BOWMAN. He did not ask for medication. 

Mr. STEARNS. He did not ask. Is there a reason why he did not 

ask? 

Mrs. BOWMAN. He did not realize he had the problem he did. 

Mr. STEARNS. So he did not even realize that this post traumatic 

stress disorder was affecting him, and he was not receptive to 

counseling or to the medication? 

Mrs. BOWMAN. No. 

Mr. STEARNS. Okay. Then the last thing I found was some kind 

of education. Did he have a high school degree? 

Mrs. BOWMAN. Yes. 

Mr. STEARNS. He did. Okay. 

So, once those three are in place, then the building of the selfesteem is the key. And the parents somehow have to convince him 

or her that everything is going to be all right; we are going to work 

through it. In this case, it did not happen, and it is so tragic and 

sad. 

I think, as legislators, we can direct the Department of Veterans 

Affairs to not only brief you but to come into your house and set 

up perhaps a casual type of counseling where the veterans themselves, who are back and who are, shall we say, aware of this problem, can sit down with Timothy and say, ‘‘Okay, let’s shoot the 

breeze here and talk about it. What is happening in life? Who are 

you dating?’’ and things like that. So, I mean, that is what you are 

telling me would have been a big step. 

My last thought here is that both of you feel that you were—or 

were not—adequately briefed enough to know how to help Timothy. 

Can you just elaborate on that a little bit? 

Mr. BOWMAN. No, we were not briefed on what direction to send 

him. The only information we got was, like, of a mandatory nature. 

Before you could do anything, as far as getting him help, you had 

to get him registered with the VA. He had to go to the VA office 

with his DD–214 and get registered there, and then you could start 

the process. 

He came home with a battlefield injury that was going to be with 

him for the rest of his life, a broken hand that was a little bit 

handicapped after combat. So he needed to go to the VA because 

there was some follow-up surgery that was going to need to be done 


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in a couple of years. In order to do that, you have to register. Well, 

he finally did that, but he was home for about 7 months before he 

registered. 

A lot of the guys who came out of combat were like that. They 

would not take that step to go get registered at the VA. It was almost kind of a mental block that they just kind of did not want to 

do it. Then one of the guys in the unit started working at the VA 

office, and then all of a sudden they all started rolling in, because 

everybody started pushing them. 

Tim had an appointment with the VA that was actually scheduled for a couple of weeks after he died. We got a reminder letter 

in the mail that, you know, gave me the appointment time and 

stuff. And I stopped up at the clinic in Freeport to see what it was 

about, and of course, they couldn’t tell me because of HIPAA, so we 

don’t know if that was about his hand. It would have been his first 

appointment. We don’t know if that was his hand or what it might 

be. 

As long as we have brought the VA registration issue up, one of 

the things that has always kind of bugged me about this is that 

a veteran has to go to the VA office with his DD–214. Why isn’t 

the VA sitting there when they get off the bus when they are coming home from Iraq? There are 118 guys coming off of three buses 

at a National Guard armory. Why don’t they have somebody at 

that armory with a computer and a desk, registering them before 

they can go home? 

They are coming out of combat. You know that they are going to 

need help. Sign them up right there. That way, you know where 

they are, you know who they are, and they are in the VA system 

right away. Don’t make it so that the soldier has to go to the VA. 

Make the VA go to the soldier. 

[Applause.] 

Mr. STEARNS. Thank you, Mr. Chairman. 

Just a point in passing for Members. There are tests, written 

tests, that soldiers can take when they get out that, once you take 

these tests—it is just a question and answer over a period—they 

take this test, it will tell them of their post traumatic stress disorder, tell them of their depression and their emotional disability. 

And once they know that I would think that would be a step, too. 

The CHAIRMAN. But, Mr. Stearns, we have lots of evidence that 

those are not, one, filled out accurately. Because, again, the soldier 

knows if he checks anything he is going to have to stay and not 

get home; two, his deployment is threatened; and, three, commanding officers have called in soldiers who have made the wrong 

check on those questionnaires and said you are going to have problems unless you change that. So, as I said in my opening statement, the whole culture of the military is set against him. He is 

not encouraged nor shown the importance of talking about this and 

getting help. 

Mr. STEARNS. Thank you, Mr. Chairman. 

The CHAIRMAN. Mr. Rodriguez, who in his former life was a professional mental health worker, so we thank you, Mr. Rodriguez, 

for your involvement on this. 

Mr. RODRIGUEZ. Mr. and Mrs. Bowman, first of all, thank you 

very much for your testimony. I know that it is difficult, and it is 


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also hard to hear these types of tragedies. But it is something that 

we have to dialogue about and hear about in order for us to start 

doing something about it, and I want to thank you for coming forward. 

I have had a situation in Eagle Pass, Texas, where one of my soldiers had communicated with his family and seemed in good spirits 

and then the next day committed suicide. And he was a soldier. So 

when you commit suicide and you are in the military, that person’s 

body was brought back and was treated in a very different way. 

Here is a soldier who committed suicide while in duty. 

And I just had another request from another community on a soldier whose parents noticed—this was going to be either the third 

or fourth time they were going to go to Iraq—noticed that there 

was something very different about their son. And I made some 

calls, and I had difficulty trying to see if we can just get some 

treatment for this soldier prior to getting sent to Iraq again. And 

I know the family, so there was no issue as it dealt with the courage that was needed in order to go there or anything like that. It 

had to do with some mental health problems that they had encountered. And so, somehow, that issue of stigma has to be something 

that we need to work on. 

And as indicated earlier, I know our Chairman, Bob Filner, has 

talked about providing treatment for every single soldier; and that 

way that stigma would not be there for a period of time. And sometimes you are not able to pick up on that diagnosis initially until 

much later, and so we have to be able to come back a year later. 

And I just wanted to see if you might have any reflections on 

that? How long before you witnessed anything or you were able to 

pick up on something from the very beginning and how long was 

he out from the military before. 

Mr. BOWMAN. He came home in March of 2005, March 29—— 

Mrs. BOWMAN. Nineteenth. 

Mr. BOWMAN. Okay—and he died on November 24th of 2005. So 

he was only home for 8 months before his demons took him over. 

And, like I said before, his symptoms, he concealed them so well 

that we could see that there were maybe some problems, but you 

couldn’t identify—you couldn’t put the pieces together to make the 

picture clear enough to be able to push him toward a certain area, 

certain direction. 

The check-ups—the after-action check-ups when they come home, 

we feel, are extremely important. When they get off the bus, get 

them in the system, get them home for a couple of weeks, bring 

them and the family back, go through the demobilization, unbootcamp process with everybody, however long that takes. 

But then bring them back in 90 days. Bring them back in for 1 

day, a Saturday, a Sunday, then wait another 90 days, and then 

maybe you stretch it out to 6 months the next time. But don’t just 

come to a point and stop and then throw them away. 

We can track a cow with mad cow disease to the middle of a pasture in Montana. You have got to be able to track these veterans. 

And you don’t make it optional, which means you have to pay 

them for it. It goes back to the price, but the price is small compared to what the veteran will pay and his family. Bring him back 

in. The symptoms of PTSD will manifest themselves anywhere 


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from 30 days to 5 years. So you have got to know what you are 

looking at, and you have to be able to see down the road, and the 

evaluations have to mean something. They can’t be that four-page 

test that Tim took when he was at Fort Carson. I have got that 

test. It is a joke. 

Mr. RODRIGUEZ. Let me also thank you for your testimony and 

also indicate—and I want to take this privilege to recognize 

Umberto Aguirre from Del Rio, who is here, and the GI Forum. 

Will the members of the GI Forum please stand? 

I want to personally thank them, because they have been working with our veterans. I know we have some homeless shelters 

throughout the country and some training programs and these veterans have continued to reach out to a lot of the veterans out there. 

And I want to personally thank the GI Forum. Thank you for being 

there and all the leadership of the GI Forum and thank you very 

much for your testimony. 

The CHAIRMAN. Thank you, Mr. Rodriguez. 

Mr. Boozman. 

Mr. BOOZMAN. Thank you, Mr. Chairman. 

I just want to thank you for your testimony. It was very helpful. 

We certainly appreciate the sacrifice of your son and sacrifice of 

your family. My dad did 20 years in the Air Force. 

And, again, it is a matter of resources. We need to put a lot more 

resources in the area. Your son, you know, we can talk about, oh, 

not reporting for a variety of different reasons; and, you know, I 

didn’t have the privilege of knowing him. But sometimes it is that 

you are afraid of it being a stigma on your report for future promotion or whatever. 

And then a lot of times with guys—and a lot of my friends were 

this way—it is also an admission of a personal weakness perhaps 

that you didn’t think you ought to be having. I don’t mean that as 

a personal weakness, but the connotation, you know, I am having 

these feelings that I shouldn’t have, and I am a tough guy and you 

don’t—you know, like I say, tough guys are like that. 

So we just need to get it figured out. We need to put a lot more 

resources. Some States are doing a much better job than other 

States right now. We need to look at the States who are doing a 

really good job. And then, again, when it comes down to it, require 

a very high level of care, a very high level of how we attack this 

problem, and then just mandate that we get it done and provide 

the funding. 

So, again, thank you very much for being here. It was very, very 

helpful. 

Mrs. BOWMAN. Thank you. 

The CHAIRMAN. I just want to ask unanimous consent that our 

colleague from Rhode Island, Mr. Kennedy, who is the author of 

the Mental Health Parity Act, be allowed to join us, at the dais for 

the Committee hearing today. Hearing no objection, it is so ordered. 

I now recognize Mr. Mitchell, who is Chairman of our Oversight 

and Investigations Subcommittee, and was the first one to make 

sure that we followed up on that CBS News report with this hearing, thank you. Mr. Mitchell. 

Mr. MITCHELL. Thank you, Mr. Chairman. 


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First, Mr. and Mrs. Bowman, I want to offer my condolences. I 

want to thank you for having the courage to come forward today 

and share your son’s story. 

You spoke in your testimony about the VA’s reaction to the CBS 

News investigation about veteran suicides, and I guess I would like 

to know this. How did you feel when you heard the VA’s reaction 

and did it make you feel like the VA was working to help families 

like yours? 

Mrs. BOWMAN. No. 

Mr. BOWMAN. My wife can attest to the fact that when I saw Dr. 

Katz’s reaction on the TV, the first thing I wanted to do was reach 

through the screen and choke him. That as a family member was 

my reaction to their response to that number. Why not take that 

number and say, you know, oh, my God, we have got a problem 

here. Let us do something about it. This is obviously an issue. But 

instead it is, let us pick on the guy who put the number together. 

You know, I don’t get it. As a family member, I was appalled. I 

was absolutely appalled. It is just one more case where the VA let 

the veteran down. 

Mr. MITCHELL. Thank you. 

The CHAIRMAN. Thank you, Mr. Mitchell. 

Ms. Berkley. Again, thank you for your leadership in this area. 

Ms. BERKLEY. Thank you, Mr. Chairman. I appreciate the fact 

that you have scheduled this hearing, and I appreciate Mr. and 

Mrs. Bowman for being here. I know it can’t be an easy thing for 

you, but we appreciate it very much. 

When somebody dies from my home State of Nevada in the line 

of duty, I call the family, and it doesn’t matter whether they live 

in my district or not. I think it is the only right thing to do, to offer 

my condolences, not only as a congresswoman but as a parent and 

a mother who has sons of her own. 

Earlier this year, I had the occasion of calling a grandmother 

who raised her grandson. He had served one tour of duty in Iraq; 

and he had come home to Pahrump, Nevada, which is a very small 

bedroom community outside of Las Vegas, and was emotionally a 

mess. And he told his grandmother he cannot go back. He cannot 

go back. He doesn’t care if goes to jail. He doesn’t care if this happens, if that happens. 

Now, the military’s response to him was to give him Valium and 

send him back. He was back for 24 hours, and he blew his brains 

out. It was in this context that I spoke to his grandmother to offer 

my condolences. Now, I could talk to this woman for the rest of her 

life and I could never heal the hole in her heart that she will have 

for the rest of her life. 

There are so many statistics. I have got pages of them in front 

of me now, and you are living this. And it is important for us to 

recognize, and I think just by holding this hearing and bringing 

this to the attention not only of the American people, but of Members of Congress, we are making a giant leap forward. Because a 

generation ago, even a decade ago, this conversation could not have 

taken place. 

Mr. BOWMAN. You are right there. 

Ms. BERKLEY. I came from the Vietnam era. That was my war. 

I was in college. Now, I meet with my Vietnam vets all the time 


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back in Las Vegas. Most of my homeless in Las Vegas are Vietnamera vets. I talk to them. I have normal conversations with them as 

if I was sitting there talking to you. 

But they came back messed up, and we didn’t recognize that 

there is a mental health price to pay for service to our country. You 

can recognize a wound and treat it, but we were so ignorant of the 

fact that people, men and women, are coming back with wounds 

that we cannot see. 

Taking care of these veterans, taking care of our National Guard 

members, taking care of our military is the cost of waging war; and 

this is not an area that can be short-changed. It should not be 

short-changed. 

Now, I had another constituent, Lance Corporal Justin Bailey. 

He returned from Iraq with PTSD. He developed a substance abuse 

problem. And he came from a nice middle-class family. His father 

is a teacher in my district. They are normal, average, good Americans that believe in this country, believe in the cause and believe 

that their son was serving his country. 

He came back with undiagnosed PTSD. They know it now. He 

developed a serious substance abuse disorder. They begged him to 

get help through the VA. He didn’t want to go. They convinced him 

to go. He went. Now, he was on five different substances when he 

checked himself into the VA. The VA gave him two more medications, and 24 hours later he was dead at the VA. 

I tell you this because if we don’t have—we can pass every law 

in the world here, but if we don’t have adequate education, if we 

don’t have adequate training, if we don’t have adequate personnel 

that can recognize the problem when they see it and confront it, 

nothing we are doing here is going to make much of a difference. 

So I have introduced a Mental Health Improvement Act which 

aims to improve the treatment and services provided by the VA to 

veterans with PTSD and substance abuse disorders; and I am hoping that my colleagues, particularly here on the Veterans’ Affairs 

Committee, will join me in co-sponsoring this legislation. 

It isn’t enough to recognize the problem, although we are moving 

forward in that direction, and I think it is good. It is not enough 

to pass legislation. We have to ensure that once these young men 

and women get into the system that the system knows what to do 

with them, and this legislation I hope will help that. 

I want to thank you again for being here and hope that your 

tragedy will kick-start this legislative process so that we can protect our men and women in the military when they come home 

from their service. Let us eliminate the stigma attached to mental 

health problems and mental health issues. 

And you are so right, and so many of my colleagues that have 

mentioned this, you are right in saying the VA and the Department 

of Defense need to go to our fighting men and women, not the other 

way around. We will save countless numbers of lives and improve 

the quality of their lives for the rest of their lives. And I thank you 

very much. 

Mrs. BOWMAN. Thank you. 

Mr. BOWMAN. Thank you. 

The CHAIRMAN. Thank you. 

Mr. McNerney. 


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Mr. MCNERNEY. Thank you, Mr. Chairman. 

I don’t have any questions, really. I just want to thank the Bowmans for your courage in coming today, and I think it reflects 

honor upon your son. Now it is our duty to learn from your experience and see that some of these changes are implemented that will 

make a difference in people’s lives, particularly your observation 

that help should be anonymous and helpful, as well as your suggestion that post-deployment treatment be mandatory. We will be taking a look at those. 

Thank you for your courage. 

That is all. 

Mrs. BOWMAN. Thank you. 

Mr. BOWMAN. Thank you. 

The CHAIRMAN. Thank you. 

Mr. Walz, who, I just want to tell the Bowmans, is the highest 

enlisted man ever to be elected to Congress and has lots of experience, decades with the Minnesota National Guard. And also, they 

have a program that he might want to describe, the Yellow Ribbon 

Campaign, which tries to deal with the returning servicemembers 

in a way that at least starts on the path that you have suggested. 

Mr. Walz, thank you for your efforts. 

Mr. WALZ. Thank you, Mr. Chairman; and thank you, Mr. and 

Mrs. Bowman, for being here. There are no words that are going 

to be said here that are going to ease the pain of your loss, and 

we clearly understand that. I have to say, though, especially Mrs. 

Bowman, you occupy one of the highest and most respected positions in this society as a Gold Star mother. And I have to tell you 

as a Member of Congress and as a veteran and a retired sergeant 

major and a citizen, I am ashamed that you have to come here 

today, that the idea that you would have to come here and ask this 

Congress to do the right thing for your son is absolutely appalling. 

And with all due respect to our news organizations, while I am 

happy they broke that story, there is not a single person in this 

room that doesn’t know this was an issue. There are Members, 

there are people sitting behind you, veterans and advocates that 

have fought decades on this very issue; and I have worked with 

them. They have advocated for this, they have spoken about it, and 

we have seen year after year after year not addressing this in a 

real comprehensive manner. And that is simply appalling, and it 

is a shame. 

And I can tell you there is not a Member up here especially, and 

there is not a Member in Congress, that hasn’t stood in front of soldiers, talked about them, talked about how great they are, but time 

and time and time again this Congress, and all of us are guilty of 

this, have simply failed to move things forward that make a difference. And that is an absolute shame. 

And I have said that there is no one in this country again that 

should ever allow anyone to stand in front of a soldier if they are 

not going to stand behind him and move this, never. We have seen 

those yellow ribbons. Many of them are very faded now, and you 

can barely read them, and the fact of the matter is we haven’t done 

what they said. We haven’t addressed these issues. We haven’t 

taken this in. 


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Senator Dole occupied the same position of both of you, and Ms. 

Shalala, and they sat here and addressed the issue at Walter Reed. 

And Senator Dole was very clear in what he said. He said, you 

spent billions putting them in harm’s way. Spend billions in whatever it takes to get them out. And that is very clear to us what we 

need to do. So there are things here. And Mr. Kennedy is going to 

speak in a little bit, and I think this is an very important piece of 

this puzzle. 

And both of you with your keen understanding of how this 

works, especially from National Guard families, I can tell you this. 

Having been one of those that came back—we were in support of 

OEF, but sitting there with OEF/OIF veterans when we came back, 

they showed us the Horse Whisperer and told us to be nice when 

we went home, and that was the extent of it. That was in 2004. 

Now I am proud to say that, because of the people sitting in here 

and people who came before me, things have changed over the last 

4 years. They have not changed enough. But Mr. Kennedy is following and moving something forward that the late Senator from 

Minnesota, Senator Welch, advocated so clearly, mental health parity and this issue of understanding and destigmatizing mental 

health. 

And I being in there and knowing as a first sergeant knows exactly what you are saying and watching as people aren’t trained on 

this, that there is a discrimination that goes against a soldier who 

has the courage, the fortitude and, as you said, the insight to admit 

this. 

So there are a couple things I want to ask you, because I think 

you do have a keen understanding on this. We started noticing this 

in Minnesota; and the State of Minnesota, under the Adjutant General and the Governor, did something that actually I guess in letter 

of the law violated VA recommendations. We set up a program that 

said, do you know what? This hands-off policy, it is what soldiers 

think they want. The last thing you want when you come home is 

to set meetings and things like that or to talk to anybody. 

What we found was and what the research shows is that most 

of these patterns of behavior and most of this PTSD gets worse in 

the first 90 days. If you can address it early on, while it is fresh, 

in an environment that is nonthreatening and everybody is in it together—we have what we call Beyond the Yellow Ribbon Campaign, and we bring them back right away, and we reevaluate 

them, and we do something this Congress is going to do now to put 

forward. We make sure we are testing them for traumatic brain injury. 

As many of us know—it was the Blind Veterans of America that 

brought it to our attention earlier—we are starting to see a lot of 

veterans with eye troubles that were actually mild traumatic brain 

injury and those types of things. So we are starting to screen them 

early, we are starting to put them in front of the right people, and 

we are starting to bring their families in to understand. 

As you said so clearly, many of us were much older and we had 

children at home. Many of these Guardsmen have not only small 

children, they have teenage children that clearly understand what 

is going on. 


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What we are trying to do and will vote on this later today is to 

get the money to do a pilot program to take this thing nationwide. 

My question to you is, do you think this is the way to go? Is this 

the way to address it? 

Mrs. BOWMAN. Absolutely. 

Mr. BOWMAN. And you need to bring all the soldiers in. One of 

the stigmas that has always been held up, especially with National 

Guard, is they will bring a chaplain or a counselor in for drill 

weekend. And anybody who wants to see the chaplain, he is over 

in room 105. And everybody looks at who is going to walk in that 

door. They know who is going in that door. And the Guard says, 

you know, they have to come to us. So our thought from the very 

beginning is bring them all in. Everybody gets a screening. You 

don’t single out the guy who has a problem. You screen everybody. 

Because half the people who don’t walk in the door have the biggest problems, and you have to screen everybody. That way there 

is no stigma among the unit. Everybody walked through that door 

and saw that counselor. 

Mr. WALZ. Well, once again, thank you. And, again, this group 

behind you, this group sitting out here, they are the ones that are 

going to assure accountability on this. I think the time of lip service has pretty much run its course, and there is going to be a day 

of reckoning if we get this thing right or we get it wrong. Because 

we can’t continue on like this. Especially, as I said, everyone in this 

room knows it is an issue. Now let us fix it. 

I yield back, Mr. Chairman. 

The CHAIRMAN. Thank you, Mr. Walz. 

Mr. Hall. 

Mr. HALL. Thank you, Mr. Chairman; and thank you both, Mr. 

and Mrs. Bowman, for coming here. My condolences for your loss, 

and my thanks to your son for his service to our country. My apologies, as my colleague, Mr. Walz, said, that you should have to be 

in this position. 

All of us who represent the different districts around the country 

have veterans come to us, I am sure, with all kinds of problems 

and especially with PTSD; and no small number of those are either 

suicidal impulses or other clearly identified PTSD symptoms. 

I have a friend who is a Vietnam vet who was diagnosed with 

post traumatic stress syndrome. At the time, it was called PTSS. 

And you said, Mr. Bowman, you thought that the term ‘‘disorder,’’ 

it was counterproductive because it seemed to describe it as something being wrong with a person, as a malady, and it should be 

more treated as an injury of war so that it wouldn’t carry the stigma. 

So I am wondering if perhaps a wording change like that, that 

we do—because words do matter. And what the government calls 

things, the labels we put on them as a society or as a branch of 

government or the VA, for instance, or the medical community can 

stigmatize more or less. So I am curious if you would think that 

something like post traumatic stress syndrome would be better 

than, say, disorder. 

Mr. BOWMAN. I think anything that makes the term something 

that is not permanent. The term ‘‘disorder’’ applies to muscular 

dystrophy, multiple sclerosis, something like that, a debilitating 


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disease that once you get it, you have got it for the rest of your 

life. Now that doesn’t mean that PTSD goes away. But it is an injury that, if it is dealt with in the first 90 days, again, if you can 

combat it early enough, you can reduce its impact to the point 

where you have got a healthy, fully functioning soldier who is actually better off now than he was when he went to combat because 

he has gone through the battlefield, he has gone through the mental anguish of war, and now he has found a way to deal with it. 

Mr. HALL. Thank you. 

And I think it is important that, until we are able to do that, we 

not redeploy combat soldiers who have PTSD. So it is doubly important that we identify all of them, which would reinforce the concept that you have both spoken to, and Congressman Walz and others have spoken to, of bringing all soldiers in for screening, rather 

than just say ‘‘go to door number five,’’ or whatever it is, so that 

they are watched and identified. 

I don’t really have more questions for you. I just thank you for 

being here. 

And I want to say that in my short time in office, my staff has 

helped servicemembers, veterans, ranging from 84 years old, a 

World War II veteran, within the last couple of weeks who we got 

100 percent clarification for PTSD for a soldier who had two ships 

sunk out from under him in the Pacific Ocean in World War II and 

twice found himself floating in the ocean with body parts and 

sharks and other comrades around him and so on and was rescued 

twice. Until 2 weeks ago, having tried repeatedly since the 1970s 

with his friends and with people who were trying to help him, and 

it was just this year that he finally was classified. 

On down through Vietnam-era veterans right up to a 25-year-old, 

twice-deployed soldier who came back from Iraq and spent 2 years 

looking for a PTSD classification. He had all the classic symptoms: 

an exaggerated startle reflex, suicidal tendencies, couldn’t go to 

sleep without seeing in his mind’s eye the picture of his fellow soldiers being killed or of an innocent Iraqi girl who was caught in 

the crossfire in Fallujah and other things. They are images that are 

hard to get out of one’s mind once you have been through that experience. And we were able to get him—because he came forward 

to us, we were able to get him the classification, 100 percent PTSD 

classification. 

But it is the ones who, because they are trying to be strong and 

because they can hide it, as you said, are hard to identify; and that 

is why I think it is critical that we screen everybody. The percentages are running so high that I think that is really the only way 

to be safe and to make sure that we don’t let soldiers like Timothy 

slip through the cracks. 

And, once again, thank you for being here; and, Mr. Chairman, 

thank you for holding this hearing. 

I yield back. 

The CHAIRMAN. Thank you. 

Mr. Snyder. 

Mr. SNYDER. Thank you, Mr. Chairman and Mr. Buyer, for this 

discussion today. 

And I want to thank the both of you, as others have, for being 

part of this national discussion. I hope you are pleased with the 


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kind of comments and discussions that you have triggered here 

today. 

I did not know your son. My guess is that he would be proud, 

as a 23-year-old, of what you are doing today. Because you are not 

doing it for him. You are doing it for the sons and daughters of everyone else around the country. 

I also appreciate the context that you have put this in, which is 

the absolute finality of devastation of suicide is terrible for that 

person and for the family and friends of that person. But in your 

very last line you say, ‘‘Our veterans should and must not be left 

behind in the ravished, horrific battlefields of their broken spirits 

and minds.’’ 

Because somebody does not commit suicide does not mean they 

are out of the ravished, horrific battlefields of their broken spirits 

and minds. And there is a lot of human misery that is out there, 

and we know it is out there. I suspect there is some in this room 

or has been some in this room. 

We don’t do the thing saying, will everybody who needs mental 

health counseling right now or in the last year please stand up and 

go to the door if you would like to be interviewed. Because we all 

have our private moments of devastation. But for some of us 

human beings that becomes something that just eats at you hour 

after hour, day after day, week after week, month after month, 

year after year and, unfortunately, tragically results in suicide in 

some. But it is also tragic if it is untreated for those months and 

years and decades, as you have pointed out in your statement. 

Mr. Kennedy, who I hope we will be hearing from here shortly, 

has recognized through his work for some years now that in the 

private sector, the nonmilitary, nongovernment part of our lives, 

we have not solved this issue of how to deal with mental health 

challenges. A lot of insurance doesn’t cover it. We have a lot of 

human misery out there that goes untreated because people don’t 

know how to get it and pay for it, and that is a problem that we 

have in this country. 

But thank you for your service and being part of this national 

discussion and debate. 

Mrs. BOWMAN. Thank you. 

The CHAIRMAN. Thank you. 

Mr. Kennedy, thank you for your work on mental health parity. 

You and I have talked about these issues for a long time, and I will 

recognize you for any statement or for questions. 

Mr. KENNEDY. Thank you, Mr. Chairman. 

I also want to join my colleagues in offering my condolences to 

you for your terrible loss and say that it is this personal story that 

you have offered that I think is going to be the catalyst for the 

change. Tragically, in this country, the statistics don’t move people, 

but a personal story like yours does. 

The statistics in this country, suicide is twice the rate of homicide in this country. We read about murders every day, but we 

don’t read about suicides every day. It is the silent killer in this 

country. It is epidemic. But your story here today is helping to 

highlight something that is an untold story that is too often the 

case for so many families and now, especially, amongst our returning veterans. 


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So you are, as my colleagues have said, really profiles of courage 

in really sharing your story to benefit other families from having 

to go through what you have been through. So I really salute you 

and thank you for your son’s service. 

My colleagues have referenced the mental health parity bill that 

Senator Paul Wellstone originally introduced that is now actually 

in the midst of being considered between the Senate and the 

House. And it has a lot to do with your story because many of these 

returning veterans, they are all going to be returning to the private 

work force. And, as you know, the stigma continues. And this Committee has set up what are known as Vet Centers because of the 

stigma, because they know many veterans won’t go to the VA for 

their mental health services because they are afraid it will show 

up on their record, and so they set up Vet Centers for that purpose. 

Because of that, you can understand that many veterans may not 

even choose to avail themselves of anything having to do with the 

VA when it comes to mental health; and they may, as now private 

sector employees, choose to get their mental health services 

through the private sector. 

That is why it is even more important that we pass mental 

health parity legislation. Because all these returning veterans will 

need to be covered as private-sector employees, and we have a 

chance now to pass this sweeping parity bill that basically says 

mental health should be treated like every other part of your 

healthcare in a holistic way. 

And it is so very important because of the facts that I have just 

stated, but I wanted to ask you, with respect to families, veterans’ 

families, do you think the VA is doing enough to address the families’ mental health needs as a means to address the veterans themselves, mental health needs? In other words, one of the ways that 

veterans suffer so greatly is when they return their families are 

suffering themselves, having had a very difficult time themselves 

being away from their loved one. 

And what ways do you think, also—do you think that peer-topeer programs like the vet-to-vet support groups are effective? And 

do you think that the VA ought to be taking these programs to 

scale? Meaning do you think that we ought to really ramp them up 

so that they are not just here and there, but they ought to be national, and so that every veteran returning gets to talk to another 

vet, and that we in the Congress support these veteran-to-veteran 

peer support programs? 

If you could comment on those? 

Mr. BOWMAN. As far as the VA help for the families, I have never 

seen a VA person approach me in my entire life. Nobody even came 

to us after Tim died. Nobody offered us family counseling. His battalion commander was checking to find out if we qualified for family counseling after he died, and there is nothing out there for us, 

even though he gave his—as I feel he gave his life for his country. 

So I can’t comment on what the VA is doing for families, because 

I have never seen it. And as being in the National Guard array 

with a lot of the kids that I know, they haven’t seen it either, because they are stretched out. Out of 118 soldiers in my son’s unit, 

there were from 78 or 79 different towns spread across Illinois, 

Iowa, some small towns, some big towns. But nobody has ever 


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jumped up and said, hey, somebody came to me with some support 

information. And we know these families because we have stayed 

in touch with them. So that to me is a gray area. 

Mr. KENNEDY. And you think the families could be a big help to 

the returning veteran. If they knew in advance when their loved 

one was returning more about mental health because they had received some preparation and had gotten some support, they might 

be the greatest resource in that regard. 

Mr. BOWMAN. Yes. Especially with Guard and Reserve. Because, 

as I said, and we saw it with Tim and I have seen it with other 

Guardsmen. They can suck it up for a weekend drill. And they will 

go in and spend a weekend drill and they will look like the most 

normal human being you ever find. Well, who has them for the 

other 28 days out of the month? The family. That is when you are 

going to see the breakdowns, the nightmares, the night terrors, the 

sweats, the screams, the swinging in the middle of the night, sleeping in the closet with a 9mm. All those signs are going to be seen 

by somebody other than Guard people. 

So if you educate the family on those signs then at least they 

have a chance to locate some help for them before it turns into a 

disaster. 

Mrs. BOWMAN. And we ourselves chose to go on our own and get 

counseling. We have been in grief counseling for a year, both of us 

now, as well as our daughter. And it has made a huge difference 

for us. 

Mr. BOWMAN. And mental healthcare for—well, we discussed this 

earlier. I went to our local mental health association, which has offices all over our area. They are supposed to be the place to go. And 

by the time I got done with their initial screening paperwork, the 

financial paperwork, the pre-interview with the caseworker and all 

the other stuff—and I told him right up front, I don’t qualify for 

any financial assistance whatsoever. I am going to pay for this 

visit. Just walk me into a counselor. And by the time I got all done 

and I did get to the counselor I was so mad at the system of trying 

to get there I told her if I was standing on a ledge right now I 

would have already taken the step because I can’t believe what you 

just put me through. And that is what I am supposed to go to as 

a citizen in my own neighborhood. 

Then I go off the grid and find somebody that is a licensed private counselor, and she won’t work in that system because of all 

that paperwork, and she has got all kinds of patients that she sees, 

and she has been very successful. It is frustrating just in the mental health aspect of it. 

Mr. KENNEDY. Well, you just made a great case for mental health 

parity; and we will work on that, too. 

The CHAIRMAN. Thank you, Mr. Kennedy. 

Mr. Buchanan, do you have any questions? 

Mr. BUCHANAN. No. 

The CHAIRMAN. Mr. Buyer. 

Mr. BUYER. Thank you very much. 

And once again, Mr. and Mrs. Bowman, thank you very much for 

being here. 

I would like to make an association toward the comment of Dr. 

Snyder. And you are absolutely correct. We as a country do not do 


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well in not only a tracking system with regard to suicides but on 

the issue on prevention, identifying risk factors and things. So, as 

a country, I agree with you we don’t do well; and it is a subject 

matter that we also don’t discuss much. 

So, as I look at the Center for Disease Control, they put out their 

study, the National Violent Death Reporting System. So, as you 

look into this—now, this is using their reports and status from 

2001, their latest numbers, among Americans ages 15 to 24, homicide is the second leading cause of death; homicide was contributing, an average, of 14 deaths per day in this age group of 15 to 

24. Suicide was the third leading cause of death; and, on average, 

we have 10 deaths per day in this age group of 15 to 24 for suicides 

as a country. 

Then when you look at the propensities—I continue on—the 

males take their own lives at nearly four times the rate of females. 

So 78.8 percent of all U.S. suicides are males. Now, of all males, 

suicide is the eighth leading cause of death, and it is the sixteenth 

leading cause of death for females. 

Now when you look at these statistics—and what is kind of interesting about statistics and numbers and how you analyze these 

things, you also have to look at this a little bit further. Males, 

when they have made this compulsive decision to commit suicide, 

are more effective. Why? Because they use guns. Women don’t use 

guns. Women use pills. And they aren’t as successful at this compulsive decision to end their life. And then it reinforces the other 

statistic that shows that women have a higher statistical average 

to repeat an attempt on suicide. 

So it is interesting when you start reading these statistics, yes, 

they begin to tell a story, but it is not a whole story because we 

don’t have a very good tracking system. We don’t do very good statistics. As a matter of fact, when I looked at this national reporting 

system, really not many States report. You can see that. 

So that is why I agree and associate myself with Dr. Snyder. He 

is absolutely correct. We, as a country, on this particular issue are 

not doing well. 

So in your statement when you said when CBS News broke the 

story about veteran suicide, the VA took the approach of criticizing 

the way the numbers where created instead of embracing it, well, 

I just want you to also know that CBS News—there are other 

writings out there that have highly criticized CBS News and their 

story and the way they came up with their own statistics. My gosh, 

you have the New York Post. Their headline is—they called it 

bogus. I mean, they went after the way CBS News came up with 

statistics. 

What I enjoyed about your testimony today is that, regardless of 

statistics and the war of statistics and how you come up with them, 

there is a challenge in front of us. 

I loved your use of the word ‘‘injury.’’ And I have heard Bob Filner also talk about if you use the word ‘‘disorder’’ there is a stigma 

that is attached with it and we have to come up with a better language. And he is absolutely correct. That needs to be done. And we 

are going to need to work with the great minds of mental health 

to come up with the right language. 


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And to my good friend, the Sergeant Major, this is an issue that 

didn’t happen just because CBS News broke the story in November. 

We are going to have the testimony coming up here by the Inspector General (IG), and the IG is going to talk about their report on 

implementing VHA’s mental health strategic plan initiative for suicide prevention. 

Sergeant Major, this was started in the year 2004. And I would 

agree with you, Sergeant Major, that the VA was very slow in getting this on the ground. And so there I would agree with you. We 

are going to have some testimony coming up on these initiatives, 

and I welcome your participation in that panel. 

I yield back. Thank you. 

The CHAIRMAN. Thank you, Mr. Buyer. 

I would offer, since the television program CSI is so successful, 

stress injury is pretty descriptive, but it is hard to change such a 

thing. 

Mr. BOWMAN. Again, all you have to do to change that term is 

do it right now. 

The CHAIRMAN. All right. We will talk about CSI, combat stress 

injury. I think the next panel may be a—have a—— 

Mr. HARE. Mr. Chairman, would you indulge me for just 1 second 

here? 

Let me just say this to all of you, and I appreciate the Ranking 

Member, but your figures on pieces of paper do not reflect people. 

And, ultimately, just listening to this testimony today, families are 

not brought into this loop when it comes to their servicemember 

having problems. The servicemember is not screened when they 

come back. There is a stigma attached to all of this. 

I agree with my friend from Minnesota. What we have to do at 

the end of the day is to say, ‘‘this is enough.’’ We have hit the wall 

with this issue here, and we have to look at what we are doing. 

The VA has to be much more proactive than they are. These are 

great cards, but if they don’t work they don’t work, and we have 

to figure out what does work. 

So I would just again say to you I want to thank you so much. 

I am so sorry about what happened to you. But we have, as I said 

to you in my office, a moral obligation to try everything we can possibly try to make this better. And if it costs us a few more bucks, 

so be it. But, ultimately, at the end of the day, our job as I see it 

is to make sure other families like yourself don’t have to go 

through the pain that you have had to go through. And I think, to 

be honest, the VA has a whole lot of work they could do in educating the parents and making sure our troops are not singled out. 

So I just want to thank you so much for coming today, and we 

will get this done one way or another. We will get it done. 

The CHAIRMAN. Again, you all have obviously thought a lot about 

this since Timothy’s death. You are very articulate, and you have 

helped us all understand this issue. 

Two major things strike me, in conclusion, about your recommendations. Number one, I think the President and the Administration have been dead wrong in trying to wall off this war from 

public consciousness. They are so afraid of opposition that they 

don’t want to educate people as to what is going on. 


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If all of us—parents, teachers, ministers, employers—know what 

PTSD is, know what TBI is, traumatic brain injury, we can all help 

Timothy; and that is a public education campaign. 

People all over the country want to help. I sat down with the 

Outdoor Advertising Association of America. If they were asked, 

their billboards would be useful for getting people to understand 

what PTSD is, just knowing where to turn to get information. That 

is a public education campaign that I think we have to do. And if 

the President just called any of these people in his office they 

would do it for free as a service to their Nation and to Timothy and 

his comrades. 

In addition—and I have been trying to get this into this year’s 

budget—it is clear from what you say and everything we have 

learned that it should be a part of active duty on either return from 

combat or separation from service—and it has to be not only active 

duty but the Guard and Reserves—go through a process. I have 

called it a ‘‘deboot’’ camp. I have called it basic untraining, decompression. I am now focused on a heroes homecoming camp. That as 

part of your active duty, for whatever number of weeks we can get 

the VA and DoD to agree to, that every soldier with his or her unit, 

with his or her family, gets diagnosed for both PTSD and traumatic 

brain injury. 

Because, as policymakers, I think we have to assume that everybody has it unless we find out they don’t, as opposed to you prove 

to us that you have it and then we set up all kinds of things. You 

don’t have PTSD, you have personality disorder and get rid of you 

that way. So it has to be mandatory; and that allows early treatment, which is absolutely necessary. 

In addition, if you had this heroes homecoming camp, you could 

do job counseling and credentialing and educational counseling. All 

the spouses would be together for mutual support. All the soldiers 

would be together for that kind of comradeship, which was so important for them in combat. 

And I think we just have to do this. We expect kids, as you said, 

to be in Baghdad 1 day and taking their kids to soccer 2 days later. 

It is absolutely contrary to anything that the brain can accomplish. 

So I hope that we can move in those areas. We have to change 

a culture. 

But Dr. Martin Luther King once said, you can’t make a man 

love me, but you sure as hell—I don’t think he said ‘‘sure as hell’’— 

but you sure can make him stop lynching me. That if we have certain laws and behaviors, that will contribute to the change of the 

culture. 

I think your testimony has brought us a long way. You have a 

chance for any last-minute statement. You have been here for almost 2 hours. That is a long time for congressmen and women to 

stay and talk to you, but it shows how powerful your testimony has 

been. And any last statement we would welcome. 

Mr. BOWMAN. Just a couple of things. 

One, I truly—we truly are honored to be here today. We decided 

after Tim died that his death was not going to be for nothing, that 

good would come of his death. It is the only way that we can deal 

with his death. 


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This has been therapeutical for us. There is no doubt about it. 

Because we know that his name has meant something. We know 

that he has already saved lives. 

On another note, I am an Assistant Illinois State Captain for Patriot Guard Riders. If you are familiar with that organization, we 

are the people who stand between funerals and protesters. That is 

my therapy that I have taken on so that I can survive day in and 

day out. 

We have done two funerals in Illinois that were soldiers that 

took their own lives, and I have never been so embarrassed by the 

military in my life as to see the way that those families were treated—no honor guard, no flag folders, no pall bearers, nothing. Patriot Guard Riders folded the flags. We carried the casket. 

There is no reason that every person who served a day in the 

military in this country should not be accorded the military funeral 

rights that every soldier should be given, and that includes the 

most honor you can hand them. Because that honor at graveside 

is what that family will remember. And if you want to help that 

family heal, the country has to remember that they need to thank 

that family for that soldier, and they have to thank that soldier. 

And the only way you have to do that is at the graveside and at 

the funeral. 

And I implore anybody who can work on anything to do that, is 

to make that happen. Because a suicide carries a bad enough stigma with it as it is. I was told after our son died, before his funeral, 

do everything you can for him now, and we did. And his unit was 

home. So all of his unit buddies were there. He was also a member 

of the fire department. Between the two of them, they coordinated 

everything and made it just an absolutely beautiful service for 2 

days. 

But not everybody is that lucky, and I am asking you to help 

those that don’t have those connections. 

Thank you. 

The CHAIRMAN. Thank you. You have honored your son and your 

family, and we thank you so much. 

We will ask the second panel to come forward. 

Again, thank you, Mr. and Mrs. Bowman. We thank both of you 

for joining us. 

The CHAIRMAN. Again, I must introduce you with a personal 

thank you as you all have educated me with your books about combat stress injury and suicide. 

Penny Coleman, whose husband, a Vietnam vet, committed suicide, is the author of Flashback: Posttraumatic Stress Disorder, 

Suicide and the Lessons of War. 

Ilona Meagher is the author of Moving a Nation to Care: 

Posttraumatic Stress Disorder and America’s Returning Troops and 

has taken upon herself to have Web sites which track suicides because her government does not. 

The CHAIRMAN. With that, you have the floor, which—I don’t 

know how you arranged which to go first, but please, Ms. Coleman, 

you are next. 


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STATEMENTS OF PENNY COLEMAN, ROSENDALE, NY, AUTHOR, 

FLASHBACK: POSTTRAUMATIC STRESS DISORDER, SUICIDE, 

AND THE LESSONS OF WAR; AND ILONA MEAGHER, CALEDONIA, NY, AUTHOR, MOVING A NATION TO CARE: POST– 

TRAUMATIC STRESS DISORDER AND AMERICA’S RETURNING 

TROOPS 

OPENING STATEMENT OF PENNY COLEMAN 

Ms. COLEMAN. Mr. Chairman, Members of the Committee, fellow 

panelists, good afternoon. 

I am the widow of Daniel O’Donnell, a Vietnam veteran who 

came home from his war 38 years ago with what is now known as 

PTSD and subsequently took his own life. 

I use the term PTSD grudgingly, like Mike Bowman. It is the official term, but it is deeply problematic. My husband did not have 

a disorder. He had an injury that was a direct result of his combat 

experience in Vietnam. Calling it a disorder is dangerous. It reinforces the idea that a traumatically injured soldier is defective, and 

that idea is precisely what keeps soldiers from asking for the help 

they need. 

I met Daniel 6 months after he returned from Vietnam, and I 

married him a year later. The man I fell in love with was gentle 

and playful and very funny on good days. But there were other 

days when he would fly into rages over trifles and more than a few 

nights when he would wake up screaming and sweating and fighting something terrible that wasn’t there. Or he would take to his 

bed with the blinds drawn sometimes for days, and all he would 

tell me was that he didn’t want to live. 

I thought that if I loved him enough I could fix him. I was wrong. 

I had no idea what I was up against. After Daniel died, I tried to 

blame him, but I ended up blaming myself. 

For my book Flashback, I interviewed other women who lost 

loved ones to suicide in the wake of Vietnam. In addition to their 

grief, these women, like me, lived with guilt and shame and isolation. I now believe that our isolation was exploited to help camouflage a terrible tragedy. 

Unlike Agent Orange vets or Gulf War vets, who have never 

stopped demanding that the VA take responsibility for their illnesses, in the case of veteran suicides the most logical advocates 

were dead. We, their widows, did not become advocates. We believed their deaths were our fault, and we each thought we were 

the only one. 

It is more than 30 years since the war in Vietnam ended, and 

still no one has any idea how many Vietnam veterans have taken 

their own lives because no one has ever tried to track or count 

them. The 1990 National Vietnam Veterans Readjustment Study 

mandated by Congress and government funded, the study that 

proved the syndrome now called PTSD, never even mentioned suicide, in spite of the fact that suicide was central to every study that 

preceded it, including those on which it was based. No data, no 

proof; no proof, no problem. 

The United States invaded Iraq—— 

Mr. KENNEDY. Would you repeat that again? 

Ms. COLEMAN. Which piece? The last paragraph? 


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Mr. KENNEDY. What was left out. What was that study? 

Ms. COLEMAN. The National Vietnam Veterans Readjustment 

Study, which claimed to be the biggest study that had ever been 

done on any demographic group and claimed to address all of the 

issues, the healthcare issues of Vietnam veterans, never mentioned 

suicide or suicidal ideation. 

Mr. KENNEDY. Wow. 

Ms. COLEMAN. It is an astonishing omission. 

The CHAIRMAN. And what year was that? 

Ms. COLEMAN. Nineteen-ninety it was published. The research 

was done between 1986 and 1988, I believe. 

The CHAIRMAN. Thank you. 

Ms. COLEMAN. The United States invaded Iraq in March of 2003, 

and by August, so many American soldiers had killed themselves 

that the Army sent a mental health advisory team to investigate. 

Their report confirmed a suicide rate three times what the military 

considers statistically normal. It also acknowledged that one-third 

of the veterans who are being—of the psychiatric casualties who 

are being evacuated had suicide-related behaviors as part of their 

clinical presentation. Nonetheless, the team’s conclusion was that 

soldiers were killing themselves for the same reasons that soldiers, 

quote, typically kill themselves, personal problems. 

A supplement to the report listed things that soldiers most often 

identified as stressors—seeing dead bodies, human remains, being 

attacked, losing a friend. But the report itself only mentions marital problems, financial problems, legal problems, what they call 

underdeveloped life coping skills. Translation, soldiers are dying 

because they are managing their lives and their affairs badly. 

Every year since 2003, the suicide rate in the military has increased; and another team of military psychiatrists have been dispatched. Their conclusions are always the same: insufficient life 

coping skills. 

As recently as August, Elspeth Ritchie of the Army Surgeon General’s Office insisted that, in spite of the suicide rate that had 

reached a 26-year record high, Pentagon studies still haven’t found 

the connection between soldier suicides and war. There are various 

possible explanations for the Pentagon’s refusal to accept that connection, but one of the most compelling is certainly budgetary. 

To cite just two examples, soldiers often resort to self-medication 

when they are denied or discouraged from treatment, and that is 

commonly used to justify a dishonorable discharge, and that means 

that a soldier will be deprived of healthcare benefits. Or VA claims 

that somehow more than 22,000 soldiers, most of whom had already been diagnosed with a post traumatic stress injury or a traumatic brain injury, have been dismissed from the service with a diagnosis of personality disorder which is considered a preexisting 

condition, which also therefore absolves the VA of any responsibility for their future care. Such cynical cost-saving measures are 

devastating to the lives of soldiers and their families. 

There is currently no cure for post traumatic stress injuries. 

Though many learn to manage their symptoms, far too many will 

suffer the effect of their combat experience for the rest of their 

lives. They will continue to have nightmares and flashbacks. Many 

will continue to be hypervigilant, have startle responses that are 


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often violent. Many will have trouble managing their anger and 

their relationships for the rest of their lives. Many will try to selfmedicate to help them forget. And far too many will die by their 

own hands. 

But that sad truth cannot be used as an excuse for inaction. Our 

soldiers and our veterans need all the help they can get as soon 

as possible. Their psychic injuries may not be curable, but they are 

treatable. Their lives and the lives of their families can be made 

infinitely less difficult if they are given the care and support they 

have earned. 

They can be assured that their suffering is a normal response to 

an abnormal situation. They can talk to other veterans and practice compassion for themselves by feeling it for others. They can be 

taught proven techniques for managing their stress and their anxiety. And they can be relieved of the added burden of financial 

worry, all of which may help dissuade them from suicide. 

This is a public health issue of monstrous proportion, and I am 

here to bear witness to the fact that military suicides are not a new 

phenomenon. They are old news. This has happened before, and it 

should never have been left to citizens to sound the alarm. 

The disingenuous surprise and denial from official sources is simply unacceptable. I am deeply concerned that the issue is being politicized, that sides are being taken, lines drawn that make it appear as though there are two sides to this issue. There are not. 

There can’t be. These are our soldiers, our veterans. They are also 

our husbands, our wives, our parents and our children; and they 

are dying by the thousands. 

I am grateful to CBS News that they have finally given us some 

solid numbers. Six-thousand two-hundred fifty-six veteran suicides 

in 1 year. Those numbers are astonishing. They cannot be justified 

or ignored. Our soldiers and our veterans are not disposable, and 

yet that is how they are being treated. More than 6,256 veteran 

suicides a year, and each one of those numbers represents an individual beloved face and a life-shattering experience. 

I know that Daniel came back from Vietnam with an injury that 

finally and directly caused his death. I believe that he decided that 

he deserved to die because he had suffered too little or that he 

wanted to die because he had suffered too much. We call his death 

a suicide, but I have come to believe it was either an execution or 

euthanasia or some tragic combination of the two, and that continues to break my heart. 

I am grateful to this Committee for holding these hearings. May 

only good come from your efforts. Thank you. 

[The prepared statement of Ms. Coleman appears on p. 69.] 

The CHAIRMAN. Thank you. 

Ms. Meagher. 

OPENING STATEMENT OF ILONA MEAGHER 

Ms. MEAGHER. Thank you, Chairman Filner, Ranking Member 

Buyer and other distinguished Members of the Committee. I thank 

you for the opportunity to appear before you today. 

To open, I would like to briefly share my thoughts on why I think 

I am before you. 


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I am not only someone who spent 2 years researching and writing about post traumatic stress and our returning troops. I am also 

a veteran’s daughter. My father was born in Hungary, served 2 

years in an antitank artillery of a Hungarian conscript, fought 

against the Soviet Union on the streets of Budapest during the 

1956 Hungarian Revolution, later fled to America and in 1958 

again became a soldier, this time wearing a United States Army 

uniform and serving as a combat engineer in Germany. 

My father’s unique experience of having served on both sides, 

both East and West, in such differing armies during the Cold War 

gave him a unique perspective on military life. And so growing up, 

my sisters and I often heard my father say you can always tell how 

a government feels about its people by taking a look at how they 

treat their troops. Looking at our returning soldiers and their widely reported struggles with the military and with the VA healthcare 

systems they rely on, of being stigmatized from seeking care or of 

being placed on lengthy VA waiting lists when they need immediate help, some even committing suicide before their appointment 

dates arrive, has raised this citizen’s alarm bells. 

For years, we have had a ‘‘see no evil, hear no evil’’ approach to 

examining post-deployment psychological reintegration issues, 

which includes suicide. After all we have learned from the struggles of the Vietnam War generation and the ensuing controversy 

over how many of these veterans had or had not committed suicide 

in its wake, why is there today no known registry where Afghanistan and Iraq veterans’ suicide data is being collected? How can we 

ascertain reintegration problems, if any exist, if we are not 

proactive in seeking them out? 

As late as May 2007, the Department of Veterans Affairs spokeswoman Karen Fedele told The Washington Post that there was no 

attempt to gather Afghanistan and Iraq veteran suicide incidents. 

Quote, ‘‘We do not keep that data,’’ she said. ‘‘I am told that somebody here is going to do an analysis, but there just is nothing right 

now.’’ That was in May 2007. 

Meanwhile, the Army reported that its suicide rate in 2006 rose 

to its highest level in 26 years of keeping such records. Last month, 

at long last, the Associated Press revealed that the VA is finally 

conducting preliminary research. They have tracked at least 283 

OEF/OIF veteran suicides through the end of 2005. I have a note 

here. I have seen that the VA testimony may include a different 

figure than this, so we are already disputing this figure. The Associated Press reported 283 OEF/OIF veteran suicides in the VA system. That figure was nearly double the rate of the additional 147 

suicides reported by the DoD’s Defense Manpower Data Center. 

Looking only at these two suicide figures from the VA, 283—and 

from the DoD, 147—there have been at least 430 Afghanistan and 

Iraq veteran suicides that have occurred either in the combat zone 

or stateside following their deployments. Lost in the VA and DoD 

counts, as the Bowmans discussed, are those veterans who have returned from their deployments, who are still in the military and 

who are not yet in the VA system. The DoD says they do not track 

those incidents, and I assume neither does the VA. 

Many of the 430 confirmed suicides that we now know about are 

as a result of our wars in Afghanistan and in Iraq. They should, 


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but will not, be listed with the DoD’s official OEF/OIF death toll, 

which, yesterday, stood at 4,351. If they are 430 confirmed OEF/ 

OIF suicides, that translates to an additional 10 percent of the 

overall fatal casualty count of these wars that are due to suicides, 

10 percent. Therefore, dismissing the issue of veterans’ suicides in 

the face of this data is negligent and does nothing to honor the 

service and sacrifice of our veterans and families and communities 

that literally are tasked with supporting them once they return. 

Yet, prior to last month’s CBS News investigation, which we 

have heard about, one additional note in that CBS News investigation noted that 20- to 24-year-old Afghanistan and Iraq veterans 

are two to four times more likely to commit suicide. They are not 

the only ones who have talked about its being double the rate of 

suicide for our veterans. There was a June 2007 study as well— 

we could talk about that—that showed that the veterans’ suicide 

rate is double the rate of the civilian population. 

In my written testimony, I have included 75 suicides that I and 

other citizen journalist colleagues have been tracking since September 2005 and which, today, reside in the ePluribus Media PTSD 

Timeline. They offer only a small and incomplete sliver of insight 

into how some of our returning troops are faring on the home front, 

especially in light of the fact that at least another 355 incidents 

could be added among them according to the VA and the DoD. I 

believe they collectively, though, tell an even greater tale about the 

failure of us as individuals and as a society to ensure that our returning warriors are cleansed completely from the psychological 

wounds of war. They also reflect the failure of our government institutions to protect those who protect us. 

While I realize that these distressing stories are the exception 

and not the rule, to our exceptional military family members and 

their having to deal with the deterioration of a loved one they 

thought had safely returned from combat, they are the rule. In 

1956, the same year that my parents fled to this incredible country, 

the 84th Congress in this very House that we sit in today had this 

to say in a presidential commission report on veterans’ benefits: 

‘‘The government’s obligation is to help veterans overcome special, 

significant handicaps incurred as a consequence of their military 

service. The objective should be to return veterans as nearly as 

possible to the status they would have achieved had they not been 

in military service, and maintaining them and their survivors in 

circumstances as favorable as those of the rest of the people. War 

sacrifices should be distributed as equally as possible within our 

society. That is the basic function of our veterans’ programs.’’ 

Finally, I am not a pedigreed expert or a government official. I 

am shaking in my seat. I am not seasoned in testifying before Congress, so I do appreciate the opportunity to stand in for the civilian 

population and to represent them, but those who are the professionals and the seasoned, pedigreed officials from the U.S. General 

Accountability Office, the Congressional Research Service and even 

to the Veterans Administration have sat in this very seat over 

these past years, and they have told you that we are falling far 

short in providing the resources and programs that our returning 

veterans need and military families need to successfully return to 

their personal lives following their service to this Nation. 


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To those who resist hearing the cold, hard truth of where we are 

today, I have only one thing to say: The time is here to stop fighting the data. Let us, please, start fighting for our troops. This is 

America. We can do better. We must do better. Thank you. 

[The prepared statement of Ms. Meagher appears on p. 76.] 

The CHAIRMAN. Thank you both very much. 

Dr. Snyder, do you have any questions? 

Mr. SNYDER. I was browsing through your book. I wanted to ask: 

Is it May-ger? 

Ms. MEAGHER. Mee-ger. 

Mr. SNYDER. Meagher. I am sorry. 

Ms. MEAGHER. That is fine. 

Mr. SNYDER. You gave a series in your statement here of very 

specific things. I appreciate what you say, by the way, about shaking in your boots. We do that quite a bit here because sometimes 

we are not sure what way to go either with some of these things. 

But one of the issues, in fact, was referred to earlier by Representative Kennedy here. You talked about outside community-based resources that are available, and I recognize that there—I think 

there are a lot of communities that are trying to step forward right 

now to help families the best they can. I think about what happens 

as the years go by. Sooner or later, the war in Afghanistan and 

Iraq will be a historic event, and years will go by, but we know 

these problems that you all are dealing with and talking about, 

both of you, do not go away. 

So we come back to this issue of having services available, not 

just for the individual veteran but also for that veteran’s family. It 

may be issues of marital difficulties, of substance abuse, of anger 

management, of the fact that the veteran still does not realize that 

what is haunting him is what happened before, and so we still 

come back to this issue of the inadequacy of our mental healthcare 

system in the United States. 

If both of you want to discuss that broader issue, it is that which 

is not just for the veteran, himself, and that we expect to give the 

highest care to the veterans’ healthcare system or to the military 

retiree system of healthcare, but it is for our system nationwide. 

I have directed this to Ms. Meagher, but I would like you to comment also on it if you would, Ms. Coleman. 

Ms. MEAGHER. I do have some comments because I approach this 

from—of course, I am a veteran’s daughter, as I said, but I am a 

concerned citizen, so I am not a journalist. I did what is called ‘‘citizen journalism’’ because I saw a problem. And the problem that 

I saw was that we were not, first of all, in our Nation, called up 

to pay attention to the issue. Our soldiers are returning, and there 

are no victory gardens being planted. There are no war bonds funding drives. There is no indication that we are at war. That translates into the same things that are happening in communities. 

While there are incredible organizations and people in pockets all 

across the country whom I met while I was on my book tour and 

learned a lot from who are ready and willing to do something, they 

do not have the ability to tap into who the veterans who are in the 

community. So I heard over and over from these incredible people 

doing incredible things that we are ready and waiting, but they are 

not coming in. 


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Now, nobody asked them to do these things, and it is unfortunate 

that our leadership did not ask because it would have made for a 

stronger country. I believe that many of the things that I comment 

on cannot be legislated, and I cannot, I think, say—— 

Mr. SNYDER. Did you say ‘‘cannot be’’? 

Ms. MEAGHER. We need to move our society forward and ask 

them to pay attention to this issue and to take it seriously. 

Mr. SNYDER. I agree with that. I think of things, though, like— 

you mentioned your father today. My father died, who was one of 

Patton’s guys, and he got involved, and he would talk to me sometimes. Like after I went into the Marine Corps, we would talk 

about some of this stuff—about the burial details he got involved 

in. He just felt that, someday, one of those guys might be him. He 

would go down into these burned-out tanks and would have to 

bring out these bodies of Americans, and it would just haunt him. 

He could never watch any show on television but a game show— 

no cop shows, no crime shows, no westerns, no war movies. It was 

only game shows because they had no violence in them. 

Well, I do not think he knew what was going on, but I think it 

was you, Ms. Coleman, who talked about the person who sleeps in 

his closet or maybe it was the Bowmans or both of you. Okay. Well, 

I also think that there are going to be children in those households 

who are around this stuff, and there are these veterans who know 

that they are having problems that may be impacting negatively on 

those children. Well, we do not have a system where the children 

could go down to the VA hospital where they could get good quality 

mental health counseling for a 5-year-old or for a 9-year-old or for 

a 12-year-old or for a 15-year-old. Again, we get back to Mr. Kennedy’s work here. 

So that is what I was getting at, the community-based resources. 

Even now, you are talking about our not really being called forward as a country, but think of where we will be 5 and 10 and 15 

and 20 years from now when memories will have faded about our 

responsibilities, and we are still going to have families from these 

folks who are going to have these needs. 

I think it is on the second page where the two of you recommend 

and you talk about complimentary counseling to all immediate family members. That is what triggered my thought because we need 

to have a system in this country of providing better mental health 

coverage because that need is going to be there for a lot of years 

for these families, and it may be generational. And I think that we 

are going to be grappling with it on this Committee, but we need 

to be grappling with it in our entire healthcare system. 

Ms. MEAGHER. I do have one suggestion that could be easily 

done, and I would have done it myself if I only had the opportunity. 

Mr. SNYDER. Yes. 

Ms. MEAGHER. I think it could be easily done. 

All of these resources that are out there—now, I am from Illinois, 

and the Bowmans are as well. We have National Guard troops. 

They come from the community. 

Mr. SNYDER. Right. 

Ms. MEAGHER. So they know the community. The community 

knows them. And there are resources available to them, but there 

is not a database. There is nothing where somebody who is sitting 


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in Texas or in Illinois can simply just go to a database to see ‘‘what 

is available in my community.’’ The military is not giving the information to the soldiers, and the soldiers do not know where to go 

often. They do not know that there are psychologists who are at the 

ready to donate their services. There are programs. There are all 

types of programs. So there could be a database. There could be 

something that is put together that has resources for people. 

Mr. SNYDER. In fact, the problem that we run into with our Reserve component—and Arkansas has had a lot of Reserve component troops, both Guard and Reserve. What they run into is they 

may come from communities where, in fact, the healthcare providers there are not part of the military healthcare system because 

they have not had to be. Nobody has come in and said, ‘‘Do you accept TRICARE?’’ Now they are going through, ‘‘What is TRICARE? 

Why is that important to us?’’ ‘‘Well, it is, because we have been 

mobilized as a family, and that is now our healthcare system because my husband or wife is not on their work-related healthcare 

system anymore. This is our healthcare system. If you do not take 

it, it means I cannot get healthcare, and I am going to have to go 

someplace that takes my insurance.’’ So we run into those kinds of 

issues. 

My time is up, Ms. Coleman, but I wanted to give you a chance 

to comment. 

Ms. COLEMAN. I think that one of the saddest things about these 

wars has been the fact that we have been invited not to participate. 

Mr. SNYDER. I am sorry. I could not hear you. 

Ms. COLEMAN. I think one of the saddest things about these wars 

has been that we have been asked not to participate, that we have 

been deprived of the image of funerals and of coffins and of tears 

and of wounds even. I think that has deprived us of the opportunity to check in with our consciences, and I think it has deprived 

us of the opportunity to help those who have been wounded to 

carry the burden of their pain. And I think it has not contributed 

to a reinforcement of our social fabric, and I think that is too bad. 

Mr. SNYDER. Thank you both for being here. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Ms. Herseth Sandlin. 

Ms. HERSETH SANDLIN. Well, thank you to both of you. 

I was going to pose a question or two with regard to what you 

two have seen or as to, in your conversations with others, whether 

or not there is a difference either in the experience or in the numbers of active duty versus the National Guard and Reserve. We 

have done a lot of work on this Committee over the last couple of 

years in examining that question in a lot of different contexts. 

On the one hand, you could say, well, perhaps it is our national 

Guardsmen and Reserves because the community itself, the entire 

community, is affected by that or a set of communities is by a particular unit’s being deployed, and so that support network is particularly strong among the families during deployment and when 

those men and women return home, and there would be a greater 

likelihood that they would be somehow finding or maneuvering 

through the community, given the support of that community, to 

find resources to meet their needs. At the same time, I hear you 


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saying that there are some communities, particularly larger ones, 

perhaps, and they are unlike those that I represent in South Dakota or perhaps some in Arkansas, where the unit is from five or 

six different very small communities versus a larger community or 

a community where there is a larger base. 

Have you noticed a difference? How do we best address that situation? Perhaps a database is good in terms of the resources that 

are available in a community for National Guardsmen and women, 

but what other issues do we have to get over for active duty in response to—of course, we have talked about the stigma in the past 

and the concern that these men and women have as it relates to 

seeking those resources and a fear about how it affects their military careers. 

So can either of you talk about the differences that you think 

exist? Are there numbers broken down to suggest that we have 

higher rates of suicide among active duty versus National Guard 

and Reserve, or is it exactly the opposite? 

Are there other hurdles that we can help address based on the 

constituencies that we all represent here and the different constituencies that we represent back in our districts to help you and to, 

again, be part of that network within a community to facilitate information and to reach out and to know who these people are and 

to make them aware of the services that are available to them? 

Ms. COLEMAN. The information that has been available since the 

beginning of these wars about active duty troops has been very 

hard to get a hold of. Newspaper reporters have had to file Freedom of Information Act (FOIA) requests to find out what was happening in terms of suicides among active duty troops. 

When The Hartford Current did a series of articles in May of 

2006, by submitting FOIA requests, they got information about several suicides. I think when CBS News was trying to initiate their 

report, they also submitted a FOIA request to the Department of 

Defense. And the Department of Defense gave them some number 

of active duty troops, but told them that veteran suicides were just 

something that they were not keeping track of. I do not know. 

Ms. MEAGHER. There are some stats and some specific changes 

and differences as far as Guard and Reserve troops, how their experience unfolds. 

According to the DoD, they did a Pentagon task force study on 

the troops in the summer of 2007, and they reported that 38 percent of soldiers—31 percent of Marines—showed symptoms of 

PTSD, psychological problems. Meanwhile, 49 percent of the National Guard and 43 percent of the Reserves did. 

Now, as to some of the reasons that I have seen in the data that 

I have read, there are a few things that are happening there. When 

Reserves are called up, they may have their own businesses. Those 

businesses may go under if they have been deployed two or three 

times. Although the Bowmans spoke about their own family support since they are in the same community, it is not like a base. 

There are not specific places where the family members can go to 

get support. So some do not come in like that half of the base that 

did not come in that the Bowmans mentioned, and some might 

come in for these little impromptu gatherings, but there is not one 

area where everybody can support each other. So that is significant. 


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There are also differences in—I have seen in reports of National 

Guard troops that they may deploy all as one unit, but often, especially with individual ready Reserves that are activated, they are 

used as fillers, and so they are going with people who they might 

not have trained with. There are also a lot of other issues that 

revolve around insurance issues, but worries about financial—if 

you have lost your business, that is an added stress. It is not PTSD 

per se, but it is an added, additional stressor. There are worries 

about their families at home, and many of them have kids that 

some of the younger active troops do not have. 

Ms. COLEMAN. One other thing, suicide statistics are renowned 

for being difficult to gather. The Center for Disease Control and 

Prevention (CDC) says that they expect that it is somewhere between 10 and 50 percent underreported. If a veteran drives the 

family car into a tree or overdoses or gets into a confrontation with 

a policeman, those are not necessarily going to be recorded as suicides, and they are what Mike Bowman called a ‘‘killed by’’ service. 

I think that it is very difficult to actually get a handle on the number of suicides. 

When CBS News asked State governments to give them the 

number of suicides that they had recorded, those were the suicides 

that family members chose to acknowledge, and a lot of States do 

not consider something as suicide unless there is a note that has 

been left. I think that the numbers that we do have are as good 

as we can get. 

Ms. HERSETH SANDLIN. Thank you both. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Mr. Kennedy. 

Mr. KENNEDY. Thank you. 

I just want to follow up on my initial point, when we were speaking with the Bowmans, and it was with regard to the family issues, 

the thought that the Bowmans were paying out of pocket right now 

for counseling was really troublesome to me. You know, here they 

are trying to get counseling for the loss of their son who suffered 

as a result of his service, and they are paying for it personally 

rather than the United States paying for it. I mean, I think that 

we owe it to the families to be paying for their mental health counseling as a result of the loss that they suffer when they lose a father, a spouse, a loved one in the line of service. In the case of a 

suicide, certainly, this ought to be extended to families as well, and 

it is just absolutely incredible to me that we do not have this extended to family members. 

I would like to ask you to comment on—you know, the Kaiser 

Foundation just completed a study of adverse childhood experiences. In California, they have measured the trauma dose, basically, of children who come from families where they have high 

doses of Cortisol. Basically, it is a child who comes from a family 

where there is domestic violence. You know, the fight-or-flight instinct in a human being means you have high doses of Cortisol if 

one is threatened. For children, if they hear loud screaming, if they 

see violence, Cortisol is released in the brain just as it would be 

for any one of us and just as it would be for a veteran or for anybody in a situation where it is fight or flight. This creates changes 

in the brain. 


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In any event, they have measured this in families where children 

come from homes where there is domestic violence, where there is 

drug or alcoholism, where there are these kinds of high-risk situations. These children are at much higher risk for suicide themselves, for drug abuse, for a whole list of things down the road, and 

this has been borne out by evidence now. 

So what strikes me is not only are we going to see a wave of 

challenges with veterans down the road, but we are going to see 

a wave of challenges with their families. We are talking now about 

a registry for trying to track veterans’ suicides. It would seem to 

me we ought to be getting a registry of tracking the children of 

these veterans. Can you comment on that? I mean, we have got a 

whole generation of the children of these veterans, and they have 

been seeing their parents go off for two or three tours of duty. 

In dealing with that kind of trauma, what do you think we are 

going to deal with with these kids down the road with their parents’ coming back and having suffered all that they have suffered 

and the impact on them? 

Ms. COLEMAN. After the war in Vietnam, 20 years after the war 

in Vietnam, the Australians created what they called a ‘‘nominal 

role.’’ They got in touch with all of their Vietnam veterans, the 

ones who were still alive, and they have yearly contact with them, 

and they keep track of what is happening not only with them but 

what is happening with their children. And one of the things that 

they found was that those children were three times more likely to 

kill themselves than their peers, which was an eye opener and a 

tragedy. 

Ms. MEAGHER. That is one of the things, the secondary PTSD of 

the family members. After reading an article about a cluster of suicides and of murder-suicides that had taken place at Fort Lewis in 

2005, that is what brought me into the issue. I read in that article 

that the reporter had listed how many other family members—how 

many wives, how many children—were affected, and that is when 

it really clicked with me that this is a larger issue than just the 

mere data, than just the mere stats of the individual people. 

What makes military suicides different than any other suicide 

that might be in the general population is that we have a responsibility for these family members. If a person—and I have a sister 

who committed suicide, so I know that that is another additional 

reason why I was emotionally very attached to the families who 

were dealing with this issue, because I knew the stigma that our 

family had to go through. While my sister was not a veteran, she 

was a private citizen, and there is no obligation for the government 

to do anything. There is no obligation for the community to care— 

my family cared—but for our soldiers and for our military family 

members, we have an obligation to them. So that is what makes 

it different. 

As far as things that you could legislate, we have not really 

talked much about what we can do to prevent and to protect and 

to shore up our veterans for this new type of warfare that they are 

in. I know that there is a Psychological Kevlar Act. There are only, 

I believe, ten co-signers. Phil Hare, Representative Hare, is one of 

them, and I am proud to be from his State. 


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I think we need to look into proactive measures to be able to help 

our troops from basic training onward. We need to push the military culture to change and to grow in their idea of what it means 

to prepare a soldier for battle. It is not just to pull the trigger. It 

is also to be able to live with that, that work. 

Mr. KENNEDY. I appreciate your mentioning the Psychological 

Kevlar Act. That is my bill. 

It seems to me, if we put our soldiers through strenuous boot 

camp, that ought to be not only for the physical but for the psychological nature. They ought to be prepared for what they are going 

into, and we ought to have mental health literacy as well as physical literacy when we go in. 

I was really struck, Ms. Coleman, by the fact that children of veterans of Vietnam in Australia were three times more likely to commit suicide than their counterparts. That is pretty—— 

Ms. COLEMAN. We do not have those same statistics. 

Mr. KENNEDY. We do not have the same statistics here, but that 

is in Australia. Whether this is a question of our Veterans Affairs 

Department, it seems to me it is a question of our national interests. It is properly, maybe, an issue that has to do more with our 

U.S. Department of Health and Human Services—another area of 

our governmental policy—but it is an issue that we have to address 

as a Nation and that we should address as a Nation. 

Ms. COLEMAN. Coming off of what Ilona said about it’s being 

really important that we focus on preventative care, it seems to 

me—think about this. What if we immediately granted full disability to all combat veterans who submit a claim through an appropriate VA representative? Those benefits would continue until 

the VA succeeds in denying the claim after all of the appeals have 

been resolved. The VA would then have an incentive to streamline 

their process, but it would also put the emphasis on prevention as 

opposed to diagnostic and curative, which is public health. I know 

that the flagship suicide prevention hospital in the VA is the 

Canandaigua Center for Excellence, and all of their literature emphasizes public health outreach. It seems to me, if there were not 

an adversarial relationship between veterans and the VA, that that 

would make it much easier for them to get the care they need, and 

that would probably make it much less expensive to take care of 

them over the long run. 

The CHAIRMAN. Thank you, Mr. Kennedy. 

Mr. Buyer. 

Mr. BUYER. Ms. Coleman, I would like for you to know that information that we obtained to help prepare for this hearing we got 

readily available off the Web, so we contacted the Defense Manpower Data Center. Anyone in the country can get on the Web, and 

they can pull down the statistics. So, in your testimony to us that 

they are hiding this information, I just want you to know that it 

is readily available to people. 

Secondly, I would like to add, Ms. Meagher, that I want to thank 

you for your contribution. I think it was therapeutic to you, as this 

experience had to be. Now, as a policy maker, the challenge is the 

many types of disease groups that we deal with. Name a disease, 

and then we have to do this analytical overview of populations and 

their propensities to have come down with, say, cancer even if they 


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had not been in the military, because then we try to examine, if 

it was something caused by military service, and the causal connection, the link, because then there are dollars attached to those 

kinds of things. So we study all of these things. 

On this issue, with regard to suicide, we recognize that as a society. I will go back to Dr. Snyder’s comment as being absolutely correct that, as a society, we have a challenge, and it is the propensity 

of these young adults, 15- to 24-year-old males, to committing suicide in our society, and when it is one of the top ten killers, we 

have a problem in our society. 

Then you do the overlay of obligation. I agree with you. When 

you put on the uniform and we do the inculcation and the matriculation process, our obligations to care for them will continue. The 

overlay on what we have just discussed and what makes it really 

challenging is what I brought up earlier: There are individuals who 

want to use that data for their own causes and antiwar themes. 

What happens is that we then get away from what we really want: 

What do I want for my comrades? 

What I want for my comrades is I want them to be able to go 

obtain their mental health without a stigma, and that is why I 

really dislike the word ‘‘disorder.’’ There is this whole balance that 

we have to go through between the military. Dr. Snyder has to 

struggle with this being on the Armed Services Committee. You 

have got a responsibility here as commanders to develop military 

cohesion that will be effective on the battlefield right? If you are 

effective and you have got the cohesion, you are also saving lives 

because buddies look after buddies. Balance that with the privacy 

then of a soldier. Now, commanders also have played an integral 

role. Because they are responsible for military cohesion, they need 

to know about the mental status of their soldiers so they can define 

the cohesion to be successful. So somewhere in here is this challenge of providing mental health services so that the commanders 

can also have a comfort zone. It is not only the commanders. It is 

the buddies, the man to their right and left; are they okay to carry 

a weapon? You know, this is very challenging, and I think the military is doing a better job today than what they have done in the 

past on their abilities to have soldiers talk about their experience 

when they debrief. It used to be John Wayne. You know John 

Wayne. ‘‘I went in. I did bad things. I feel good. I am fine. I am 

going back to my job.’’ No. It is okay to talk about it. 

In listening to the professionals—the psychiatrists, the psychologists and the counselors—they talk about early intervention is, in 

fact, the best. The reason it is the best is that, as to these risk factors that we all are in search of, not everybody shows it, and that 

is what is so hard. You have done that through your own life in 

struggling with, ‘‘What could I have seen about my sister?’’ I do 

that about my friend. What was there? You know, my brother and 

I have these conversations. We did not know. We did not see. We 

were with him. I never saw it until he did something impulsive. 

So I think the Chairman is on the right track here in trying to 

come up with some form of a classification where soldiers and our 

veterans when they return home—our Guardsmen, Reservists— 

have a comfort zone where it is okay to obtain mental health counseling; at the same time, our commanders are in a comfort zone 


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that the individual is not imbalanced—do you know what I mean, 

that he is okay? It was okay to talk about, when I went into the 

room, bad things that happened. 

‘‘Oh, bad things happened? No. What exactly happened?’’ 

‘‘I shot and killed two.’’ 

‘‘How did you feel about it?’’ 

‘‘I did not like it. It was my job. It was my duty. I had to do it, 

but I keep thinking about it.’’ 

‘‘Well, what do you keep thinking about?’’ 

So you are forced to talk that thing through, and that is helpful, 

and commanders are trying to do that kind of thing. The more we 

move to that prevention aspect of it, I think the better off we are 

going to be in the end. 

So I compliment you, Mr. Chairman. I yield back. 

The CHAIRMAN. Thank you. 

I wish all commanders were as open as you suggest. 

Mr. Kennedy. 

Mr. KENNEDY. Yes. We are working on a network of care—an 

Internet-based, comprehensive resource—for those who can access 

it both for providers and for those trying to get help, and that is 

going to be available, hopefully, throughout the VA system. We are 

working on that. That is a very good suggestion. 

The CHAIRMAN. I want to give you both a chance to comment on 

the data question that Mr. Buyer raised. 

It has been my experience that this data is not available. We 

have asked people sitting in your chairs for data. They have not 

provided it from the VA and from the DoD. 

When I read your Web site, Ilona, it brought to mind, you know, 

what if the Pentagon had to raise its money through bake sales? 

You know, you are trying to do something that the government 

should do, and your resources are very limited to do that, but the 

government is not doing it, and it seems absolutely necessary that 

they do. They do not want to know, it looks to me. I mean, this 

could be tracked. We can do this. We do not want to know the answer as far as I can tell. 

Would you comment on the availability of data, both of you? 

Ms. MEAGHER. Well, I can say this, that I am just a private citizen 

who, in 2005, was interested in the topic and thought to myself, 

Well, there is this cluster of suicides and murder-suicides, and some 

of them were highly decorated in Fort Lewis in Seattle. I wanted 

to see, is it just happening there, or is it happening elsewhere? 

So I used simple search engine technology. I just started 

Googling, and I started to find different incidents all across the 

country reported in local media. Now, large Web sites like The New 

York Times and The Washington Post, they are able to archive all 

of their incidents. Small, local communities do not. So, a couple of 

months later, maybe that police standoff—we are not just talking 

suicide here. Of course, we are for this hearing, but there are a lot 

of things that are going on, and we try to track them all, and it 

is not meant to stigmatize. Obviously, there is a larger portion of 

troops who have the support services that they need, who have the 

family in place to help them, to make the right decisions, to make 

the right calls, but for those families who are having these problems—the suicides, the police standoffs, the drunk driving inciVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00050 Fmt 6633 Sfmt 6633 E:\HR\OC\39647.XXX 39647

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dents, the domestic violence and on and on—those things need to 

be tracked and preserved, not to point a finger but just so that we 

can have some data for them to do some research on, have the people who know how to do this research do it, and if it is lost, then 

it is lost, and we lose an opportunity to preserve that. 

Mr. KENNEDY. So we should track it within the corrections system, too? 

Ms. MEAGHER. Yes. 

Mr. KENNEDY. And we are not. 

Ms. MEAGHER. If I can make one more point about law enforcement, there are a lot of things the communities can do, and I have 

already seen them happen. In my area in Dixon, the Mayor has 

tried to be proactive by bringing in law enforcement and educational institutions and churches and healthcare organizations. 

Law enforcement needs to be, in many ways even, a safe haven. 

We need to have military families be able to pick up the phone— 

be it to law enforcement or to their healthcare providers—and not 

have to fear that, if they do pick up the phone again, there is the 

stigma. 

If I pick up the phone and if one is having a PTSD episode, if 

a loved one is having an episode, one should not be penalized for 

having to pick up the phone before it gets to this pancaking of, you 

know, one incident after another, and then we have a bad record, 

and then we have lots of problems. That just increases stress. We 

need to think about ways to prevent that. 

Mr. KENNEDY. In my State, my municipal police academies have 

gotten together and have put their own debriefing and program together at their own expense because so many of the Guard and Reservists are, obviously, first responders. When they come back, if 

the VA is not doing it, they are going to do it themselves to help 

reintegrate these Guard and Reservists back into the first responder community. Of course, the issue of those ending up Guard 

and Reservists and others ending up in prison is also something we 

are doing as a State initiative. We are trying to track those who 

are ending up in our corrections system because of the issue of reacting badly because of the problems that they are facing emotionally and psychologically. 

Ms. COLEMAN. In August of 2007, the Army released a 165-page 

suicide event report for the year 2006, and that was described in 

all of the reports that I read as a first time ever public analysis 

of what the Army called ‘‘confidential data’’ submitted by units 

from across the Army over the past 2 years. I think it included previously unreleased statistics on attempted suicides, and it found 

hundreds of attempted suicides, particularly among active duty soldiers who had returned from the war, and an increase in the number of soldier suicides in Iraq from the previous year. I do not think 

those figures had been available before. 

The Department of Defense’s Web site, up until very recently, 

had two, three, four acknowledged suicides among active duty 

troops, and there were a lot of noncombat accidental deaths but almost no suicides. This is a very different picture of what has been 

happening within the service. 

The CHAIRMAN. We thank you for your testimony. There is a lot 

of movement here because we have votes over on the floor for 


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which we have to take about a 30- to 35-minute recess. We will decide how we are going to conclude the hearing when we get back. 

Both of you have done tremendous work in trying to have this 

Nation understand these issues, in trying to get a sense of both 

raising the consciousness about the issue and speaking to our consciences to respond to it. These are our young men and women, and 

we have an obligation to them, and we have to understand the extent of the problem and face it squarely and then figure out what 

we are going to do about solving it. So you have done a great service to the Nation with your books, with your articles, with your 

Web sites. We look forward to working with you when we have any 

needed legislation that we are going to do here. Thank you so 

much. 

We are going to recess for 35 minutes. 

[Recess.] 

The CHAIRMAN. Again, I apologize to our witnesses for the recess. 

And also we tried to, I think, do too much in one day. So I think, 

with the agreement of all the participants, we are going to move 

on to panel five for the Department of Veterans Affairs to present 

its testimony. And then early next year we will hold another hearing for other testimony to continue. 

I think the morning testimony was very compelling and took a 

longer time than we had imagined. We thank you for waiting this 

long. 

Dr. Katz, Deputy Chief, Patient Care Services, Office of Mental 

Health in the Department of Veterans Affairs; and Dr. Kara Zivin, 

Research Health Scientist with the Health Services Research and 

Development of the Department of Veterans Affairs. 

You are recognized, Dr. Katz. 

STATEMENTS OF IRA KATZ, M.D., PH.D., DEPUTY CHIEF PATIENT CARE SERVICES OFFICER FOR MENTAL HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY ROBERT ROSENHECK, M.D., DIRECTOR, DIVISION OF MENTAL HEALTH SERVICE AND OUTCOMES RESEARCH, VETERANS HEALTH ADMINISTRATION; LAWRENCE ADLER, M.D., DIRECTOR, MENTAL 

ILLNESS RESEARCH EDUCATION CLINICAL CENTER, VETERANS INTEGRATED SERVICES NETWORK 19, VETERANS 

HEALTH ADMINISTRATION; AND FREDERICK C. BLOW, PH.D., 

DIRECTOR, SERIOUS MENTAL ILLNESS TREATMENT RESEARCH AND EVALUATION CENTER, ANN ARBOR VETERANS 

AFFAIRS CENTER FOR CLINICAL MANAGEMENT RESEARCH, 

VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; AND KARA ZIVIN, PH.D., RESEARCH 

HEALTH SCIENTIST, HEALTH SERVICES RESEARCH AND DEVELOPMENT, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS (ON HER OWN BEHALF) 

OPENING STATEMENT OF IRA KATZ, M.D., PH.D. 

Dr. KATZ. Thank you, Mr. Chairman and Members of the Committee. 

I want to begin by expressing my most profound condolences to 

Mr. and Mrs. Bowman and to Ms. Coleman. What they have spoken of is important to me personally and to all of my colleagues. 


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I want to assure them that we have taken their words to heart, 

and so has the Department of Veterans Affairs. 

I want to thank you, Mr. Filner, for holding this hearing. The 

discussion represents an important day for mental health in America. 

I want to go over my prepared oral testimony, but to say that, 

especially after the discussion this morning, it is only a fraction of 

what I am personally feeling, and it is also only a fraction of what 

VA is doing. 

There is no question, suicide among veterans is a tragedy. The 

Department of Veterans Affairs recognizes our obligation to work 

to prevent suicide, both in individual patients and in the entire veteran population. We are concerned about epidemiology. We are 

more concerned about people and the tragedies that they represent. 

But we focus on epidemiology because findings in this area can 

guide prevention. 

VA has a long track record of research and publication in this 

area. One of our leaders is Dr. Han Kang, who is here. Others are 

on this panel with me. 

One peer-reviewed publication from a long-term, 20-year followup of Vietnam-era veterans reported that the rate of suicide among 

veterans who were deployed to Southeast Asia did not differ statistically from veterans of the same era who were not deployed. Another published study of veterans from the first Gulf War provided 

similar findings. 

VA and Dr. Kang have just completed a preliminary evaluation 

of suicide rates among veterans returning from Iraq and Afghanistan. From the beginning of the war through the end of 2005, there 

were 144 known suicides among these new veterans. This number 

translates into a rate that is not statistically different from the rate 

for age-, sex- and race-matched individuals from the general population. 

However, suicide rates among veterans are too high. The population receiving care from the Veterans Health Administration has 

more risk factors for suicide than the general population. Most veterans are male, and men have higher suicide rates. Those who 

come to the VA for care tend to be older, less well-off and more 

likely to have a mental health condition or another chronic illness. 

Those with the greatest need for care are those who are most likely 

to come to VA. And this increased need is associated with increased 

risks of suicide. 

The CHAIRMAN. I am sorry to interrupt, Dr. Katz. I just don’t understand that conclusion, that those with the greatest need are 

those who are most likely to come. 

We have talked for 3 hours about the reasons why people don’t 

come. And I could make the same case, since you are making a hypothesis here, that there is no real data that the people most in 

need don’t come. I could make the very same argument. 

So, why do you think that? I don’t understand it at all. You don’t 

know who is coming or why those who are not coming aren’t coming. You don’t know that. 

Dr. KATZ. I will take the question for the record and get back to 

you, post hearing. 


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The CHAIRMAN. I am just asking. You drew a conclusion which 

I think is wrong, and you can’t argue for it? I mean—— 

Dr. KATZ. Well, those who come—for example, there are the demographic issues—age, sex and all. But, most significantly, those 

who come to VA for care are more likely to have mental health conditions than others. 

The CHAIRMAN. But you are not giving me any basis for making 

that statement. I don’t know why that is the case. Again, those who 

have been subject to arguments that, you can’t come if you are 

weak and they accept that, no matter how difficult—I mean, the 

suicides we heard about in the morning session, they never got in 

touch with the VA, and they had pretty difficult situations. So I 

just don’t know why you would just make that assumption. 

Dr. KATZ. Well, it is not just an assumption. There is no question 

that there are many people in need who don’t come to VA for care. 

That is a problem, and it is a problem that we have to solve. But, 

on a statistical basis, those who do come to us have major care 

needs and, with those major care needs, increased risks for suicide. 

The CHAIRMAN. But those who don’t come could even be in greater need. You say the reverse here, and I don’t know on what basis 

you are doing that. 

Especially, in light of the little bit of data here, 144 known suicides. We have heard arguments all morning that your data is 

probably incomplete. There is unreported stuff. There is underreported stuff. There is not tracking. I mean, you are not anxious, 

it doesn’t seem to me, to go after this stuff. So you are basing your 

conclusions on very suspect data to begin with. 

Dr. KATZ. Mr. Filner, I would like to get back to you about your 

concerns. But I want to stress that the issue is prevention. Arguing 

about rates isn’t the issue. The issue is—— 

The CHAIRMAN. You are the one that is arguing the rates. Every 

one of your paragraphs ends with a thing about the rates—every 

one of them. You are not talking about prevention here at all. I 

read your whole thing, and I couldn’t figure out what you were 

doing to stop suicides, frankly. 

Dr. KATZ. Well, I will tell you, our suicide-prevention activities 

are based on the principle that decreasing suicide requires both enhancing overall mental healthcare and programs specifically designed to prevent suicide. 

Part of the training for all staff has been to teach that even 

strong and resilient people can develop mental health conditions. 

We also teach, both within our facilities and in the community, 

that care for these conditions is available and must be provided 

quickly. We also teach that treatment works. 

The VA Suicide Prevention Program includes two centers that 

conduct research and provide technical assistance. It also includes 

a suicide-prevention call center and suicide-prevention coordinators 

located in each of VA’s 153 hospitals. All together, 200 staff members, 200 mental health professionals in VA, have suicide prevention as their major responsibility. 

The Department is partnered with the Lifeline Program of the 

Substance Abuse and Mental Health Services Administration to develop a suicide hotline for VA as part of the national 1–800–273– 

TALK system. Since it began, there have been more than 6,000 


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calls from veterans, 1,300 referrals to suicide-prevention coordinators, and more than 300 rescues where police or ambulances were 

called, any one of which may have been life-saving. 

The CHAIRMAN. Any suicides amongst those? 

Dr. KATZ. In our current follow-up, we haven’t seen any. 

The CHAIRMAN. I am sorry? 

Dr. KATZ. We haven’t seen any. 

The CHAIRMAN. You have 6,000 calls and you are giving me all 

this data of 1,300 referrals, 300 rescues. But you haven’t seen or 

you don’t know if there are any suicides? 

Dr. KATZ. We are doing follow-up of those who have called, and 

have been referred to VA facilities and the results from the followup will be available soon. 

The CHAIRMAN. These are obvious questions. I don’t know why 

you don’t have them before you come in. You give us all this data, 

which is a lot of activity, but I don’t know about any results. I can’t 

tell from your report that we have any results here. You are giving 

me a whole bunch of numbers, and usually that is a reason why 

you don’t—— 

Dr. KATZ. Mr. Filner, with permission, I could send to you the 

stories of a number of people who have called the hotline, so you 

could see the dedication and skill of VA professionals in action. 

The CHAIRMAN. I am not arguing that at all. The people who are 

doing this are wonderful people. They are dedicated. They are 

doing their job. 

We heard testimony that something like 6,000 veterans have 

committed suicide last year, or 2005, the year that CBS News was 

doing it. What about that? I mean, there is nothing in here that 

talks about that statistic. I mean, I don’t even care if it is right. 

It is somewhere close to the truth. What about that? You say you 

saved 300, but what about the 6,000? 

Dr. KATZ. Mr. Filner, VA has a major suicide-prevention program, the most comprehensive in the Nation. The numbers, frankly, aren’t the issue. 

The CHAIRMAN. What if it was 3,000? What if it was 1,000? What 

is the difference? 

Dr. KATZ. If the number were 300, we would still be doing everything possible. 

The CHAIRMAN. But you are not referring to why. Why do those 

6,000 exist, with all this work you are doing? What is the measure 

of your effectiveness if all these people didn’t know the hotline 

number, they didn’t call the hotline—— 

Dr. KATZ. Sir, the 6,000 exists because mental illness is a real 

illness, and mental health conditions can be fatal. 

The CHAIRMAN. I understand. But to have credibility for what 

you are all doing professionally, you have to address these issues, 

and you are just ignoring them. You don’t have a word in here 

about that. I mean, it takes away the sense of credibility that you 

are trying to raise here that you are doing all this, because we 

have both anecdotal evidence and now we have more statistical 

data that we are failing as a Nation. Not you individually, not anybody who is on a hotline with anybody, but as a Nation we are failing. And you are acting as if everything is goodness and light in 

this effort. 


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Dr. KATZ. Sir, Patrick Kennedy talked about mental health in 

America, and he is right. VA, in suicide prevention, is ahead of the 

rest of America, as we should be. 

The CHAIRMAN. I will accept that. What happens to the 6,000 

veterans who committed suicide last year, the 6,000 who committed 

suicide the year before and the 6,000 the year before that? What 

is going on with them, if we are so successful? 

Dr. KATZ. That is why we have the foremost researchers in 

America working on this problem. That is why our mental health 

budget has increased 60 percent since the beginning of the war. 

The CHAIRMAN. I understand, but when you ignore these issues 

in a report that is supposed to talk about what you are doing, you 

damage your credibility, you damage whatever we are trying to do. 

Because I have to say, you are ignoring the whole problem here 

with this report. You are using activity as a substitute for effectiveness. Just because all these people are working doesn’t mean they 

are effective. 

Again, I don’t know. We have a National Guard, which you are 

not even discussing here. We have all the people who are not enrolled in the VA, which we are not discussing here. 

Mr. Bowman is still here. He made a really interesting suggestion: Go meet these kids at the bus when they come off. That is 

what I want to talk about. You heard their testimony. Throw this 

prepared testimony away and talk to the Bowmans, talk to Ms. 

Coleman, talk to Ms. Meagher, and say what we are going to do 

about these issues. You are not doing that. I mean, you had the advantage of listening to them. Respond to them. 

You are reading this report, which, you know, had so many questions to begin with, but I still don’t know what you are doing for 

those people, I still don’t understand it. 

You have a National Guard parent whose whole unit has never 

heard anything about how to help address possible suicide. So what 

are we doing about that? If you say, ‘‘Well, we are VA; we can’t 

help the National Guard,’’ then say that, and then I will be happy 

to figure out legislation that says, you know, how you can do that. 

Mr. BUYER. Sir, can we have regular order and permit the witnesses to testify, please? 

The CHAIRMAN. If they had regular order about how to write 

their reports, we would be okay. I mean, it is not helpful, the way 

you are doing this. 

You can complete your testimony. 

Dr. KATZ. Mr. Filner, with your permission, could I yield time to 

Dr. Rosenheck? 

Mr. BUYER. Dr. Katz, would you finish your statement, please? 

Dr. KATZ. Sure. 

I was talking about the major programs for suicide prevention 

that VA is conducting complementing our major expansion of our 

general mental health programs. 

We have held two VA suicide-prevention awareness days for required education for all employees. The first focused on enhancing 

awareness of the issue; the second, training staff on how to work 

with available prevention resources, including the hotline and coordinators. 


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The coordinators get calls and referrals from the suicide hotline, 

as well as from providers. They educate their colleagues. Then—— 

The CHAIRMAN. Dr. Katz, did you study the well-publicized incidents when Marines or soldiers walked into a VA hospital saying 

they thought they had this PTSD thing, which they didn’t understand, and were having suicidal thoughts? They were told that 

there was nobody available, or an appointment would not be available for a month, and they went home and killed themselves. Have 

you addressed that in here? 

I mean, you are telling me about in-service training. That is 

great. What happened about that training when these kids came 

into the hospital and then went out and killed themselves? Do you 

address that? 

Dr. KATZ. In this document, no. In fact, the VA has—— 

The CHAIRMAN. Why not? Well, you are telling me about in-service training. There are well-publicized incidents when that either 

failed or had not occurred yet. Tell us what happened in those 

cases. 

Dr. KATZ. I will send you the case reports from the hotline. They 

are incredible human stories. 

I also want to talk about policy, how, beginning this summer, we 

established a policy that any new request or any new referral for 

a mental health appointment has to have an evaluation within 24 

hours to determine the urgency. If there is an urgent need, care 

must be provided immediately. If not, the patient has to be seen 

within 2 weeks. 

The CHAIRMAN. Did this happen after these incidents? One in 

Minnesota, one in Florida, and, I think, there was another State. 

And 2 weeks wouldn’t have saved them anyway. I mean, was this 

in response to that, so it wouldn’t happen again? 

Dr. KATZ. These policy advances were in response to new patients from Iraq and the needs of established veterans. 

The CHAIRMAN. Okay. I will let you continue, but, look, if you 

don’t deal with these stories and this evidence where we have 

failed our patients, then your credibility of what you are doing is 

zero. It looks like you are just shoving them under the rug, you 

don’t want to talk about them, you don’t want to deal with them, 

and so you avoid them. Some of us have memories about these 

things, and some of us have policy issues. You don’t enhance your 

credibility when you avoid them. 

Finish your testimony, please. 

Dr. KATZ. Well, Mr. Filner, you are being somewhat dismissive 

of a major public health effort in suicide prevention that VA is 

doing. 

The CHAIRMAN. I am not dismissing the effort. I am dismissing 

the way you are talking about it, as if everything is goodness and 

light, we have no problems, everybody is being helped, we saved all 

these lives. We just had 3 hours of testimony that this is not true. 

Respond to that. 

Dr. KATZ. I was profoundly affected by what I heard. 

The CHAIRMAN. But you are reading the whole report that you 

wrote before you heard them, as if they didn’t testify. 

Dr. KATZ. My reaction is thank God we are doing what we are 

doing. I truly believe we are saving lives. 


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The CHAIRMAN. I don’t disagree with that. I want to know, what 

about the lives we are not saving too? 

Dr. KATZ. They affect all of us. 

The CHAIRMAN. Well, tell us about them. That is all. Enhance 

your credibility by dealing with all of them. 

You may finish. 

Dr. KATZ. I do want to end by mentioning that we applaud Congress for passing the Joshua Omvig Prevention Bill, recently signed 

by President Bush. We have implemented essentially all of the provisions of the bill already, and, in fact, we did so before it was 

passed. 

We continue to do research to develop and implement new strategies to improve our ability to save lives by preventing suicide. We 

believe our healthcare system can and must serve as a national 

model for mental healthcare and suicide prevention now and in the 

future. 

Thank you. 

[The prepared statement of Dr. Katz appears on p. 84.] 

The CHAIRMAN. Dr. Zivin. 

OPENING STATEMENT OF KARA ZIVIN, PH.D. 

Dr. ZIVIN. Good afternoon, Mr. Chairman. 

I would like to take this opportunity to express my condolences 

to all the families who have lost a loved one to suicide. 

I am honored to provide testimony to the Committee about suicide among veterans treated for depression in the VA health system. I come before this Committee as a mental health services researcher who has conducted research on this topic. The views and 

opinions are expressed on my own and do not necessarily represent 

those of my current employer, the Department of Veteran Affairs, 

or the views of the VA research community. 

I am here today to report on findings from a study that I conducted, along with my colleagues at the Department of Veterans 

Affairs, National Serious Mental Illness Treatment Research and 

Evaluation Center, SMITREC, and the VA’s Health Services Research and Development Center of Excellence in Ann Arbor, Michigan, where I am a research investigator, as well as an assistant 

professor of psychiatry at the University of Michigan Medical 

School. 

We recently published a paper in the American Journal of Public 

Health examining suicide rates using data from the VA’s National 

Registry for Depression for 807,694 veterans of all ages diagnosed 

with depression and treated at any Veteran Affairs facility between 

1999 and 2004. In all, 1,683 veterans in VA depression treatment 

died by suicide during the studied observation period, representing 

0.21 percent of this treatment population. 

When we calculated the overall suicide rate in this population 

over the 51⁄2-year study period, it was 88.3 per 100,000 person 

years, which is approximately seven to eight times greater than the 

suicide rate in the general adult U.S. population. 

A higher suicide rate would be expected among a population of 

patients in treatment for depression than the general U.S. population, given that depression is a potent risk factor for suicide. 


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Because most healthcare systems lack the capability of assessing 

suicide rates among their treatment populations, there are few 

points of comparison with nonveteran treatment populations. However, at least one prior study reports a suicide rate for men receiving depression treatment in managed-care settings between 1992 to 

1994 of 118 per 100,000 person years, a suicide rate which is somewhat higher than that observed in this veteran depression treatment population. 

In our study, we observed that the predictors of suicide among 

veterans in depression treatment differed in several ways from 

those observed in the general U.S. population. Typically, people in 

the general population who die by suicide are older, male and 

white and have depression and medical or substance abuse issues. 

In this study, we, too, found that depressed veterans who had substance abuse problems or psychiatric hospitalization in the year 

prior to their index depression diagnosis had higher suicide rates. 

However, when we divided the depressed veterans into three age 

groups—18 to 44 years, 45 to 64 years, and 65 years or older—we 

found that the younger veterans were at the highest risk for suicide. Differences in rates among depressed veterans of different age 

groups were striking: 18- to 44-year-olds completing suicide at a 

rate of 95 suicides per 100,000 person years, compared with 77.9 

per 100,000 person years for the middle-age group and 90.1 per 

100,000 person years for the oldest age group. 

We did not assess whether individuals had served in combat during a particular conflict, although the existence of a military service-connected disability was considered. 

In this VA treatment population, men veterans were more likely 

to commit suicide than women veterans. Suicide rates were 89.5 

per 100,000 person years for depressed veteran men and 28.9 per 

100,000 person years for veteran women. However, the differential 

in rates between men and women in this population of three to one 

was smaller than that which has been observed in the general population of four to one. 

We found higher suicide rates for white depressed veterans, 95 

per 100,000 person years, than for African Americans of 27.1 per 

100,000 person years and for veterans of other races, 56.1 per 

100,000 person years. Veterans of Hispanic origin had a lower rate, 

46.3 per 100,000 person years, of suicide than those not of Hispanic 

origin, 86.8 per 100,000 person years. Adjusted hazard ratios also 

reflected these differences. 

Surprisingly, our findings revealed a lower suicide rate among 

depressed veterans who also had a diagnosis of post traumatic 

stress disorder, PTSD, compared to depressed veterans without 

this disorder. Depressed veterans with a concurrent diagnosis of 

PTSD had a suicide rate of 68.2 per 100,000 person years compared 

to a rate of 90.7 per 100,000 person years for depressed veterans 

who did not also have a PTSD diagnosis. 

We investigated further to examine whether specific subgroups of 

depressed veterans with PTSD had higher or lower suicide risks. 

We found that concurrent PTSD was more closely associated with 

lower suicide rates among older veterans than among younger veterans. This study does not reveal a reason for this lower suicide 

rate, but we hypothesize that it might be due to a high level of atVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00059 Fmt 6633 Sfmt 6633 E:\HR\OC\39647.XXX 39647

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tention paid to PTSD treatment in the VA system and the greater 

likelihood that patients with both depression and PTSD will receive 

psychotherapy and more intensive visits. In general, individuals 

with depression and PTSD diagnoses have higher levels of VA mental health services use than individuals with depression without 

PTSD. 

Interestingly, depressed veterans who did not have a service-connected disability were more likely to commit suicide than those 

with a service-connected disability. This may be due to greater access to treatments among service-connected veterans or more stable 

incomes due to compensation payments. 

We hope that our findings will help inform clinical treatment and 

policy initiatives to reduce suicide mortality among veterans with 

depression. 

I thank you for this opportunity to testify and will be pleased to 

answer any questions that you have. 

[The prepared statement of Ms. Zivin appears on p. 86.] 

The CHAIRMAN. Mr. Mitchell. 

Mr. MITCHELL. This question is for Dr. Katz. 

And I have read your testimony. I didn’t hear your testimony, 

but I read your testimony. And one of the things I am concerned 

about is, throughout your testimony, you are talking about those 

programs you have in place, which is good, and that you are effective for those you have in place. 

But what bothers me is, this morning we heard testimony from 

the parents of Timothy Bowman, whose numbers will not be in 

your figures. He committed suicide. He will not be part of the DoD 

or the VA’s numbers. And my concern is, unless somebody comes 

and registers with you, what outreach do you have? 

You know, this is a very serious problem, those who do not register. All you have are figures of those who came in and registered 

with the VA. Even in Arizona, this is a growing concern. Veteran 

suicide rates in Arizona have risen 39 percent since 2003, and onequarter of all suicides in Arizona are with veterans. This is, I 

think, an epidemic. 

And I know what you are saying with all of those figures that 

you have there, but my concern is, do you really have enough resources to go after the veterans who do not show up and are not 

on your figures, the figures either from DoD or the VA? Because 

I think it is important that we go out and try to get the correct 

figures. 

Am I understanding that you have not really collected figures, 

total figures, on all those returning from Afghanistan or Iraq? 

Dr. KATZ. Well, I want to begin by—actually it is very ironic. We 

know that Tim Bowman was a person and that his loss is terrible, 

and, as a Nation, we have to mourn him. The question is, is he a 

statistic? Is he counted in VA research? And the answer is yes. Dr. 

Kang’s research counts all veterans, whether or not they have come 

to VA for care. 

This raises questions about, the people who don’t come to VA for 

care, how are we reaching out to them? Our Vet Centers have 

hired over one hundred peer counselors, ex-vets who go out to postdeployment health reassessment, who go to Guard and Reserve 

meetings, and who speak in community centers and related venues. 


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There are more than 90 returning veterans outreach teams in our 

medical centers and clinics. We really have extensive outreach. 

Is it enough to enroll every veteran? No. Is it enough to prevent 

every suicide? Apparently not. 

We have, thanks to you, considerable funds. And our goal, our 

mission and our challenge is to use these funds effectively. We really have to go reaching out to people and providing services, where 

mental healthcare has never gone before. We have intensive research going on, and VA has, by necessity, become more adept at 

translating research into clinical and public health action than anyone else. Are we there yet? Of course not. Have you given us 

enough resources? Yes. Our challenge is to use them to improve 

lives and save lives. 

Mr. MITCHELL. So, Dr. Katz, you are telling me that you have 

enough resources to do the job that is necessary to find these veterans and to treat these veterans. You have enough resources. 

Dr. KATZ. Yes, sir. 

Mr. MITCHELL. Thank you. 

The CHAIRMAN. Mr. Buyer. 

Mr. BUYER. You know, sometimes, Mr. Mitchell, it is not just a 

matter of resources, it is what are you going to do with them. 

Mr. MITCHELL. Yes. 

Mr. BUYER. When you look back, 3 years ago we gave them $300 

million, and they couldn’t even spend $100 million of it. 

Dr. KATZ. Can I comment about that, sir? 

Mr. BUYER. You may. 

Dr. KATZ. A year ago, the Committee raised concerns that there 

was underexecution of mental health enhancement funding. I guess 

that is bureaucratic talk for under-spending of the resources. 

This past year, there were $306 million allocated for mental 

health enhancements in VA. The actual spending was $325 million. 

We overspent and, to be honest, we were congratulated by senior 

leadership for overspending, because nothing is more important 

than mental health. 

Mr. BUYER. I hate to get into the numbers and statistics, but I 

am going to do that for just a second, because, really, it is all sort 

of disturbing to me. 

I look at the Inspector General’s (IG) report, and the IG says, all 

right, out of the 25 million veterans in the United States, they estimate as many as around 5,000 veterans per year are turning to 

suicide, of the 25 million. Then CBS News, they throw out a number of 6,256 in 2005. I mean, since this report came out, I mean, 

there is a difference of 1,200. That is still a big number to me. 

But I am curious, do you know how CBS News came up with 

that number if the IG or the VA comes up with a different number? 

Are you familiar with how they—has CBS News shared with you 

the methodology of how they came up with their number? 

Dr. KATZ. They shared their algebra but not their raw data. We 

want the numbers. It could help to guide and fine tune our prevention efforts. They handed me the numbers when I was interviewed, 

and then they took it back. We requested it from the producers. 

The Inspector General requested it from the producers. They are 

not forthcoming about the numbers. I would think that, as a matVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00061 Fmt 6633 Sfmt 6633 E:\HR\OC\39647.XXX 39647

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ter of citizenship, CBS News should be required to provide these 

numbers, so VA can translate them into prevention. 

Mr. BUYER. Well, the numbers are important in how we get to 

them. 

Let me ask Dr. Zivin, is it important for us to understand the 

gender distribution in these numbers? 

Dr. ZIVIN. The gender distribution, was that your question, sir? 

Mr. BUYER. Yes. Is that important for us to know as policymakers. 

Dr. ZIVIN. It is important for us to know all characteristics associated with suicide and how those may be similar or different in 

the VA or among all veterans than the general population. And 

that is something we are studying. We have both VA- and NIHfunded research to examine all characteristics associated with suicide. 

Mr. BUYER. Have you seen the CBS News report? 

Dr. ZIVIN. I have seen it, yes, sir. 

Mr. BUYER. And what is your opinion regarding the fact that 

gender distribution would have been left out of their numbers? 

What does that tell you? 

Dr. ZIVIN. Sir, I would like to ask the members of this panel if 

they would like to comment on this, or perhaps we could get back 

to you about this. 

Mr. BUYER. Well, if anyone here on the panel has an opinion on 

it, please let us know. Because I think it is rather bothersome that 

they would leave out gender distribution. Does anyone have an 

opinion with regard to that? 

Dr. KATZ. They controlled for gender but did so in a very strange 

way. Their number for veteran suicides is not, in fact, an accurate 

reflection of the rates of suicide. 

Dr. Rosenheck, you wanted to comment? 

Dr. ROSENHECK. Well, actually, I wanted to shift gears a little bit. 

Mr. BUYER. No. 

Dr. ROSENHECK. Okay. 

Mr. BUYER. I get to shift gears. 

Dr. ROSENHECK. In direct response, none of us feel we have seen 

a complete report of this data so that we, as professors, can judge 

the validity of the conclusions. 

Mr. BUYER. All right. I am not going to challenge the intent of 

CBS News, because I am hopeful that their intent and motivation 

was pure. And if it was pure, they have nothing to hide and should 

be willing to work with you, with regard to the numbers. 

Let me ask this question. The Canadian Government uses the 

term ‘‘operational stress injury’’—they don’t use PTSD to describe 

their diagnosis. Would that be useful and helpful to us, if we would 

turn to ‘‘operational stress injury’’ so we can maintain PTSD but 

come up with another type of description whereby it encourages 

soldiers and veterans to come in to discuss this without stigma? Do 

you have an opinion with regard to that? 

Dr. KATZ. Well, I think we heard from the world’s experts about 

what we call it. And in terms of what it is called and how people 

react to that, the world’s experts are the consumers and the families. If they want to change the name, we should change the name. 

Mr. BUYER. Mr. Chairman, with latitude, I have one last question. 


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One of the concerns is being able to provide mental health services to members of the National Guard and the Reserve components when they return from their overseas deployments. In Indiana, on January 2nd, I will stand with the 76th Brigade. We are 

going to send an entire brigade to war. Not since World War II. 

So what outreach programs do you, the VA, have in place for the 

National Guard and the Reserve? 

Dr. KATZ. There are peer counselors from the Vet Centers who 

should be there, as should returning veterans outreach people from 

our medical centers and clinics. 

Mr. BUYER. How do we prepare the families while the soldiers 

are gone? What do we do that is proactive? 

I think that is what the Chairman—my interpretation is, what 

are you doing on the prevention side? Let’s not just wait until they 

come home. What are we doing to help prepare the families? 

We do a lot with the families, not only their care packages, and 

they have their own support groups. But what do we do, in being 

off our heels and on our toes, to be proactive on what they should 

look for? What should they be doing to be helpful to them while 

they are deployed? Are we doing anything? 

Dr. KATZ. Vet Centers are authorized to provide outreach and 

education for families under specified circumstances while the veteran is deployed. VA is not authorized by law to do so. 

Mr. BUYER. Under specified circumstance. That is telling me that 

is some sort of limited service. 

Dr. KATZ. I am actually confessing my personal lack of knowledge about the specifics. I am embarrassed. I apologize for it. We 

will have to get back to you. 

Mr. BUYER. I understand that these men and women are activated so now they are part of DoD. 

Dr. KATZ. Yes. 

Mr. BUYER. But we deal with the consequences of war, the consequences. And it is easy to take care of them when we see the 

physical wound, so it is the mental wound that is our challenge. 

So this leads to the whole path of how we work cooperatively 

with DoD in trying to get bi-directional, on-time, real-time mental 

health data. That is a real challenge. 

But here is what I want to do. I want to do this with you. We 

now know we have a brigade that is going. I am going to work with 

you. I want you to work with myself and the Chairman of this 

Committee, as we also work with DoD, and you tell us what we can 

do that is proactive with regard to this brigade as it goes, and what 

authorities do you need, what do you need from us. You probably 

don’t need much authority. A lot of things you can do. But tell me 

what you can’t do, and we can break down these barriers. 

Will you take that on with us? 

Dr. KATZ. Absolutely, with pleasure and with honor. 

Mr. BUYER. All right. Thank you. 

I yield back. 

The CHAIRMAN. And I give the same answer, with pleasure and 

with honor. 

Mr. BUYER. All right. Thank you. 

The CHAIRMAN. Let me just say a few words. 


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Mr. Buyer mentioned that CBS News had 6,000 and IG had 

5,000. That is a big difference. Both of those are a big difference, 

from what I see in this. It is a different universe, Iraqi and Afghanistan, since 2005—144. I mean, this is a purposeful putting forth 

the lowest figure that you could possibly get to. 

Dr. KATZ. No, sir. Those are the full count of suicides in returning veterans. 

The CHAIRMAN. But you chose a universe on purpose that never 

would touch—how about 5,000 or 6,000? That would get people annoyed. 144? Oh, I can live with that. You are giving numbers here 

that do not reflect reality in terms of the problem that we have to 

face and you have to face as policymakers. 

And, frankly, your statement, Dr. Katz, that ‘‘CBS News should 

be required to give the statistics’’—— 

Dr. KATZ. Yes. 

The CHAIRMAN [continuing]. That is disgraceful from an organization, that they have to FOIA, we have to FOIA, a parent has to 

FOIA, to get any information on this. 

I have, from this chair to that seat—and maybe you were one 

who was there, I can’t recall now—at least three or four different 

times in the last 7 or 8 months, asked for data on suicides from 

the VA. They always said they will get back to me. They have 

never gotten back to me. You try to get data, you get all kinds of 

different numbers from different universes. 

And besides, the data you use, as we have heard this morning, 

is all slanted anyway. I mean, it is a very specific definition of a 

suicide that you are using that is way underreported from the reality. 

CBS News tried to get the data. They didn’t want to spend 6 

months going to States and do this thing. They couldn’t get the 

data from you because you don’t track this stuff. You simply don’t 

track it. You don’t want to know about it. 

And I had a whole report from Dr. Zivin, who—I never, by the 

way, ever heard somebody on the panel say they are not speaking 

for the Department of Veteran Affairs when you are here. I mean, 

they must have approved this, but you are not speaking for them. 

I don’t know, that is strange. 

But you give four or five pages of data. I don’t see anybody on 

this panel, in prepared testimony, say what you are going to do. 

How does this inform your treatment? What prevention are you 

doing to do based on this? 

This is a bunch of numbers that is meaningless in the context 

that we are working in today. That is, you had time to give this 

data to somebody to say, ‘‘What are we doing about using this data 

for actual clinical or preventive operations?’’ And there is nothing. 

It is just a case of—of ‘‘analysis paralysis.’’ It is just a bunch of statistics that you are going to throw out to us here and say that you 

have done your duty. You guys have not done your duty. You have 

not given us adequate numbers or even an explanation of the problem in getting those numbers. 

We haven’t talked about, if there are 5,000 or 6,000 or 2,000 veterans that are dying every year, how are we going to get to them? 

You tell me what you are doing, but you are not telling me about 


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the evidence that we have that we are not being effective. How are 

you dealing with that? You have not done the job. 

We are going to have another hearing on this. 

[Applause.] 

And I want you to come back with a better report. This is not 

very useful. Again, all you do is compare some things in a strange 

universe that does not come to grips with the issue. 

Dr. KATZ. Mr. Filner? 

The CHAIRMAN. Mr. and Mrs. Bowman this morning, and the 

other testimony, were crying out for help. I responded to say, here 

is what I am thinking about to respond. I don’t know if it is good 

or bad. I said we have to have a public education program. I said 

we have to have mandatory diagnosis of PTSD and brain injury. I 

said we have to do that in a unit with family there. 

You didn’t come up with anything. You didn’t even respond to my 

meager suggestions. 

Dr. KATZ. Mr. Filner, I really need to respond to one specific issue. 

The CHAIRMAN. Respond to them all. I don’t care. 

Dr. KATZ. Well, we can provide additional numbers. 

The CHAIRMAN. You always say that, and we never get anything. 

Dr. KATZ. We can provide additional—— 

The CHAIRMAN. I have done this for at least several years. 

Dr. KATZ. You are delivering the message to America that there 

are major problems in VA treatment. I want to deliver the message 

that care is available and that treatment works. We have programs 

in place that can help people. 

The CHAIRMAN. How would you have helped Timothy Bowman or 

the Timothy Bowman that is coming tomorrow? Nobody has talked 

to them, nobody has done anything, nobody has counseled them, 

nobody made Timothy aware of anything, and nobody is making 

the Timothys of tomorrow aware. So how are you responding to 

their cry for help? 

Dr. KATZ. It is tragic that—— 

The CHAIRMAN. But what are you doing about it? 

Dr. KATZ. We are doing the—— 

The CHAIRMAN. But it didn’t reach these people. 

Dr. KATZ. That is tragic. 

The CHAIRMAN. Well, then find a more effective way. Don’t keep 

telling us you are doing things when they are not effective. It is 

proven not effective. You reach a very small percentage of those 

who need help. Why? 

Dr. KATZ. Sir, I really think we want to emphasize the message 

that treatment is available and treatment works. Because that 

message is a matter of public health, and that message can be lifesaving. 

The CHAIRMAN. Well, let me tell you the message that I want to 

send, that we have an epidemic, as has been said before, we have 

a public health crisis. And no matter how hard you are working 

now, we are not doing the job. We need to do more. 

And you need to tell us, rather than how much stuff you are 

doing, what we need to do to be effective. You answered Mr. Mitchell that you had sufficient resources. You don’t have anybody to call 

up Mr. Bowman to even offer condolences, let alone help his counseling. So, I mean, surely some more resources would be nice. 


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Mr. Mitchell, you have a question? 

Mr. MITCHELL. Yes. I would like to follow up on that with Dr. 

Zivin. 

According to your testimony, your study was based on veterans 

who had been diagnosed with depression and were treated at VA 

hospitals or VA facilities. 

What I would like to know is, what about veterans who don’t fall 

in either of these categories? What about the veterans who have 

not been diagnosed with depression or who have not been treated 

at VA facilities? What about the veterans who are suffering from 

post traumatic stress disorder or haven’t visited a VA facility? 

Could you shed any light on the scope of the problem facing 

these and other categories of veterans? 

Dr. ZIVIN. It is true that we focus in this study specifically on depressed veterans treated in the VA population, and that represents 

only a fraction of all veterans who either have depression or PTSD 

or both. And one of the things that we are doing as part of our ongoing research and what Dr. Katz was just alluding to is that we 

are now collecting and having data on all veterans, with or without 

depression, and rates of suicide. 

One of the other things to mention is that the VA has developed 

a comprehensive strategic plan which is specifically focused on 

treatment for PTSD, suicide prevention and a number of other initiatives specifically targeting at-risk veterans. 

And I will ask my colleagues here to comment further, if you 

have other questions. 

Mr. MITCHELL. Just one comment to add to that. There are some 

people who come back who don’t believe that they have a problem, 

and therefore, they don’t register. Maybe they don’t fill out the 

forms or tests that I understand are necessary, yet they have it. 

Is there any outreach? 

I understand, Dr. Katz, you said you have programs, but there 

are only programs if somebody comes in. What about the people 

who have not been diagnosed yet who end up with this disorder 

months, maybe years, later? What about those who have not registered with the VA? 

What kind of programs do you have in place, not just to reach 

those who have registered and who have been diagnosed, what 

kind of programs do you have in place to go beyond that? 

Dr. KATZ. We are in agreement that a major challenge for us is 

reaching more people. We have talked about what we do for those 

who enter our doors, either the Vet Centers or medical centers and 

clinics. We have talked about the outreach that we are doing. How 

do we effectively reach the rest of the community? 

Dr. Kussman is writing a letter that should go out this week or 

next to all veterans, raising these issues. Other strategies are being 

developed including additional follow-up to the post-deployment 

health reassessment. We recognize the need to do more to reach 

more people, yet we are working intensively—and we are working 

intensively on how to do it. 

Dr. Rosenheck reminded me of a fact from Dr. Han Kang’s work 

that makes this issue very poignant. Among returning veterans, 

among OIF/OEF veterans, the rates of suicide among those who 

come to us don’t differ from the age-, sex- and race-matched indiVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00066 Fmt 6633 Sfmt 6633 E:\HR\OC\39647.XXX 39647

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viduals, but the rates of suicide among those who don’t come to us 

are higher. It is reassuring about what we are doing and a clear 

message about what we should be doing next. 

Mr. MITCHELL. Absolutely. 

And one last question, real quickly. Do you believe that there is 

a suicide epidemic? 

Dr. KATZ. There is a suicide epidemic in America. 

Mr. MITCHELL. Among veterans? 

Dr. KATZ. The numbers—what are the numbers? About 18 veterans kill themselves each day in America. That is too many. About 

four or five—— 

Mr. MITCHELL. According to CBS News, it was 120 a week. 

Dr. KATZ. About the same. 

Mr. MITCHELL. That is not higher than the general population? 

Dr. KATZ. Rates among veterans are somewhat higher than the 

general population because of demographics and increased in risk 

factors for depression, related conditions. 

Mr. MITCHELL. I think one way we can find out about that is if 

you have the data. And I think that is—you know, one of the people were arguing about earlier was the methodology data that CBS 

News had. And if we had the data, we could certainly refute or 

agree that there is or is not an epidemic and it is more so among 

veterans. I think that is what we have been trying to find out. 

Dr. KATZ. Some of the Nation’s foremost investigators in this 

area are before you. 

Dr. Blow, could you talk about some of the data? 

Dr. BLOW. Sure. Among veterans receiving services in VHA, so 

those actually touching the VHA, the rates are about 11⁄2 times 

age- and sex-adjusted population rates. The rates for women are 

about two times that of that U.S. population overall rates for 

women. So it is much higher for women than for men. 

Mr. MITCHELL. Again, these are people in your system. 

Dr. BLOW. That is exactly right, the 5.5 million veterans who actually we serve. 

Mr. MITCHELL. We already heard about someone not in the system. That is the purpose of what we are trying to find, people who 

are not in the system being treated. 

The CHAIRMAN. Mr. Mitchell, this room has been reserved for another Committee, so we have to adjourn this. 

I have one last—you have a last statement. 

Mr. BUYER. Dr. Katz, I want you to go back from here and talk 

with your chief and your team, and I want you to be ahead of us. 

Work with your counterpart in DoD between their BattleMind 

Training initiative that they have, along with your initiatives, and 

we will use that brigade as a cohort. And we are going to circle 

back here next week, okay? But get ahead of us. All right. 

Dr. KATZ. Thank you. 

The CHAIRMAN. Thank you, Mr. Buyer. 

And let me again—I mean, I am very disappointed with the testimony. When Mr. Mitchell gave you a chance just to talk about outreach, you said that the Deputy Secretary is writing a letter. That 

doesn’t do it. 

Look, I will just comment on one thing. We know, we absolutely 

know as a fact—I don’t care what any researcher tells me—that the 


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images of war in Iraq trigger PTSD reactions in people from earlier 

wars. I could figure out a hundred ways for you to go out to those 

people now. Just take the Vietnam vets. Go out, find them and say, 

‘‘We are going to help you.’’ 

You have all this great stuff you are telling me about. We know 

Iraq is going to trigger this from Vietnam vets. Go find them. Go 

to the Vet Centers, go to the Vietnam Veterans of America, go to 

the VSOs who are here. Go to the major cities. Set up a place 

where you can screen people more. Go out to communities. 

You are doing this research which doesn’t tell us anything, and 

you are not reaching the people who need the help. We said it 

many times this morning. We have an obligation. You are not 

meeting that obligation. You are doing stuff and you are spending 

a lot of money and you have all these professors, but we are not 

meeting the needs. And until we do that, we are not going to be 

satisfied here. 

We are going to take this up early next year. We will continue 

the hearing we started today. But we are going to talk to the new 

Secretary, General Peake, and let him know how disappointed we 

are in this, and hopefully we can move to do our veterans a greater 

service. We are not doing the job now. 

Mr. Kennedy. 

Mr. KENNEDY. I would just like to ask that you apply the bottom 

line to the families of veterans so that they can better identify 

these symptoms amongst their own family members. Right now they 

are not given the tools, so to speak, of being able to act as the identifier and supporter of their own loved one when they come home. 

Am I right? 

Dr. KATZ. You are right. Vet Centers, as well as DoD, can begin 

on it. For medical center and clinic staff to do that would take an 

act of Congress. 

Mr. KENNEDY. But family members are the ones who spend the 

most time with their loved one. They ought to be brought in and 

made a better and bigger part of this whole process. 

Dr. KATZ. Absolutely. 

The CHAIRMAN. And acts of Congress is what we do, so just tell 

us what we need to do. 

Mr. BUYER. Mr. Kennedy, that is exactly what we are going to 

try to do. 

Mr. KENNEDY. And finally are we tracking—as you said, women 

are twice as likely to have suicide rates within the VA as men. Are 

we tracking women veterans within the VA separately from men 

and their issues, because I understand they have very specific and 

unique issues as to men veterans when they are in the VA system. 

Are we doing—— 

Dr. BLOW. There are many initiatives in the VA to enhance services for women veterans with their special needs and especially 

with the special needs that they encounter because of their combat 

exposure. 

Mr. KENNEDY. Yes, but are we tracking their women-specific 

issues, around their specific issues, mental health needs, issues? 

Dr. BLOW. Yes, absolutely. We have many different women’s 

mental health initiatives trying to find out what happens to them 

over time, and we try to address their specific needs in treatment. 


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Dr. KATZ. A minor correction. The twofold is women in the VA 

relative to women in the general population. It is still a lower rate 

than men. 

Dr. Rosenheck. 

Dr. ROSENHECK. I did want to talk to the Bowmans because I am 

the son of a veteran who committed suicide, and I have been now 

in the VA and have been a psychiatrist and have been a professor 

of psychiatry and epidemiology for almost 40 years, and my work 

is animated every day by the fact that my father was a veteran 

who had committed suicide. I want to tell you that my colleagues 

in the VA come to this work with a personal sense of mission. All 

of us, many of us—more than in any other group—are veterans, 

and more than any other group, we know and have been touched 

by mental illness and by all kinds of illness. People do not come 

to the VA as a simple, professional job. People who work in the VA 

are driven by a sense of mission and of caring, and I want to say, 

in shifting back to my capacity as program evaluator and as a 

scholar—well, I am staying with the personal—I started with the 

VA in 1973. I was a first-year resident at the VA in Connecticut, 

and I was seeing veterans coming back from Vietnam. I have 

worked at the VA for my whole career since then, and the change 

from 1973 to now is so astonishing. When I was a first-year resident, I had no language. I had no culture. I had no background to 

understand the young men who were coming and sitting in front 

of me right off the battlefield. We had no terms. 

Now, whether you talk about PTSD or PTSI, we have a language, and the whole country knows it. I get called by reporters, 

‘‘Can you get PTSD from watching the war on TV?’’ Everybody 

knows about this syndrome, and they know about it because of the 

gift of the Vietnam veterans. Every year, we are seeing more and 

more—I have been tracking it for 10 years, and the progress we are 

making in terms of the numbers of veterans we are seeing is astonishing, and the commitment of the organization from the bottom to 

the top to serving veterans who served in combat, I can just—— 

The CHAIRMAN. We thank you for that. 

Mr. KENNEDY. I understand that we do not on the women’s 

side—— 

The CHAIRMAN. Mr. Kennedy, we have to end this. 

Mr. KENNEDY. We are not tracking women-specific issues from 

the general veterans’ population, and I hope that we do a better job 

of doing that. 

The CHAIRMAN. Let me just say in conclusion, Dr. Katz and your 

colleagues, nobody is disputing your personal commitment or your 

effectiveness in dealing with veterans. What we are saying is how 

much of a—possibility exists in this country to deal with these 

issues. That is the great disappointment to me. We have the ability 

to do the job for everybody. Although we have made progress and 

we have all of these dedicated people, we have not done the job. 

And until we do the job, we are going to keep up the oversight that 

we have to do. 

This hearing is adjourned. 

[Whereupon, at 2:35 p.m., the Committee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Bob Filner, 

Chairman, Full Committee on Veterans’ Affairs 

Good morning and welcome to the House Veterans’ Affairs Committee hearing on 

Stopping Suicides: Mental Health Challenges within the Department of Veterans Affairs. 

Mental health issues have been a focus of this Committee all year long and will 

continue to be at the forefront of our agenda. Public Law 110–110, the Joshua 

Omvig Veterans Suicide Prevention Act, was enacted in November of this year. 

The House has also passed H.R. 2199, the ‘‘Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007,’’ H.R. 2874, the ‘‘Veterans’ Health 

Care Improvement Act of 2007,’’ and H.R. 612, the ‘‘Returning Servicemember VA 

Healthcare Insurance Act of 2007.’’ Each of these pieces of legislation addresses 

mental health issues in some aspect concerning the well-being of veterans. 

The demands confronting VA today are complex and sometimes overwhelming. VA 

must find a way to ensure quality and efficiency do not suffer as they move forward, 

continuing to treat veterans from past wars while adapting to the unique needs of 

the younger veterans of modern warfare who are entering the system for the first 

time. 

We know that OEF/OIF servicemembers are subject to repeated deployments, an 

intense level of close combat, extended deployment lengths and repeated family separations. 

VA has reported that of the 263, 909 separated OEF/OIF veterans who have obtained VA healthcare since FY 2002, 38 percent have received a diagnosis of a possible mental disorder. Of that population, 48 percent have a possible diagnosis of 

PTSD. The prevalence of mental health problems among returning servicemembers 

is troublesome and should be of concern to everyone. 

Recent events have been brought to the attention of this Committee through a 

CBS report on the rising suicide rates among veterans. We also know that male veterans are at elevated risk of suicide relative to nonveterans. In fact, they are twice 

as likely to die of suicide compared to male nonveterans in the general population. 

Of great concern to the Committee is the recent VA Inspector General report that 

found that nearly 1,000 veterans who receive VA care commit suicide every year, 

and as many as 5,000 a year are committed among all living veterans. 

Today we will take a hard look at programs the VA has implemented to address 

the challenges of suicide. 

I look forward to the upcoming testimony. 

f 

Prepared Statement of Hon. Stephanie Herseth Sandlin 

Thank you to everyone for being here. I congratulate Chairman Filner and Ranking Member Buyer for holding today’s hearing to examine and identify mental 

health challenges within the Department of Veterans Affairs healthcare system. 

As the wars in Iraq and Afghanistan continue to produce a new generation of veterans, it is important that Congress evaluate the impact of these conflicts on the 

mental well-being of returning servicemembers. We must closely evaluate the ability 

of the VA to meet the mental healthcare demands placed upon it. 

While I am pleased that the VA offers a wide array of mental health programs, 

there continues to be room for improvement. In particular, I believe we must do 

more to meet the mental healthcare needs of our rural veterans—who often must 

travel long distances to reach VA healthcare services. 

I am pleased that we have the opportunity to hear from today’s panelists and am 

grateful to have the opportunity to hear their suggestions and answers to the critical issues involved. I look forward to hearing their testimonies. 


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Again, I want to thank everyone for taking the time to be here and discuss these 

important matters. 

f 

Prepared Statement of Hon. Harry E. Mitchell 

Thank you, Mr. Chairman. And thank you for holding today’s hearing. 

Last month, CBS News brought some shocking, and critically important information to light. Not just that those who served in the military were more than twice 

as likely to take their own life in 2005 than Americans who never served or that 

veterans aged 20 to 24 were killing themselves when they returned home at rates 

between two-and-a-half to four times higher than nonvets the same age, but that 

the Department of Veterans’ Affairs wasn’t keeping track of veteran suicides nationwide. 

The VA is one of the best healthcare systems in the country, with literally thousands of professionals working to help veterans with mental health needs. 

But with all due respect, if the VA doesn’t know the size and the scope of the 

problem, how can we know if they’re adequately addressing our veterans’ mental 

health needs? 

As disturbed as I was by the CBS’ report, I was even more disturbed by the VA’s 

response. Instead of reviewing the information and thinking critically about whether 

the VA might need to take some additional measures, they immediately attacked 

the messenger, calling CBS News’ analysis a ‘‘questionable journalistic tactic.’’ 

Obviously it would be great to compare CBS’ numbers to those kept by the VA, 

but that’s precisely the point; the VA hasn’t been keeping them. 

I think this kind of defensiveness is a disservice to veterans, and to all the hardworking employees of the VA who are doing their best to help our wounded warriors. 

So, as we begin today’s hearing, I just want to say that I hope we can get past 

the name-calling, and hurt feelings and gotcha-fights about methodology and do 

what the American people expect us to do: work together to prevent more of these 

unspeakable tragedies and, if at all possible, try to bring some small measure of 

comfort to those who mourn. 

I yield back. 

f 

Prepared Statement of Hon. Cliff Stearns 

Mr. Chairman, 

Thank you for holding this important hearing today. The statistics regarding the 

rate of suicides among veterans is beyond alarming, it is catastrophic. These young 

men and women are heroes—each and every one of them. Veterans returning from 

war frequently become valued neighbors and leaders in their community, giving of 

their time and themselves to help others at home as they did abroad. Their presence 

reminds us of the high cost of our freedom, and inspires us to act for others rather 

than just ourselves. These young men and women who have served our Nation in 

such extreme circumstances—enduring unbelievable amounts of the stress of war so 

that those of us who remain at home can live in the peace they protect, deserve the 

utmost respect—and the utmost care that we can provide. 

It is appropriate today that we remember that the problem of the traumatic effects of war upon our veterans has been grappled with for decades. In fact, only 

about two hours away lies the battlefield of Antietam—the bloodiest single day battle in all of American history with almost 23,000 casualties. Many of those that survived left the field with more hidden wounds that bandages could not bind. Back 

then, it was called by other names like ‘‘war sickness.’’ In World War II it was 

‘‘shell-shock’’ or ‘‘battle fatigue,’’ through the years until now we refer to it as ‘‘Post 

Traumatic Stress Disorder.’’ From the very first shots fired for our independence, 

those who fought to maintain that independence have suffered under the traumatic 

stress. 

Throughout our battle history, we have learned more and more regarding best 

treatments for this condition, yet more needs to be done. I would be interested in 

statistics that could show clearly the leading factors to suicide attempts. Are most 

veterans who commit suicide suffering from PTSD, or from other complicating reasons such as substance abuse, or other mental conditions? The better we can identify the key indicators and symptoms leading toward suicide attempts, the better 

we can develop and provide treatments. As a co-sponsor of H.R. 327, the Joshua 

Omvig Veterans Suicide Prevention Act, I was proud when it was signed into law 


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on November 5, 2007. I believe that this is a key step toward attacking this problem. I also understand that the VA is improving its screening processes, hiring more 

counselors, and developing more ‘‘best practices’’ to combat this growing problem. 

However, the clock is ticking, and we need to move quickly to prevent the loss of 

more of our wounded warriors. I look forward to hearing from our panel of experts 

more about this dreadful problem and how we are going to work together to prevent 

the loss of more of our Nation’s heroes. 

f 

Prepared Statement of Mike and Kim Bowman, Forreston, IL 

(Parents of Specialist Tim Bowman, U.S. Army, Illinois National Guard, 

Bravo Troop, 106th Cavalry) 

Mr. Chairman, members of the committee, my wife and I are honored to be speaking before you today representing just one of the families that lost a veteran to suicide in 2005. 

As my family was preparing for our 2005 Thanksgiving meal, our son Timothy 

was lying on the floor of my shop office, slowly bleeding to death from a self-inflicted 

gunshot wound. His war was now over, his demons were gone. Tim was laid to rest 

in a combination military, firefighter funeral that was a tribute to the man he was. 

Tim was the life-of-a-party, happy-go-lucky young man that joined the National 

Guard in 2003 to earn money for college and get a little structure in his life. On 

March 19th of 2005 when Specialist Timothy Noble Bowman got off the bus with 

the other National Guard soldiers of Foxtrot 202 that were returning from Iraq he 

was a different man. He had a glaze in his eyes and a 1,000-yard stare, always looking for an insurgent. 

Family members of F202 were given a 10-minute briefing on PTSD (Post Traumatic Stress Disorder) before the soldiers returned and the soldiers were given even 

less. The commander of F202 had asked the Illinois Guard Command to change 

their demobilization practices to be more like the regular Army, only to have his 

questions rebuffed. He knew that our boys had been shot up, blown up by IED’s 

(Improvised Explosive Device), extinguished fires on soldiers so their parents would 

have something to bury, and extinguished fires on their own to save lives. They 

were hardened combat veterans now, but were being treated like they had been at 

an extended training mission. 

You see, our National Guardsmen from F202 were not out filling sandbags. They 

departed in October of 2003 for 6 months of training at Forts Hood and Polk. On 

Tim’s 22nd birthday, March 4, 2004, Foxtrot left for Iraq where they were stationed 

at Camp Victory. Their tour took them directly into combat including 4 months on 

‘‘the most dangerous road in the world,’’ the highway from the airport to the Green 

Zone in Baghdad where Tim was a top gunner in a Humvee. Tim as well as many 

other soldiers in F202 earned their Purple Hearts on that stretch of road known as 

Route Irish. We are STILL waiting for Tim’s Purple Heart from various military paperwork shuffles. My wife and I are not here today as anti-war protesters. Our son 

truly believed that what his unit did in Iraq helped that country and helped many 

people that they dealt with on a daily basis. Because of his beliefs, I have to believe 

in the cause that he fought and died for. That doesn’t mean that I don’t feel that 

we lost track of the overall mission in Iraq. 

When CBS News broke the story about veterans suicides, the VA took the approach of criticizing the way that the numbers were created instead of embracing 

it and using it to help increase mental healthcare within their system. Regardless 

of how perfectly accurate the numbers are, they obviously show a trend that desperately needs attention. CBS did what NO government agency would do; they tabulated the veteran suicide numbers to shed light on this hidden epidemic and make 

the American people aware of this situation. The VA should have taken those numbers to Capitol Hill asking for more people, funding, and anything else they need 

to combat this epidemic. They should embrace this study as it reveals the scope of 

a huge problem, rather than complaining about its accuracy. If all that is going to 

be done with the study is argue about how the numbers were compiled, then an average of 120 veterans will die every week by their own hand until the VA recognizes 

this fact, and does something about it. 

The VA mental health system is broken in function, and understaffed in operation. There are many cases of soldiers coming to the VA for help and being turned 

away or misdiagnosed for PTSD and then losing their battle with their demons. 

Those soldiers, as well as our son Timothy, can never be brought back. No one can 

change that fact. But you can change the system so this trend can be slowed down 

dramatically or even stopped. 


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Our son was just one of thousands of veterans that this country has lost to suicide. I see every day the pain and grief that our family and extended family goes 

through in trying to deal with this loss. Every one of those at-risk veterans also has 

a family that will suffer if that soldier finds the only way to take the battlefield 

pain away is by taking his or her own life. Their ravished and broken spirits are 

then passed on to their families as they try to justify what has happened. I now 

suffer from the same mental illnesses that claimed my son’s life, PTSD, from the 

images and sounds of finding him and hearing his life fade away, and depression 

from a loss that I would not wish on anyone. 

If the veteran suicide rate is not classified as an epidemic that needs immediate 

and drastic attention, then the American fighting soldier needs someone in Washington who thinks it is. I challenge you to do for the American soldier what that 

soldier did for each of you and for his country: Take care of them and help preserve 

their American dream as they did yours. To quote President Calvin Coolidge, ‘‘The 

Nation which forgets its defenders will be itself forgotten.’’ 

Today, you are going to hear a lot of statistical information about suicide, veterans, and the VA. But keep one thing in mind, our son, Specialist Timothy Noble 

Bowman, was not counted in any VA statistics of any kind. He had not made it into 

the VA system because of the stigma of reporting mental problems. He was National 

Guard, and he was not on a drill weekend when he took his life. The only statistical 

study that he was counted in was the CBS News study. And there are many more 

just like him. We call them KBA’s, killed because of action, the unknown fallen. 

I challenge you to make the VA an organization to be proud of instead of the last 

place that a veteran wants to go. It is the obligation of each and every one of you 

and all Americans to channel the energies, resources, and the intelligence and wisdom of this Nation’s best and brightest to create the most effective, efficient and 

meaningful healthcare system for our men and women who have served. We must 

all remove the stigma that goes with a soldier admitting that he or she has a mental issue. Let those soldiers know that admitting they have a problem with doing 

the most unnatural thing that a human being can do is all right. Mental health 

issues from combat are a natural part of the process of war and have been around 

for thousands of years, but we categorize that as a problem. Take that soldier that 

admits a mental health injury from combat and embrace him as a model for others 

to look up to. Let the rank-and-file know by example that it’s okay to work through 

your issues instead of burying them until it’s too late. Grab that soldier and thank 

him for saying, ‘‘I’m not okay,’’ and promote him. A soldier that admits a mental 

injury should be the first guy you want to have in your unit, because he may be 

the only one that really has a grasp on reality. But instead, he is punished and 

shunned and by that example, he has become the model for PTSD and suicide. And 

while we are at it, why do we call it a disorder? That title, in itself, implies ramifications that last forever. It is an injury, a combat injury, just like getting shot. With 

proper care and treatment soldiers can heal from this injury and be as productive 

and healthy as before. 

We as a country have the technology to create the most highly advanced military 

system in the world, but when these veterans come home, they find an understaffed, 

underfunded, and underequipped VA mental health system that has so many challenges to get through it that many just give up trying. The result is the current 

suicide epidemic among our Nation’s defenders, one of which was Specialist Timothy 

Noble Bowman, our 23-year-old son, a soldier, and our hero. 

Our veterans should and must not be left behind in the ravished, horrific 

battlefields of their broken spirits and minds. Our veterans deserve better!! 

Mr. Chairman, this concludes my testimony. Thank you. 

f 

Prepared Statement of Penny Coleman, Rosendale, NY, Author 

Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War 

INTRODUCTION 

The Roman poet Horace said that it is a sweet and fitting thing to die for one’s 

country. That sentiment has been offered as comfort to widows and orphans for 

more than 2,000 years. However hollow and inadequate it might seem to those who 

are left only with memories and a folded flag, it remains central to the allure and 

romance of military culture. But I have never heard it suggested that there is anything sweet or fitting about being a psychiatric casualty for one’s country, though 

surely soldiers and veterans who were injured in their minds pledged the same and 

risked as much as their fallen comrades. 


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1Penny Coleman, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War 

(Boston, MA: Beacon, 2006). 2Lieutenant Colonel David Grossman, On Killing (New York: Little Brown, 1996). 3 Jonathan Shay, Achilles in Vietnam (New York: Touchstone, 1995). 4 Ibid. 5 Ibid. 6 Ibid. 

My husband, Daniel O’Donnell, came home from Vietnam in 1969, 11 years before 

Post Traumatic Stress Disorder (PTSD) became an official diagnostic category. Like 

most veterans, he simply refused to talk about his war experiences, so I had no way 

of knowing what he had experienced or what was going on in his head. In retrospect, I imagine he just thought he was going crazy. It must have been terrifying. 

I can only image his despair. 

After Daniel died, it never occurred to me to blame the war for what had happened to us. I tried to blame him, but ended up blaming myself. If only I had been 

kinder, more patient, more understanding, quicker to notice and identify trouble. I 

can find more compassion for us both from this distance. I can see now that he was 

just a kid who had tried to stay alive in a situation that exploded all the rules he 

had ever lived by, and that he was too sorry and too ashamed to start over. And 

I can see now that I, too, was in over my head in a situation I neither understood 

nor controlled. But at the time, and for decades after, I believed his death was my 

fault, and I crept into a psychic lair to hide my shame and lick my wounds in private. I married again and had two children, but it was an awful way to live, tiptoeing around everybody I loved, trying not to kill one of them by mistake. It was 

a long time before I could find some compassion and forgiveness for that young 

woman who had no idea what she was up against. 

The research I did for my book, Flashback: Posttraumatic Stress Disorder, Suicide, 

and the Lessons of War 1 included interviews with 16 widows, mothers, and daughters whose loved ones also took their own lives after serving in Vietnam. The story 

I have just told is only my version of a litany that ran through every interview. 

POST TRAUMATIC STRESS DISORDER AND MODERN WARFARE 

Every war in historical memory has produced psychiatric casualties. In fact, in 

every war American soldiers have fought in the past century, the chances of becoming a psychiatric casualty were greater than the chances of being killed by enemy 

fire.2 So surprise is at best a disingenuous response to what is happening yet again. 

At the same time, several issues have emerged that have affected rates of post traumatic stress injuries in modern warfare; these include the intensity and time a soldier is exposed to combat; unit cohesion, that is, the extent to which soldiers have 

been given a chance to know and trust those with whom they are fighting; and the 

nature of contemporary military training. 

Length of exposure versus unit cohesion: There were two central lessons that military psychiatrists took from the wars of the 20th century. The first is that soldiers 

fight for love—not hate. And not love of country. They’re fighting for the soldier next 

to them, the one they can trust to take their back. The interpersonal bonding that 

happens when soldiers get to know and trust each other is what the military calls 

unit cohesion, and it is known to be one of the most effective protections against 

traumatic stress injuries.3 The second lesson is that if it is bad enough for long 

enough, anyone will fall apart. Anyone. It’s not about how strong you are or how 

brave you are—how truly manly you are. There is no such thing as a bullet-proof 

mind.4

During the Vietnam era, the military took the second of these two lessons seriously. The DEROS policy (Date of Expected Return from Over Seas) let every soldier 

know they would be leaving Vietnam exactly one year after they arrived. They 

hoped that a year would be a manageable time for a soldier to withstand the stress 

of the combat environment. And indeed, the limited amount of time spent in the 

combat zone may have been the reason that only about 1% of soldiers were evacuated for psychiatric reasons, compared to World War II.5 At the same time, in the 

interest of efficiency, the military ignored the first rule, about the importance of personal loyalty and unit cohesion. After basic training, soldiers were inserted individually into the war machine according to some bureaucratically efficient system. 

They were cut off from the friendships they had established during training. They 

were sent into terrifying situations surrounded by strangers who they didn’t know 

or have any reason to trust. Furthermore, their officers were also rotated, serving 

for only six months with a unit. It has now been established that the ways in which 

DEROS undermined unit cohesion were a major contributor to the psychic injuries 

of the Vietnam war.6


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7Davis H. Marlowe, Psychological and Psychosocial Consequences of Combat and Deployment: 

With Special Emphasis on the Gulf War (Santa Monica, California: Rand, 2001). 8http://timelines.epluribusmedia.org/timelines/index.php?&mjre=PTSD&table_name=tl_ptsd 

&function=search&order=date&order_type=ASC. 9S.L.A. Marshall, Men Against Fire: The Problem of Battle Command in Future Wars 

(Gloucester, MA: Peter Smith, 1978). 10 Coleman, Flashback, 73–4. 11Grossman, On Killing, 251. 12 Carol Burke, Camp All-American, Hanoi Jane, and the High-and-Tight. (Boston, MA: Beacon, 2005). 

Current military policy has turned that on its head. Now, the military keeps units 

together, but ignores the time/intensity rule. Soldiers are repeatedly deployed, 

spending far more time in combat than even the generous limits the Army considers 

safe.7 Some units have been deployed three or four times in as many years, and it 

is becoming ominously clear that the psychic resources of our soldiers has been exhausted. 

In 2004, the release of the Abu Grahib photographs broke the unforgivable silence 

in the mainstream press about atrocities committed by American soldiers in Iraq. 

Haditha followed, then Mahmoudiyah, Ishaqi, and at this writing, multiple other instances of savage, homicidal violence directed against civilians have been reported. 

More recently, there have been the reports of veterans involved in violent incidents 

after coming home.8 These acts are being committed by American soldiers who are 

predictably out of control. They are the inevitable result of pushing our soldiers way 

beyond their limits. They are not the result of a few bad apples run amok. 

I’m not suggesting that American soldiers take no responsibility for their actions. 

I would argue that we must balance outrage at criminal and sadistic acts with the 

insistence that this new generation of soldiers and veterans not be asked to take 

responsibility for the terrible and tragic circumstances that led to those acts. Individual soldiers cannot be the only ones taking the blame. 

The nature of contemporary military training: Military training has been part of 

the experience of millions of young American men since the Revolutionary War. 

Prior to the Vietnam era, however, that training consisted largely of practicing military skills and learning to manage military equipment. It is only in the last half 

century that training has evolved into an entirely new phenomenon that makes use 

of the principles of operant conditioning to overcome what studies done over the last 

century have consistently demonstrated, namely, that healthy human beings have 

an inherent aversion to killing others of their own species.9

War Psychiatry, the army’s textbook on combat trauma, notes that ‘‘pseudospeciation, the ability of humans and some other primates to classify certain members of their own species as ‘other,’ can neutralize the threshold of inhibition so they 

can kill conspecifics.’’ 10 Modern military training has developed carefully sequenced 

and choreographed elements to disconnect recruits from their civilian identities. The 

values, standards and behaviors they have absorbed over a lifetime from their families, schools, religions and communities are scorned and punished. Using cruelty, 

humiliation, degradation and cognitive disorientation, recruits are reprogrammed 

with an entirely new set of learned responses. Every aspect of combat behavior is 

rehearsed until response becomes reflexive. Operant conditioning has vastly improved the efficacy of American soldiers, at least by military standards. It has proven to be a reliable way to turn off the switch that controls a soldier’s inherent aversion to killing. American soldiers do kill more often and more efficiently. Lt. Col. 

Dave Grossman, author of On Killing, calls this form of training ‘‘psychological warfare, [but] psychological warfare conducted not upon the enemy, but upon one’s own 

troops.’’ 11

There are any number of ways that modern training methods both support violence, aggression and obedience and help to disconnect a reflex action from its 

moral, ethical, spiritual, or social implications. Drill instructors rely on sexist and 

homophobic labels like ‘‘girl,’’ ‘‘pussy,’’ ‘‘lady’’ or ‘‘fairy’’ to humiliate, degrade and ultimately exact conformity. Recruits are drilled with marching chants that privilege 

their relationships with their weapons over their relationships with women (‘‘You 

used to be my beauty queen. Now I love my M–16’’), overtly conflate sex and violence (‘‘This is my rifle, this is my gun. This is for fighting; this is for fun.’’), and 

treat the killing of civilians as humorous (‘‘Throw some candy to the children. Wait 

till they all gather round. Then you take your M–16 now, and mow the little 

* * * * * * * down.’’) 12 Aside from teaching these young soldiers to quash their innate 

feelings about killing in general, they are being programmed with a distorted 

version, not only of what it means to be a man, but of what it means to be a citizen. 


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13Mark Benjamin, ‘‘Military Injustice,’’ Salon.com, June 7, 2005. http://archive.salon.com/ 

news/feature/2005/06/07/whistleblower/. 14Deborah Scranton, Dir. The War Tapes (Sen Art Films, 2007). 15http://www.ivaw.org/wintersoldier. 16Lisa Chedekel and Matthew Kauffman, ‘‘Mentally Unfit, Forced to Fight,’’ The Hartford 

Courant, May 14, 2006. 17Mark Benjamin, Out of jail, into the Army. Salon.com, February 2, 2006. http://www.salon 

.com/news/feature/2006/02/02/waivers/. 18Grossman, On Killing. 19 Ibid. 

Thankfully, the brainwashing has not yet been developed that will override the 

humanity of most American soldiers. As multiple deployments become the norm, 

however, and as more scrambled psyches are sent back into combat instead of into 

treatment, it is frightening to consider that the brainwashing may yet prevail. 

Given the training to which these soldiers have been subjected and the chaotic conditions in which they find themselves, it is inevitable that more will succumb to fear 

and rage and frustration. They will inevitably be overwhelmed by cumulative doses 

of horror and they will lose control of their judgment and their compassion. It is 

a credit to their humanity, not a sign of their weakness, that these men and women 

find it hard to live afterward with what they have seen and, in some cases, done. 

The soldiers who, following orders, have run over children in the road rather than 

slow down their convoy will never be the same again.13 Nor will the soldiers manning checkpoints who shoot, as ordered, and kill entire families who failed to stop, 

only to learn later that no one had bothered to share with them that the American 

signal to stop—a hand held up, palm toward the oncoming vehicle—to an Iraqi 

means, ‘‘Hello, come here.’’ 14

This generation of soldiers wants to tell their stories because they want to believe 

that Americans want to know.15 They are not looking for absolution, but they want 

the architects of current policy to accept their share of the blame. They have already 

carried home the psychic wounds and the dangerous reflexive habits of violence that 

will always diminish their lives and their relationships. In return, they are hoping 

we will listen to them this time when they ask us to look a little harder, dig a little 

deeper, use a little more discernment. 

In addition, a number of aspects of deployment and treatment in the current situation are directly responsible for adding to the problem of PTSD and suicide. These 

include the failure to screen sufficiently for mental health problems, the inappropriate use of drugs, and the re-triggering of PTSD symptoms among Vietnam veterans. 

Failure to screen: In May, the Hartford Courant ran a series of articles exposing 

the common practice in this army of deploying soldiers in spite of serious, documented mental health histories, including severe depression, bi-polarity, even autism. On their pre-deployment health forms, there’s a box a recruit can check if 

they’ve had any kind of mental health issues in the past year. Of the 3% who 

checked the box, 1 in 300 was given any kind of follow-up assessment. Some were 

already on anti-depressants when they were recruited.16 The use of waivers has 

meant that individuals with histories of emotional problems, problems that have involved them in felonious activities, including drug abuse and sale, domestic violence 

and other violent crimes, individuals who would never have been previously accepted into the military, are now being enlisted and deployed.17

The inappropriate use of drugs: Self-medication with marijuana and heroin by soldiers in Vietnam is legendary; what is less well know is that, for the first time, the 

military made aggressive use of powerful tranquilizers and anti-anxiety drugs.18 In 

the short run, those drugs were effective, if the definition of effectiveness was boots 

on the ground, but in the long run, they were the moral equivalent of giving a soldier a local anesthetic for a gunshot wound and sending him back into combat. 

It may be that the doctors prescribing in the Vietnam era did not realize the effects of those drugs over time, but today’s military doctors have the benefit of ample 

evidence.19 When soldiers are given those kinds of drugs while they are still experiencing the stressor, the drugs interrupt the development of normal coping mechanisms—and the long-term effects of the trauma are worse. Still, anti-depressants 

that come with warning labels about side effects that include suicide are being given 

to active-duty soldiers with little or no supervision, a practice that is virtually playing Russian roulette with their lives. 

The re-triggering of symptoms among Vietnam veterans: Contemporary warfare 

not only creates its own emotional casualties, but reignites the symptoms of veterans of previous wars. The Washington Post reported a year ago that ‘‘Vietnam veterans are the vast majority of VA’s PTSD disability cases—more than 73 percent.’’ 


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20Donna St. George, ‘‘Iraq War May Add Stress for Past Vets: Trauma Disorder Claims at 

New High,’’ Washington Post, June 20, 2006, A01 http://www.washingtonpost.com/wp-dyn/content/article/2006/06/19/AR2006061901400_pf.html. 21Sally Satel, ‘‘Stressed Out Vets: Believing the worst about post-traumatic stress disorder,’’ 

The Weekly Standard, August 21, 2006. 22http://www.wsbtv.com/news/9747929/detail.html. 23http://www.cbsnews.com/stories/2007/11/13/cbsnews_investigates/main3496471.shtml. 24 Aaron Glantz, ‘‘Iraq Vets Left in Physical and Mental Agony,’’ Inter Press Service, January 

4, 2007. 

These included ten thousand new claims filed by veterans who were entering the 

system for the first time, more than 30 years after their war came to an end.20

Apologists such as American Enterprise Institute scholar Sally Satel have accused 

veterans of memorizing the diagnostic criteria for PTSD before going to see a VA 

doctor. They have accused the VA doctors of over-diagnosing and thereby making 

their patients believe they are sick, and the particularly cynical accusation that 

Vietnam vets who are getting close to retirement are angling for ways to pad their 

old age with inflated disability checks.21

Veterans, however, claim that the cause of their applications for benefits, far from 

being fraud, is the daily onslaught of horrific images and stories coming out of Iraq 

and Afghanistan that have triggered their flashbacks and reactivated intolerable 

symptoms. One of those is former senator Max Cleland, a triple amputee from the 

war in Vietnam, who was compelled to re-enter therapy at Walter Reed for PTSD 

symptoms that have flared up since the war in Iraq began. Cleland recounts that 

he cannot read newspapers or watch television now because both are triggers for 

PTSD, something that he claims is happening to Vietnam veterans all over America.22

FACTORS IN THE CURRENT POLICIES THAT ARE TRAGICALLY INCREASING 

THE INCIDENTS OF SUICIDE 

In November 2007, CBS News released the results of their investigation into veteran suicides. Using the clout that only major broadcast networks seem capable of 

mustering, CBS News contacted the governments of all 50 States requesting their 

official records of death by suicide going back 12 years. They heard back from 45 

of the 50 States. From the mountains of gathered information, they sifted out the 

suicides of those Americans who had served in the armed forces. What they discovered is that in 2005 alone—and remember, this is just in 45 States—there were at 

least 6,256 veteran suicides, 120 every week for a year and an average of 17 every 

day.23

I am grateful to CBS News for undertaking this long overdue investigation. And 

though I am also heartbroken that the numbers are so astonishingly high, I am tentatively optimistic that perhaps now that there are hard numbers to attest to the 

magnitude of the problem, it will finally be taken seriously. 

Part of taking that seriously will be to acknowledge the ways in which the current 

spate of suicides is being exacerbated by government and military policy. In the 

above section, I presented a number of the major factors in the high incidence of 

PTSD among American soldiers and veterans. In this section, I will point to additional factors that explain why PTSD so often leads to suicide. A few examples include the redeployment of psychically injured soldiers, a lack of sufficient medical 

care professionals, lengthy waits for treatment, complex bureaucratic red tape, and 

a variety of justifications for dishonorably discharging traumatized veterans, thus 

rendering them ineligible for VA psychiatric care. It is difficult not to connect all 

of these factors to a tragic prioritizing of budgetary considerations at the expense 

of the lives of soldiers and veterans. 

Redeployment of psychically wounded soldiers: In November 2006, the Pentagon 

released guidelines that allow commanders to redeploy soldiers suffering from traumatic stress disorders. Service members with ‘‘a psychiatric disorder in remission, 

or whose residual symptoms do not impair duty performance’’ may be considered for 

duty downrange. It lists post traumatic stress disorder as a ‘‘treatable’’ problem and 

sets out a long list of conditions when a soldier can, and cannot be returned for an 

additional tour in Iraq.24 Post traumatic stress injuries, under the best of circumstances, are treatable, but not curable. Sending soldiers back into the situation 

that triggered their injury in the first place is taking undue, I would say cruel, license with their mental health. 

Lack of sufficient medical care professionals/Lengthy waits for treatment: The Defense Health Board’s Task Force on Mental Health has reported that there is a 

shortage of active duty mental health professionals. According to the report, ‘‘DoD 

has already dramatically reduced its number of active duty mental health profesVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00077 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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25http://www.usmedicine.com/article.cfm?articleID=1610&issueID=102. 26 Anne C. Mulkern, Denver Post, July 05, 2005. 27 ‘‘Vets Healthcare Not Meeting Standards: Army Has Yet To Fully Staff New Units Created 

To Fix Problems At Walter Reed’’ (GAO: Washington, DC, Sept. 26, 2007). http:// 

www.cbsnews.com/stories/2007/09/26/national/main3300260.shtml. 28 Brian Friel, ‘‘Hurry Up And Wait,’’ Government Executive, May 1, 2007. http:// 

www.govexec.com/features/0507-01/0507-01s4.htm. 29 Chris Adams, VA’s ability to provide benefits worsens, December 1, 2006. http:// 

www.mcclatchydc.com/staff/chris_adams/story/15238.html. 30St. George, ‘‘Iraq War May Add Stress.’’ 31Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM–IV) (Washington D.C.: 

American Psychiatric Association, 1994), available online at www.psychologynet.org/dsm.html. 32Daniel Zwerdling, ‘‘Soldiers Say Army Ignores, Punishes Mental Anguish,’’ ‘‘All Things Considered,’’ National Public Radio, December 4, 2006. http://www.npr.org/templates/story/ 

story.php?storyId=6576505. 33 Joshua Kors, ‘‘How Specialist Town Lost His Benefits,’’ The Nation, April 9, 2007. http:// 

www.thenation.com/doc/20070409/kors. 

sionals and there are proposals to further reduce active duty staffing.’’ 25 As a result, 

according to other researchers, ‘‘doctor-to-patient ratios are climbing, waiting periods to see specialists are growing, and the time that psychiatrists spend with the 

most troubled patients—those with post traumatic stress disorder, or PTSD—is 

shrinking.’’ 26 In September 2007 a Congressionally mandated report by the nonpartisan Government Accountability Office found the Pentagon and VA care for 

service members suffering from PTSD and Traumatic Brain Injury was ‘‘inadequate’’ 

with ‘‘significant shortfalls’’ of doctors, nurses and other caregivers necessary to 

treat wounded soldiers.27 The result is that soldiers and veterans requesting treatment for PTSD still typically are put on waiting lists and wait six months to a year. 

Complex bureaucratic red tape: Since the start of the Iraq war, the back-log of unanswered disability claims has grown from 325,000 to more than 600,000, with 

800,000 new claims expected in each of the next two years.28 On average, a veteran 

must wait almost six months to have a claim heard. If a veteran loses and appeals 

a case, it usually takes almost two years to resolve.29 The number of claims adjusters at the VA likewise dropped. It is worth noting that if a service member or veteran dies while an appeal is pending, the appeal dies as well.30

Moreover, a veteran applying for compensation for Post Traumatic Stress Disorder 

must submit a 26 page form, the key to which is a detailed essay on the specific 

moments when he or she experienced a terrifying event or series of incidents that 

caused mental illness to develop. This is not easy because one of the symptoms of 

PTSD is for a person to try to block out any memory of that event. According to 

the psychiatric guide DSM IV, a person with PTSD often displays a ‘‘persistent 

avoidance of stimuli associated with the trauma and numbing of general responsiveness.’’ 31 In other words, the last thing a person experiencing PTSD wants to do is 

sit down and write an essay on why, and exactly how, they’ve become mentally ill. 

A veteran must also back that claim up with hard evidence that their PTSD is indeed ‘‘service connected’’—in essence proving he or she was indeed in the place they 

said they were and that the terrifying incident did indeed occur. If the veteran received a medal during the incident the job is easier. If not, the vet must track down 

their service records to see if any paperwork was generated as a result of the incident that caused the development of their injury. DoD paperwork is notoriously difficult to track down, if it exists in the first place. I applaud the efforts of Representatives Donnelly and Upton for introducing H.R. 1490, The Fairness in Veterans Disability Benefits Act, which aims to simplify the process for new veterans as they 

transition out of the military and try to provide for their families. It is certainly a 

step in the right direction, but $400 per month is not going to pay the rent anywhere in this country. 

Ineligibility for medical benefits: A variety of patterns related to PTSD are currently leading to a denial of medical benefits. In some cases, soldiers and veterans 

who have applied for help with PTSD symptoms try to manage terrifying symptoms 

by self-medicating with drugs or alcohol; this substance abuse, itself a complication 

of PTSD, is then used to justify a dishonorable discharge, even in cases in which 

a soldier has repeatedly asked for treatment.32 In other cases, diagnoses such as 

‘‘pre-existing conditions’’ are used by the military to deny its responsibility for treating soldiers suffering emotional trauma.33

One of the saddest consequences of the Bush administration’s failure to anticipate 

and plan for an extended conflict in Iraq is the billions of additional dollars the VA 

has discovered it needs to cover the shortfall in its healthcare budgets for the past 

three years. Administration apologists such as Sally Satel have kept up a steady 

stream of accusation and innuendo in the media ever since it became clear that 

their new war was going to suck in, chew up and spit out devastated soldiers every 


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34http://www.sallysatelmd.com. 35 Jaffe, Greg. ‘‘Balancing Act: As Benefits for Veterans climb, military spending feels 

squeeze.’’ Wall Street Journal, Jan. 25, 2005, pA1. 36Mark Benjamin, ‘‘The VA’s Bad Review,’’ Salon.com, October 26, 2005. http://archive 

.salon.com/news/feature/2005/10/26/suicide/index.html. 37Kari Lydersen, ‘‘War Costing $720 Million Each Day, Group Says,’’ Washington Post, September 22, 2007. http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007 

092102074.html. 38Steven Milloy ‘‘Politicized Science Produces Bad Public Policy,’’ August 17, 2006. https:// 

www.foxnews.com/story/0,2933,209078,00.html. 

bit as reliably—and expensively—as the war in Vietnam did.34 It is worth recalling 

that, prior to the scandal concerning conditions at Walter Reed, President Bush’s 

appointees at the Pentagon had strenuously lobbied Congress against funding military pensions, health insurance and benefits for widows of retirees. Their argument: 

that money spent on caring for wounded soldiers and their families could be better 

spent on new state-of-the-art military hardware or enticing new recruits to join the 

force. In January 2005, Bush’s Undersecretary of Defense for Personnel and Readiness David Chu, the official in charge of such things, went so far as to tell the Wall 

Street Journal that veterans’ medical care and disability benefits ‘‘are hurtful’’ and 

‘‘are taking away from the Nation’s ability to defend itself.’’ 35

Indeed, what we have seen in the past four years are frantic and often tragic attempts to save money, all at the expense of the veterans. The military tried charging wounded soldiers at Walter Reed for their lunches. Congress made them take 

that back. They tried spinning PTSD as veteran fraud and insisted that 72,000 

100% disabled vets get themselves recertified. 100% disabled vets are the most fragile and the most likely to be further traumatized by a complicated bureaucratic 

process. Congress made them take that back as well, but not before at least one 

overwhelmed veteran took his own life with his recertification request papers on his 

chest.36

A new study by Columbia University economist Joseph E. Stiglitz, who won the 

Nobel Prize in economics in 2001, and Harvard lecturer Linda Bilmes concludes that 

the war is costing $720 million a day or $500,000 a minute.37 This total, which is 

far above the administration’s prewar projections, attempt to take into account the 

long term healthcare costs for the U.S. soldiers injured in Iraq so far. Veterans 

groups joke the Bush Administration has instituted a policy of ‘‘don’t look, don’t 

find,’’ in order to absolve themselves of criminal, financial, and medical liability for 

their treatment of veterans. 

RECOMMENDATIONS 

The basis for addressing the virtual epidemic of death that constitutes suicide 

among soldiers and veterans much be first to acknowledge the problem. While 

Americans may disagree about current American policy in Iraq, surely we can all 

agree with the motto of the VA, ‘‘To care for him [and now her] who shall have 

borne the battle and for his widow and orphan.’’ 

In August of 2006, Fox News proposed that Congress provide that certain types 

of military service—such as any service in theaters of combat, not just actual combat experience, and other forms of hazardous duty—automatically qualify veterans 

for lifetime health benefits. There is much to be said for that proposal. Among other 

things, it would eliminate the motivation for unjust dishonorable discharges and alternative diagnoses. It would also mean that scientific research involving combat 

veterans might be less politicized and less likely to be skewed.38

Less extreme but still vitally needed specific steps include: 

• Attack stigma: The ‘‘D’’ in PTSD should immediately be dropped. To call the 

psychic injuries of soldiers a disorder reinforces the misperception that there is 

something inherently wrong with the soldier. The prejudice that reinforces, in 

soldiers, veterans, caregivers and military officers alike, is in many ways responsible for the resistance of sufferers to ask for the help they so desperately 

need. Military personnel at all levels must be educated to understand that 

PTSD is not a sign of weakness or cowardice. Soldiers and veterans must be 

debriefed to help individuals understand and cope with the stress that is a normal response to an overwhelming situation. Treatment for emotional injuries 

must be given parity with treatments for more visible physical wounds. For example, promoting the elimination of stigmatizing questions on security clearance questionnaires can set the precedent for culture change within the Department of Defense and model similar changes in procedure for other employment 


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39 ‘‘The War inside; troops are returning from the battlefield with psychological wounds, but 

the mental-health system that serves them makes healing difficult,’’ The Washington Post, June 

17, 2007. 

categories, thus eliminating the risks to future employment for individuals in 

need of treatment for PTSD.39

• Multiply the caregivers: The military’s cadre of mental-health workers is ‘‘woefully inadequate to meet their needs.’’ The current decline in military mental 

health professionals must be reversed as quickly as possible. 

• Provide mandatory and adequate screenings for all enlistees and for all returning soldiers: In the first instance, this will help to stop the practice of deploying 

soldiers who are already emotionally fragile. It will also serve to create a medical history enabling a veteran to later prove service-connection in the event of 

emotional trauma. Finally, because everyone participates, such a screening policy would eliminate the shame and stigma. 

• Stop redeploying psychically injured soldiers. 

• Create a structure for screening soldiers and veterans outside of the chain of 

command. 

• Eliminate the wait for soldiers and veterans reporting symptoms and requesting 

treatment and ensure that sufficient emergency contacts and treatment options 

are available. 

• Hire and train additional Veteran Service Representatives and Veteran Service 

officers to help veterans navigate the system. 

• Streamline application and benefit procedures and make them more ‘vet-friendly.’ 

• Increase the number and size of Vet Centers, which provide flexible and easily 

accessed programs and resources, and create procedures for collaboration between Vet Centers and demobilizing troops. 

• Hold follow-up interviews with demobilized troops at 30, 60, and 90 day intervals and then periodically for several years. 

CONCLUSION 

I will never know if any or all of the above recommendations, if implemented, 

would have saved my husband Daniel’s life. I do know that they would have given 

both of us a better chance. I believe as well that, had deaths such as Daniel’s been 

officially acknowledged, studied, and counted, not only would our lives as survivors 

been very different, but it would be far more difficult for officials now with any 

credibility deny a connection between combat-related PTSD and suicide. 

I find hope in the fact that public attention and better knowledge of mental health 

issues have helped legitimize the psychiatric injuries soldiers sustain in every war. 

Though government apologists still shamefully spin and distort the numbers, and 

though military culture still encourages stigmatization, and even punishment, for 

what they insist on calling weakness or malingering, there is still far more information about posttraumatic stress injuries available, and that makes it less likely that 

this generation of soldiers and their families will experience the same degree of isolation on top of their grief that we felt. The difference is that we are talking about 

it now. 

f 

Prepared Statement of Ilona Meagher, Caledonia, IL, Author 

Moving a Nation to Care: Post-Traumatic Stress Disorder and America’s 

Returning Troops 

Chairman Filner, Ranking Member Buyer, and other distinguished members of 

the Committee, I thank you for the opportunity to appear before you today. 

To open, I’d like to briefly share my thoughts on why it is that I believe I’m here. 

I am not only someone who’s spent the past two years researching and writing 

about post traumatic stress in our returning troops, I’m also a veteran’s daughter. 

My father was born in Hungary, served two years in antitank artillery as a Hungarian Army conscript, fought against the Soviet Union on the streets of Budapest 

during the 1956 Hungarian Revolution, and later fled to America where, in 1958, 

he again became a soldier, this time wearing a United States Army uniform, and 

serving as a combat engineer stationed in Germany. 

My father’s unique experience of having served on both sides—East and West— 

in such differing armies during the Cold war, gave him a unique perspective on 

military life. 


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1 ‘‘Veterans’ Group Emphasizes Suicide Risks,’’ Jennifer C. Kerr, Associated Press, May 28, 

2007. 

And so, growing up, my sisters and I often heard my father say, ‘‘You can always 

tell how a government feels about its people by looking at how it treats its soldiers.’’ 

Looking at our returning soldiers and their widely reported struggles with the 

military and VA healthcare systems they rely on, of being stigmatized from seeking 

care or of being placed on lengthy VA waiting lists when they need immediate 

help—some even committing suicide before their appointment dates arrive—have 

raised this citizen’s alarm bells. 

We have had a ‘‘see no evil, hear no evil’’ approach to examining post-deployment 

psychological reintegration issues such as suicide. After all we have learned from 

the struggles of the Vietnam War generation—and the ensuing controversy over 

how many of its veterans did or did not commit suicide in its wake—why is there 

today no known national registry where Afghanistan and Iraq veteran suicide data 

is being collected? How can we ascertain reintegration problems—if any exist—if we 

are not proactive in seeking them out? 

As late as May 2007, Department of Veterans Affairs spokeswoman Karen Fedele 

told the Washington Post that there was no attempt to gather Afghanistan and Iraq 

veteran suicide incidents. ‘‘We don’t keep that data,’’ she said. ‘‘I’m told that somebody here is going to do an analysis, but there just is nothing right now.’’ 1

Meanwhile, the Army reported its suicide rate in 2006 rose to 17.3 per 100,000 

troops, the highest in 26 years of keeping such records. At long last, the Associated 

Press revealed that the VA is finally conducting preliminary research. They’ve 

tracked at least 283 OEF/OIF veteran suicides through the end of 2005, nearly double the rate of the additional 147 suicides reported by the DoD’s Defense Manpower 

Data Center. 

Looking only at the these suicide figures from the VA (283) and the DoD (147), 

there have been at least 430 Afghanistan and Iraq veteran suicides that have occurred either in the combat zone or stateside following combat deployment. Lost in 

the VA and DoD counts are those veterans who have returned from their deployments, are still in the military and not yet in the VA system. The DoD says they 

do not track those incidents, and I assume neither does the VA because these veterans are not yet on their radar. 

Yet, even with this omission, many of these 430 confirmed suicides are a result 

of our wars in Afghanistan and Iraq and should—but won’t—be listed with the 

DoD’s official OEF/OIF death toll of 4,351. It bears mentioning: Currently 10 percent of the overall fatal casualty count of these wars is due to suicide. 

Dismissing the issue of veteran suicide in the face of this data is negligent and 

does nothing to honor the service and sacrifice of our veterans and the families and 

communities that literally are tasked with supporting them once they return. 

Yet, prior to last month’s CBS News investigation, which revealed that 120 veterans of all wars committed suicide every week in 2005 and that 20–24-year-old Afghanistan and Iraq veterans are two to four times more likely to commit suicide 

than their civilian counterparts, the scope of the problem has been largely unknown 

because no one with proper resources and access to do the compiling of data came 

forward to do so. 

In my written testimony, I’ve included 75 suicides that I and other citizen journalist colleagues have been tracking since September 2005 and which today reside 

in the ePluribus Media PTSD Timeline. 

Offering only a small and incomplete sliver of insight into how some of our returning troops are faring on the home front—especially in light of the fact that at least 

another 355 incidents could be added among them according to the VA and DoD— 

I believe that they collectively tell an even greater tale about the failure of us as 

individuals and as a society to ensure that our returning warriors are cleansed completely from the psychological wounds of war. 

They also reflect the failure of our government institutions to protect those who 

protect us. 

While I realize that these distressing stories are the exception and not the rule, 

to our exceptional military families having to deal with the deterioration of a loved 

one they thought had safely returned from combat, they are the rule. In 1956, the 

same year that my parents fled to this incredible country, the 84th Congress—in 

the very House that we sit in today—had this to say in a Presidential commission 

report on veterans’ benefits: 

‘‘The Government’s obligation is to help veterans overcome special, significant handicaps incurred as a consequence of their military service. The 

objective should be to return veterans as nearly as possible to the status 


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2 U.S. Congress. House, The President’s Commission on Veterans’ Pensions. The historical development of veterans’ benefits in the United States: A report on veterans’ benefits in the United 

States, 84th Cong., 2nd sess., May 9, 1956. 

they would have achieved had they not been in military service . . . and 

maintaining them and their survivors in circumstances as favorable as 

those of the rest of the people. . . . War sacrifices should be distributed as 

equally as possible within our society. This is the basic function of our veterans’ programs.’’ 2

I am not a pedigreed expert or a government official seasoned in testifying before 

you, but those who are from the GAO and the Congressional Research Department 

and even the Veterans Administration itself, have sat in this very seat over the 

years and told you we are falling far short in providing the resources and programs 

our returning troops and military families need to successfully return to their personal lives following their service to the Nation. 

To those who resist hearing the cold hard truth of where we are today, I’d like 

to say: The time is here to stop fighting the data, and to start fighting for our 

troops. 

This is America. We can do better. We must do better. 

Suggestions to ease the veteran suicide problem: 

• Offer all returning veterans immediate compensation and treatment 

support the first six months after their return home. Fostering positive 

coping skills (vs. negative coping skills of self-medication or domestic violence) 

must be a key goal of our veterans’ reintegration programs; veterans forced to 

wait at least six months for VA compensation and treatment benefits to kick 

in do not feel supported, they feel under siege. 

• Increase 21st century asymmetrical warfare and psychological injury 

understanding and preparation. The DoD should continue to make adjustments in its training to give service members the tools they need to counter the 

modern battlefield’s unique stressors. The Psychological Kevlar Act of 2007 

would push the DoD to provide proactive psychological training for veterans 

from boot camp onward; more need to sign on to this legislation and it should 

be passed into law. 

• Force the DOD and VA do a better job of communicating with veterans 

on their rights and resources, and making outside community-based resources known to them as well. Many vets are unsure of what benefits they 

have earned and what rights they have to them. Some are discouraged from 

using them. Many community programs and groups are ready and waiting to 

assist returning veterans and military families, but are unknown to the very 

people who might benefit from them. While Secretary Robert Gates has said it 

may take up to three years to fully implement the PTSD portion of the DoleShalala recommendations, why are we not utilizing the resources that are available in communities across the country? 

• Properly and fully fund the Veterans Administration. Billions in underfunding translates to long waiting lines, lack of funds for PTSD research, and 

not enough PTSD specialists at each VA facility. 

• Reduce tour lengths, decrease overall number of combat deployments, 

and increase dwell time between deployments by funding an increase 

in forces. With each successive deployment, troops’ susceptibility to PTSD increases. Army Chief of Staff George W. Casey Jr. testified last month before the 

Senate Armed Services Committee saying that the military must be grown in 

order for dwell-time to be increased, etc. 

• Restrict the ability to redeploy troops diagnosed with PTSD. No PTSDdiagnosed troops should be redeployed into a combat zone, and troops should 

not be deployed taking psychotropic drugs such as Paxil or Zoloft, that have 

been shown by the FDA to increase suicide risk. 

• Improve post-deployment assessments. Move away from relying on questionnaires and make physicals and one-on-one demob consultations mandatory. 

In February 2006, the VA contracted the Institute of Medicine to do a thorough 

review of scientific and medical literature related to the diagnosis and assessment of PTSD; the Committee strongly concluded that the best way to determine whether a person is suffering from PTSD is with a ‘‘thorough, face-to-face 

interview by a health professional trained in diagnosing psychiatric disorders.’’ 

The DoD should follow the same rule. 

• Invest more in counseling and support. Rather than relying on quick-fix 

medications to solve returning psychological problems, invest time and reVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00082 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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sources in holistic wellness programs to help veterans and their families recover 

from the experience of war. 

• Remove stigma/punishment for those seeking help. One of the easiest 

ways to do this would be to operate under the assumption that everyone will 

need some form of support following combat. Move away from a system where 

those struggling most must somehow find the strength to conspicuously come 

forward on their own. 

• Require completion of a ‘boot camp in reverse’ transitional training 

program. Military families who have lost loved ones to suicide consistently say 

there should be a more formal reentry program following return from combat, 

weekly meetings/classes lasting from 2 to 3 months. The program should be as 

required to attend and complete by all service members as boot camp. 

• Pay special attention in supporting National Guard and Reserve forces. 

Not being a part of a cohesive unit, they are especially susceptible to PTSD. 

• Stop closing VA Hospitals and Vet Centers. We should be providing more 

opportunities for veterans scattered across the country, especially in rural 

areas, to have access to healthcare benefits. 

• Increase funding to community service boards. Many troops—especially 

those with the National Guard and Reserve or in rural areas—do not have easy 

access to health services. Make sure they have alternatives to getting the care 

they need, or fully reimburse their private healthcare bills. 

• Increase Vet Center program offerings. Offer more complimentary group 

and individual classes for troops and military families that explain what PTSD 

is, how it can be treated and how one can forge the tools necessary to move 

their lives beyond it. 

• Provide complimentary counseling to all immediate family members. If 

the service member refuses to seek help, the spouse and children should have 

access to counseling service to help them through their loved one’s reintegration 

process. 

• Increase personal data security and treatment anonymity. Many will not 

come forward to get the help they need because they worry it may come back 

to haunt them when they’re up for a promotion, being considered for a mission, 

or when looking for civilian employment. Family members, however, should not 

be kept in the dark, especially if veteran is prescribed psychotropic medication. 

Selection of OEF/OIF Veteran Suicides 

The ePluribus Media PTSD Timeline, is a collection of press-reported cases of 

post-combat related possible, probable, self-reported and/or confirmed incidents of 

PTSD or broader reintegration difficulties. The work is meant to preserve incidents 

that are at risk of being lost to us with the forward movement of time, as small 

town news websites do not archive many of their reports. 

Additional reasons for the existence of the PTSD Timeline include: 

• Allowing for ease of study of PTSD and related reintegration issues by researchers, reporters, educational and government institutions. 

• Fostering further discussion and exploration of post-combat reintegration 

issues. 

• Validating to military family members that we are paying attention to their experiences. 

What follows is a brief glimpse at the personal post-war landscape for our military 

families revealed through suicide incidents tracked by me and other citizen journalists in the PTSD Timeline since September of 2005. 

Legend: /ss/=stateside suicide /oif/=OIF combat zone suicide /oef/=OEF combat zone 

suicide 

2002 

Following the terrorist attacks of September 11th, Operation Enduring Freedom 

commenced with the invasion of Afghanistan on October 7, 2001. Fort Bragg, N.C., 

home of the Army Special Operations Command, was the first to experience a cluster of post-deployment reintegration issues when three military wives were murdered by their recently returned husbands within a span of five weeks. (One additional wife was murdered during this same timeframe, but the husband had not deployed to OEF). 

On June 11, 2002 /ss/, Rigoberto Nieves (32-year-old Special Forces sergeant) fatally shot his wife and then himself in an off-base murder/suicide after having returned home from Afghanistan in mid-March. On July 19, 2002 /ss/, Brandon Floyd 


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3 ‘‘Fort Bragg killings raise alarm about stress,’’ Barbara Starr, CNN, July 27, 2002. 

(30-year-old Special Ops soldier) shot his wife and then himself in an off-base murder/suicide after having returned home in January. 

CNN reported at the time: ‘‘Fort Bragg garrison commander, Army Col. Tad 

Davis, is reviewing counseling and stress-management programs available at the 

base. A spokesman said the Army wants to see if there is something it could do better. But one military official who had previously served at Fort Bragg pointed out 

that Special Operations soldiers may be reluctant to seek help.’’ 3

2003 

On March 19, 2003, Operation Iraqi Freedom commenced. 

Joseph Suell (24-year-old veteran and father of two who’d served in South Korea, 

Kuwait and Iraq) intentionally overdosed on June 16, 2003 /oif/, the day after Father’s Day. Corey Small (20-year-old Ft. Polk, La., army private) shot himself in 

front of others after making a phone call home on July 3, 2003 /oif/. 

The following day, on July 4, 2003 /oif/, James Curtis Coons (36-year-old army 

master sergeant with 17 years of military service, OIF Bronze Star) hanged himself 

with a bed sheet at Walter Reed Army Medical Center; he had been evacuated from 

Kuwait two weeks earlier following an overdose. 

Alyssa Peterson (27-year-old Arabic-speaking interpreter with the 311th Military 

Intelligence BN, 101st Airborne), who reportedly disagreed with interrogation techniques being used at Tal-Afar prison, shot herself on September 12, 2003 /oif/. On 

October 1, 2003 /ss/, Kyle Edward Williams (21-year-old soldier with a clean record 

who’d served in Iraq with the 507th Maintenance Company) shot and killed an Arizona man who’d broken into his car and later shot himself. 

Thomas J. Sweet II (23-year-old Ft. Riley, Kan., 5th Field Artillery Regiment, 1st 

Infantry Division sergeant) shot himself on November 27, 2003 /oif/, the very day 

he received word of his promotion. Jeffrey Braun (19-year-old 82nd Airborne Division paratrooper) shot himself on December 1, 2003 /oif/. 

2004 

Alexis Soto-Ramirez (43-year-old 544th Military Police Company specialist), who’d 

been evacuated a month earlier from Iraq due to back pain, hanged himself with 

his bathrobe sash at Walter Reed Army Medical Center on January 12, 2004/ss/. 

Five days later, on January 17, 2004 /ss/, Jeremy Seeley (28-year-old 101st Airborne specialist) walked off Fort Campbell, Ky., checked into a hotel, and overdosed 

on household poison. 

Boyd Wicks, Jr. (Marine infantry sergeant) returned from Iraq in June 2003 and 

was discharged in October; he committed suicide on February 1, 2004 /ss/, his father saying of PTSD. On March 7, 2004 /oif/, Matthew Milczark (18-year-old Marine) shot himself in a Kuwaiti military chapel. One week later, on March 14, 2004 

/ss/, William Howell (36-year-old Ft. Carson, Colo., Special Forces chief warrant officer with 17 years of military service as a Green Beret) threatened his wife with a 

gun, and then shot himself as police officers moved in on him; he’d returned from 

Iraq a mere three weeks earlier. 

Four days later, on March 18, 2004 /ss/, Brandon Ratliff (6-times decorated Army 

Reserve’s 909th Forward Surgical Team executive officer), shot himself after writing 

The Columbus Dispatch, ‘‘I didn’t think I’d have to fight over there and have to fight 

these guys, too.’’ He’d lost a promised promotion and raise following his tour in Afghanistan saving injured soldiers on the frontline. 

On March 21, 2004 /ss/, Ken Dennis (22-year-old Marine corporal and combat rifleman who’d served in Pakistan, Afghanistan, Somalia, Djibouti and Iraq) hanged 

himself with his belt in his Renton, Wash., apartment eight months after returning 

from Iraq. He’d confessed to his father, ‘‘You know, Dad, it’s really hard—very, very 

hard—to see a man’s face and kill him.’’ 

Jeffrey Lucey (23-year-old Marine Reserve) hanged himself in his basement on 

June 22, 2004 /ss/, after his parents had involuntarily committed him to the local 

VA; he was released three days later and told to stop drinking before they could 

assess him for PTSD. 

Also on June 22, 2004 /ss/, Adam Kelley (36-year-old Gulf War combat veteran) 

ended his 13-year struggle with PTSD and shot himself in his car while sitting in 

his truck behind a Las Vegas sandwich shop. His mother blamed long VA waits, 

shuffling from one doctor to another, prescribing medications that did more harm 

than good and monthly appointments with a physician’s assistant rather than weekly appointments with a physician’s aide as contributing factors. 


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Andre Ventura McDaniel (40-year-old Ft. Carson, Colo., Special Forces soldier) 

shot himself six weeks after returning from Iraq, on August 28, 2004 /ss/. On September 24, 2004 /ss/, Michael Torok (23-year-old Ft. Bragg, N.C., communications 

specialist) stabbed himself in the heart in his car parked alongside a rural Illinois 

cornfield. He had visited the Hines VAMC for various ailments following his Afghanistan service, but Hines was not screening all returning veterans for PTSD at 

the time. The next day, he told his parents he was going to visit a friend and was 

never seen or heard from again. 

On October 9, 2004 /ss/, Brian McKeehan (37-year-old Fort Euliss, Va., soldier) 

hanged himself with a bed sheet in the Virginia Peninsula Regional Jail, one month 

after returning from Iraq and 12 hours after being arrested for assaulting his wife. 

In the four weeks he was home, local police had responded to six domestic violence 

complaints. Michael Jon Pelkey (29-year-old Fort Sill, Ok., captain) shot himself on 

November 5, 2004 /ss/ a year after returning from Iraq. He had received a private 

diagnosis of PTSD, but was told of months-long waits for mental healthcare appointments on base. 

Curtis Greene (25-year-old Ft. Riley, Kan., soldier) abruptly went AWOL, saying 

he did not want to return to Iraq; after his wife begged him to return, he hanged 

himself in his barracks on December 6, 2004 /ss/. Police had previously responded 

to two domestic violence calls and he was being treated for PTSD. 

2005 

Andres Raya (19-year-old Camp Pendleton, Calif., Marine) committed suicide-bycop on January 9, 2005 /ss/ four months after taking part in the invasion of 

Fallujah. After telling his family he did not want to return to Iraq, he fired on Modesto police in an apparent premeditated 3-hour ambush in which one police officer 

was killed and another critically injured. Mark C. Warren (44-year-old 116th Armor 

Cavalry Regiment Oregon Army National Guardsman) shot himself in Kirkuk on 

January 31, 2005 /oif/. 

John Ruocco (40-year-old Marine cobra helicopter pilot from Newbury, Mass.) 

hanged himself in February 2005 /ss/, three months after returning home from 

Iraq and a few weeks before he was to redeploy. His wife said he worried about the 

ramifications of seeking help, personally and professionally. 

On February 3, 2005 /ss/, Richard T. Corcoran (34-year-old Ft. Bragg, N.C. Special Forces soldier who’d served in Afghanistan) shot his ex-wife and her boyfriend, 

and then shot himself. 

Alan McClean (62-year-old decorated Vietnam Purple Heart/Bronze Star veteran 

and minister who’d lost both legs to a landmine) shot himself in his Washington 

State church office on February 11, 2005 /ss/. Formerly supportive of the war effort, but deeply affected by the rising casualty counts, he wrote, ‘‘35 Marines died 

today in Iraq, only slightly more noticed than my legs.’’ His daughter said later, ‘‘I 

underestimated the power of the war to take his life and I really feel that though 

my dad’s been in Wenatchee, the war in Iraq killed him.’’ 

Steven Michael Logan (26-year-old Marine intelligence clerk), personally reenlisted by Secretary of the Navy Gordon R. England at the peak of Mount Suribachi 

above Iowa Jima a year earlier, shot himself on February 28, 2005 /ss/. Samuel 

Lee (19-year-old 2nd Infantry Division soldier) serving in Ramadi shot himself on 

March 28, 2005 /oif/ and Dominic Campisi (30-year-old Delaware Air National 

Guardsman), who’d served in both Afghanistan and Iraq, killed himself on April 17, 

2005 /ss/ only days after returning from Uzbekistan. 

On May 23, 2005 /oef/, Kyle Hemauer (21-year-old 29th Infantry Division Virginia 

National Guard specialist) shot himself in Afghanistan. And in Iraq on June 4, 

2005 /oif/, the highest-ranking OIF death at the time, Ted S. Westhusing (44-yearold colonel and leading scholar of military ethics) shot himself in his base trailer. 

In emails to family, he seemed especially upset that traditional military values such 

as duty, honor and country had been replaced by profit motives in Iraq. 

Justin ‘‘Paul’’ Byers (19-year-old Iowa Army National Guardsman) stepped in front 

of highway pickup truck on June 20, 2005 /ss/ after hearing of his 22-year-old 

brother’s death in Iraq. On July 9, 2005 /ss/, Jeremy Wilson (23-year-old Ft. Carson, 

Colo., 10th Special Forces Group soldier) hanged himself in his barracks a month 

after returning from Iraq. Jason Cooper (23-year-old Mt. Pleasant, Iowa, 308th 

Quartermaster Army Reserve specialist) hanged himself in his basement four 

months after his Iraq tour on July 14, 2005 /ss/. 

Eleven days after being pinned by then Army Chief of Staff Peter Schoomaker 

himself with the Army’s new Combat Action Badge, Leslie Frederick, Jr. (23-yearold Purple Heart and Bronze Star Ft. Lewis, Wash., specialist) shot himself in his 

Tacoma apartment on July 26, 2005 /ss/. 


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Two days later, on July 28, 2005 /ss/, Saxxon Rech (20-year-old Camp Lejeune, 

N.C., Marine) shot his girlfriend and himself in Washington; he had been mysteriously discharged in February. Two days later, Robert Decouteaux (24-year-old Ft. 

Hood, Tx., soldier) shot himself on July 30, 2005 /ss/, and another two days later, 

on August 1, 2005 /ss/, Robert Hunt (22-year-old Ft. Hood, Tx. 1st Cavalry Division 

radio operator-maintainer) was found dead in his apartment; both Decouteaux and 

Hunt had served in Iraq for a year and were scheduled to return in the fall. 

Another two days later, on August 3, 2005 /ss/, Stephen Sherwood (35-year-old 

Ft. Carson, Colo., 2nd Brigade Combat Team soldier) shot his wife and then himself 

nine days after returning home from a year’s deployment in Iraq. He enlisted in 

January 2004 to have health benefits because his wife was pregnant. 

Bernardo C. Negrete (53-year-old retired brigadier general who’d served in Grenada, Panama and Iraq) shot himself on September 16, 2005 /ss/ after his wife 

complained that he stop drinking and come to bed. Phillip Kent (26-year-old Fort 

Hood, Texas, 720th Military Police Battalion 2nd lieutenant/platoon leader during 

the hunt for Saddam Hussein in Tikrit), after being hospitalized for PTSD following 

his return home and being discharged early, committed suicide on September 28, 

2005 /ss/. 

On October 8, 2005 /ss/, Greg Morris (57-year-old 4th Infantry Division Vietnam 

veteran diagnosed with PTSD) shot himself; by his side were his gun, Purple Heart, 

and a folder of information on how the VA planned to review veterans PTSD cases 

[a plan that was halted following public outcry]. 

On November 8, 2005 /ss/, Chris Forcum (20-year-old Marine lance corporal) 

killed himself in Oregon six weeks after returning from Iraq. His father said at the 

time that ‘‘they teach soldiers how to fight, but they don’t teach them how to live 

when they come home.’’ Timothy Bowman (24-year-old Illinois National Guard specialist) had joined the military after 9/11; he shot himself on Thanksgiving morning, 

November 24, 2005 /ss/, eight months after coming home from Iraq. 

Jeffrey Lehner (42-year-old Marine Aerial Refueler Transport Squadron sergeant) 

shot his father and then himself on December 7, 2005 /ss/, after calling his VA 

counselor in distress saying he would not be coming in the next day. After serving 

in Afghanistan, the Gulf War veteran had returned home at the end of 2004 in need 

of help, admitting himself to a VA hospital for intensive PTSD treatment. Instead, 

he was placed with bipolar and schizophrenic patients because the PTSD ward was 

full. On December 22, 2005 /ss/, Joshua Omvig (22-year-old Iowa Army Reverse 

soldier) shot himself a year after returning from Iraq. 

2006 

On January 16, 2006 /ss/, Douglas Barber (37-year-old National Guards supply 

convoy driver), following a two-year struggle with the VA over receiving treatment 

for his PTSD, changed his answering machine message to say he was checking out 

of this world, telephoned police and waited for them on his porch; when they would 

not shoot him, he shot himself. 

Chuck Call (30-year Army gunner who’d volunteered to go to Iraq with another 

unit when his was not called up) committed suicide three months after returning 

on February 3, 2006 /ss/. Haunted by nightmares and anxiety, he sought VA benefits only to be told he did not qualify for them due to his income. On February 

20, 2006 /ss/, Jon Trevino (36-year-old Scott AFB 375th Aeromedical Evacuation 

Squadron tech sergeant who served in both Afghanistan and Iraq) shot his wife and 

himself. 

In Iraq, Tina Priest (21-year-old Fort Hood, Texas, 4th Infantry Division soldier) 

shot herself on March 1, 2006 /oif/, two weeks after saying she was raped by a fellow soldier and days after being diagnosed and treated for Acute Stress Disorder 

consistent with Rape Trauma Syndrome. 

Two days later, Donald Woodward (23-year-old army soldier) shot himself on his 

favorite Pennsylvania hiking trail on March 3, 2006 /ss/. He’d tried killing himself 

once before by lighting his truck on fire and getting inside; his wife pulled him out; 

afterward, he finally agreed to get some help from the VA, which gave him 

antidepressants and scheduled a counseling appointment a month later. He committed suicide before the appointment date arrived. 

Three days later, Greg Braun (26-year-old Army Ranger sniper with the 128th Infantry of Wisconsin National Guard) shot himself in his basement four months after 

returning home from Iraq on March 6, 2006 /ss/. He had served in Kosovo as well 

as tours in Iraq, and was a Milwaukee policeman. Eric Ryan Grossman (22-yearold Marine) ran into California interstate traffic killing himself when a minivan hit 

him on April 6, 2006 /ss/, only five days after returning from a seven-month tour 

in Iraq. 


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James Gallagher (Camp Pendleton, Calif., Marine gunnery sergeant) committed 

suicide eight months after returning from Iraq on May 1, 2006 /ss/. On July 25, 

2006 /oef/, Andrew Velez (22-year-old Army specialist) shot himself in Sharona, Afghanistan. Two years earlier his brother had died in Iraq and he was said to have 

‘‘locked up’’ after identifying his remains. He suffered flashbacks and held his wife 

hostage between tours. 

At home following a near-suicide attempt in Iraq in which he sought the help of 

his commanding officer, David Ramsey (27-year-old Ft. Lewis, Wash., 47th Combat 

Support Hospital critical care nurse specialist) slipped through the cracks stateside 

as Madigan AMC released him from their care, unaware of his near suicide attempt 

in Iraq due to a lack of access to electronic records. Missing his follow-up appointment, he shot himself on September 7, 2006 /ss/. 

On October 17, 2006 /ss/, Zachary Bowen (28-year-old Army MP who’d served 

in Kosovo and Iraq) strangled and dismembered his girlfriend and 11 days later 

threw himself off of the ledge of the Omni Royal New Orleans hotel with a suicide 

note in his pocket. A day later, on October 18, 2006 /ss/, Jeanne ‘‘Linda’’ Michel 

(33-year-old Camp Bucca Navy medic) shot herself two weeks after returning to her 

husband and three kids. While overseas, she was prescribed Paxil for depression 

without family notification, and taken off the antidepressant, again without family 

notification, when she returned home. 

James E. Dean (29-year-old corporal) killed himself via suicide-by-cop shortly after 

learning he was to be redeployed to Iraq. The Afghanistan veteran diagnosed with 

PTSD barricaded himself at his father’s farm on Christmas Day; a Maryland State 

Police sharpshooter killed him 15 hours later, on December 26, 2006 /ss/. 

2007 

On January 16, 2007 /ss/, Jonathan Schulze (25-year-old Marine machine gunner) hanged himself following two attempts to get help from the Minnesota VA system, once in Minneapolis/St. Paul, the other in St. Cloud. He was given a waiting 

list number of 26 for a counseling appointment, but was dead before the date arrived. The following day, on January 17, 2007 /ss/, Michael Bramer (23-year-old 

Fort Bragg, N.C., 82nd Airborne Division Special Forces Unit paratrooper who’d 

served in Afghanistan and Iraq) shot himself in his home. 

Justin Bailey (27-year-old Marine rifleman), among the first wave of the Iraq invasion and diagnosed with PTSD since returning, checked himself into a Los Angeles VAMC needing immediate help for prescription drug addiction. Yet, the day before his death, he received prescriptions for five medications, including a two-week 

supply of the potent painkiller methadone; he overdosed in his VAMC room on January 26, 2007 /ss/. 

Jessica Rich (24-year-old Fort Carson, Colo., 52nd Engineering Battalion Army 

Reserve heavy equipment operator) drove directly into oncoming interstate traffic on 

February 8, 2007 /ss/; medically evacuated from Iraq due to lower back pain and 

PTSD, she was on a waiting list for a specialized PTSD treatment program. 

On February 20, 2007 /ss/, Brian Jason Rand (26-year-old Ft. Campbell, Ky., 

30th Infantry Regiment sergeant) shot himself at a local park seven weeks after returning home to Clarksville, Tenn. He answered ‘yes’ to PTSD to the identifiers on 

his post-deployment questionnaire following his second tour; yet, two days after 

being diagnosed with PTSD he was redeployed to Iraq for a third and final time. 

Chris Dana (23-year-old 163rd Infantry Battalion Montana National Guardsman) 

shot himself on March 4, 2007 /ss/ after having canceled his appointment for PTSD. 

His brother said after returning in November 2005 he seemed to be melting from 

the inside; his father said his eyes had lost their shine, the joy of living. 

Stephen Edward Colley (22-year-old Ft. Hood, Texas, helicopter mechanic) committed suicide on May 16, 2007 /ss/. Returning from Iraq 6 months earlier, his father said he felt he could not get the psychological help he needed from the military 

for fear it would jeopardize his future career. On May 27, 2007 /ss/, Brian William 

Skold (28-year-old 151st Field Artillery Minnesota National Guardsman) died via 

suicide-by-cop. 

The ninth Ft. Campbell, Ky., soldier to commit suicide in 2007, Derek Henderson 

(27-year-old Afghanistan and Iraq veteran) jumped to his death from a bridge over 

the Ohio River on June 21, 2007 /ss/. He had begun carrying a 12′′ knife and wanted a gun to ‘‘fight the enemy,’’ his medical records indicating PTSD five times. On 

July 25, 2007 /ss/, Noah Charles Pierce (23-year-old 3rd Infantry Division soldier) 

shot himself in rural Minnesota. The soldier who had signed up for the military 

after 9/11 wrote in his suicide note that he had killed people and now it was time 

to kill himself. 

On August 29, 2007 /ss/, John R. Fish II (19-year-old Ft. Hood, Texas, 41st Fire 

Brigade ammunitions specialist) shot himself. He had returned from a long Iraq deVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00087 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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ployment in November 2006. Steven D. Lopez (23-year-old Ft. Bragg, N.C., Afghanistan and Iraq veteran) shot his wife and then himself on November 5, 2007/ss/; 

he had sought help from base doctors and was prescribed Paxil. 

On November 20, 2007 /ss/, Joseph Colin Russell (25-year-old two tour Ft. Hood, 

Texas, 1st Cavalry Division, 2nd Brigade soldier) shot himself at a friend’s house. 

He was homeless and accused of being responsible for the death of another vet following a fight at a nightclub. 

Two days later, on November 22, 2007 /ss/—Thanksgiving Day—Tyler Curtis 

(25-year-old two tour Iraq veteran) committed suicide three months after returning 

to Maine following his 2006 discharge from the Army. He was torn by grief for the 

families of those he may have killed. 

f 

Prepared Statement of Ira Katz, M.D., Ph.D., 

Deputy Chief Patient Care Services Officer for Mental Health, 

Veterans Health Administration, U.S. Department of Veterans Affairs 

Mr. Chairman and members of the Committee, thank you for the invitation to appear before you today to discuss the Department of Veterans Affairs (VA), Veterans 

Health Administration (VHA) Mental Health program and suicide prevention. Accompanying me today are Dr. Robert Rosenheck, Director of the Division of Mental 

Health Services and Outcomes Research; Dr. Lawrence Adler, Director of the Mental Illness Research, Education and Clinical Center (MIRECC) in Veterans Integrated Service Network (VISN) 19; and Dr. Frederick Blow, Director of the Serious 

Mental Illness Treatment Research and Evaluation Center (SMITREC) at the Ann 

Arbor VA Center for Clinical Management Research. 

Mental illness is a serious disease, affecting not only the individual who has the 

problem, but also his or her family; and the community in which he or she lives. 

The symptoms that characterize mental illnesses can cause profound suffering for 

the patient and for others. Moderate levels of the illness are strongly associated 

with problems at work and at home; severe manifestations can lead to devastating 

outcomes such as suicide. While relatively few people with mental illnesses die from 

suicide, the fact that it occurs is a constant reminder that these illnesses are real, 

and that they can be fatal. 

The Department of Veterans Affairs is determined to implement the findings of 

the President’s New Freedom Commission on Mental Health, which require all mental health providers to offer Americans with mental health needs world-class treatment focused on early intervention and recovery. Our comprehensive Mental Health 

Strategic Plan, completed in 2004, provided a blueprint for us to expand our outreach to veterans and to enhance the capacity and quality of our mental health 

services. To implement this plan, we have increased our expenditures for mental 

health services from $2 billion in 2001 to $3 billion in the current fiscal year. In 

addition, we have added more than 3600 new mental health staff members to our 

facilities since 2005, bringing the total number of VA employees working in this 

area to more than 10,000. 

While a significant number of veterans of the conflicts in Iraq and Afghanistan 

have required treatment for mental health conditions on their return home, the 

number is well within our capabilities for providing treatment. Approximately 

100,500 of the 750,000 veterans of this conflict have come to VA with a mental 

health condition since the beginning of the war. This represents only about 10 percent of the total number of veterans with mental health issues VA sees in any one 

year. Just less than half (48,559) of those veterans received at least a preliminary 

diagnosis of Post Traumatic Stress Disorder or PTSD. 

The 10-percent increase in patients with mental health conditions since 2002 

should be balanced against the 50-percent increases in expenditures and mental 

health staffing in VA since 2001. Our new resources are adequate for us to address 

the mental health needs of returning veterans, and to enhance our mental health 

services for veterans of all eras. In terms of their suffering and need for effective 

treatment, the number of returning veterans with mental health issues is very significant; but our Department is able to meet their needs. 

SUICIDE PREVENTION 

Suicide among veterans is a tragedy. The Department of Veterans Affairs believes 

that it is our obligation to work to prevent suicide both in individual patients and 

in the entire veteran population. Our suicide prevention activities are based on the 

principle that in order to decrease rates of suicide, we must provide enhanced access 

to high quality mental healthcare, and to develop programs specifically designed to 


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help prevent suicide. We have trained all VA employees about the risk factors and 

warning signs of suicide, and have offered them strategies to help them deal with 

veterans who may be at risk of taking their own lives. 

VA employees have been given the message that even strong and resilient people 

can develop mental health conditions. Care for those mental health conditions is 

readily available and should be timely provided. We know that treatment can work. 

VA’s suicide prevention program includes two centers that conduct research and 

provide technical assistance in this area to all our locations of care. One is our new 

Mental Health Center of Excellence in Canandaigua, New York, which focuses in 

developing and testing clinical and public health intervention. The other is the 

VISN 19 Mental Illness Research Education and Clinical Center in Denver, which 

focuses on research in the clinical and neurobiological sciences. Our system of care 

also includes a suicide prevention call center, also in Canandaigua with suicide prevention coordinators located in each of VA’s 153 hospitals. Altogether, VA has more 

than 200 mental health providers whose jobs are specifically devoted to preventing 

suicide among veterans. 

The Department has partnered with the Lifeline Program of the Substance Abuse 

and Mental Health Services Administration to develop a VA suicide prevention hotline. Those who call 1–800–273–TALK are asked to press ‘‘1’’ if they are a veteran, 

or are calling about a veteran. When they do so, they are connected directly to VA’s 

hotline call center, where they speak to a VA mental health professional with realtime access to the veteran’s medical records. In emergencies, the hotline contacts 

local emergency resources such as police or ambulance services to ensure an immediate response. In other cases, after providing support and counseling, the hotline 

transfers care to the suicide prevention coordinator at the nearest VA facility to ensure that follow-up is prompt and appropriate. 

In the five weeks from October 7 to November 10, 2007, 1,636 veterans and 311 

family members or friends called the hotline number. These calls led to 363 referrals to suicide prevention coordinators and 93 rescues involving emergency services. 

Since the hotline began in July, there have been more than 6,000 calls from veterans or families, more than 1,300 referrals to Suicide Prevention Coordinators in 

VA medical centers, and more than 300 rescues, any one of which may have been 

life-saving. 

Suicide prevention coordinators receive referrals of those at risk for suicide from 

both the hotline and from providers in their facilities, and ensure that care for those 

at risk addresses their high risk status. Coordinators educate their colleagues, veterans and families about risks for suicide, provide enhanced treatment monitoring 

for veterans at risk and ensure that any missed appointments are followed up on. 

The coordinators work with the entire staff of their medical centers to maintain 

awareness of those who have previously attempted suicide, and ensure that their 

care is enhanced. 

Prevention coordinators also work with patient safety officers to conduct quarterly 

safety inspections of inpatient psychiatry units, and to coordinate staff education 

programs about suicide prevention. These coordinators are in the process of organizing a system of flags in the electronic medical record to alert providers about 

those at high risk, and are conducting training for community members who have 

frequent contact with veterans to help them recognize those at risk and encourage 

them to seek treatment. 

Finally, VA has held two National VA Suicide Prevention Awareness Days 

throughout our system to focus all of our 200,000 healthcare employees on this 

issue. The first event focused on enhancing overall awareness of the issue, and the 

second trained all VA staff on how to work with available prevention resources, including the hotline and the suicide prevention coordinators. 

VA is very much concerned about the epidemiology of suicide among veterans, and 

has used findings in this area to guide our prevention programs. As new data on 

suicide rates, risk factors for suicide and regional variations become available, we 

will use that data to refine our programs, and to better evaluate their level of success. In all of this epidemiological work, VA uses information from the Centers for 

Disease Control and Prevention’s (CDC) National Death Index currently available 

through the end of calendar year 2005. 

VA’s Epidemiology Service has published findings from a long-term, 20-year follow-up on the health of Vietnam-era veterans. The peer-reviewed, published study 

reported that rates of suicide among veterans who were deployed to Southeast Asia 

did not differ statistically from veterans of the same era who were not deployed. A 

published study of veterans from the first Gulf War provided a similar finding. 

VA has now completed a preliminary evaluation of suicide rates among veterans 

returning from Iraq and Afghanistan. From the beginning of the war through the 

end of 2005 there were 144 known suicides among these new veterans. This number 


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translates into a rate that is not statistically different from the rate for age, sex, 

and race matched individuals from the general population. 

Taken together, the population of veterans who receive care from the Veterans 

Health Administration have more risk factors for suicide than the general population. Although there are increasing numbers of female veterans, most veterans are 

male. Those who come to the VA for care tend to be older, less socio-economically 

well off, and more likely to have a mental health condition or another chronic illness. It is, therefore, by no means surprising that those receiving care from VA have 

higher suicide rates than those in the general population. Those with the greatest 

need for care are those who are most likely to come to VA. This increased need can 

be associated with increased risks. This, in fact, was one of the major factors leading 

to VA’s focus on suicide prevention. 

Because of new enrollment criteria for veterans of the Global War on Terror, the 

characteristics of Iraq and Afghanistan veterans coming to VA today are different 

from those for veterans from prior eras. As a result, early data being evaluated by 

VA, suggests that while rates among OIF/OEF veterans who come to VHA for care 

are not different from the general population, rates among those veterans who do 

not come to VA appear to be higher. One possible explanation for this finding is that 

VA mental healthcare is effective, and that it can be lifesaving. Further research 

in this area is underway. 

VA’s latest data do not demonstrate an increased risk of suicide among OEF/OIF 

veterans compared to the age and gender matched American population as a whole. 

Nevertheless, one suicide among those who have served their country is too much. 

Available information on suicide rates and risk factors among veterans are reinforcing the importance of the work VA has done to enhance its mental health services since 2001; and the usefulness of our comprehensive program for suicide prevention. 

VA has already implemented the key provisions of the Joshua Omvig Veterans 

Suicide Prevention Bill, which was recently signed by President Bush, and we continue to do research to develop and implement new strategies that will improve our 

ability to save lives by preventing suicide. VA believes that our healthcare system 

can and must serve a national model for suicide prevention, now and in the future. 

Thank you for the opportunity to address the Committee. At this time, I would 

be pleased to answer your questions. 

f 

Prepared Statement of Kara Zivin, Ph.D., 

Research Health Scientist, Health Services Research and Development 

Veterans Health Administration, U.S. Department of Veterans Affairs 

Good morning, Mr. Chairman, I am honored to provide testimony to the Committee about suicide among veterans treated for depression in the VA Health System. I come before this Committee as a mental health services researcher who has 

conducted research on this topic. The views and opinions expressed are my own, and 

do not necessarily represent those of my current employer, the Department of Veterans Affairs, or the views of the VA research community. 

I am here today to report on findings from a study that I conducted along with 

my colleagues at the Department of Veterans Affairs’ National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) and the VA’s Health 

Services Research and Development Center of Excellence in Ann Arbor, Michigan. 

We recently published a paper in the American Journal of Public Health examining 

suicide rates using data from the VA’s National Registry for Depression for 807,694 

veterans of all ages diagnosed with depression and treated at any Veterans Affairs 

facility between 1999 and 2004. 

In all, 1,683 veterans in VA depression treatment died by suicide during the study 

observation period, representing 0.21 percent of this treatment population. When we 

calculated the overall suicide rate in this population over the 5.5-year observation 

period, it was 88.3 per 100,000 person-years (PY), approximately 7–8 times greater 

than the suicide rate in the general adult U.S. population. A higher suicide rate 

would be expected among a population of patients in treatment for depression than 

the general U.S. population, given that depression is a potent risk factor for suicide. 

Because most healthcare systems lack the capability of assessing suicide rates 

among their treatment populations, there are few points of comparisons with nonveteran treatment populations. However, at least one prior study reports a suicide 

rate for men receiving depression treatment in managed care settings between 


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1Simon GE, VonKorff M. Suicide mortality among patients treated for depression in an insured population. American Journal of Epidemiology. Jan. 15, 1998;147(2):155–160. 

1992–1994 of 118 per 100,000 PY, a suicide rate which is somewhat higher than 

that observed in this veteran depression treatment population.1

In our study, we observed that the predictors of suicide among veterans in depression treatment differed in several ways from those observed in the general U.S. population. Typically, people in the general population who die by suicide are older, 

male, and white, and have depression and medical or substance abuse issues. In 

this study, we too found that depressed veterans who had substance abuse problems 

or a psychiatric hospitalization in the year prior to their index depression diagnosis 

had higher suicide rates. 

However, when we divided depressed veterans into three age groups: 18 to 44 

years, 45 to 64 years, and 65 years or older, we found that the younger veterans 

were at the highest risk for suicide. Differences in rates among depressed veterans 

of different age groups were striking; 18 44-year-olds completing suicide at a rate 

of 95.0 suicides per 100,000 PY, compared with 77.9 per 100,000 PY for the middleage group, and 90.1 per 100,000 PY for the oldest age group. We did not assess 

whether individuals had served in combat during a particular conflict, although the 

existence of a military service-connected disability was considered. 

In this VA treatment population, men veterans were more likely to complete suicide than women veterans. Suicide rates were 89.5 per 100,000 PY for depressed 

veteran men and 28.9 per 100,000 PY for veteran women. However, the differential 

in rates between men and women (3 : 1) was smaller than has been observed in the 

general population (4 : 1). 

We found higher suicide rates for white depressed veterans (95.0 per 100,000 PY) 

than for African Americans (27.1 per 100,000 PY) and for veterans of other races 

(56.1 per 100,000 PY). Veterans of Hispanic origin had a lower rate (46.3 per 

100,000 PY) of suicide than those not of Hispanic origin (86.8 per 100,000 PY). Adjusted hazard ratios also reflected these differences. 

Surprisingly, our initial findings revealed a lower suicide rate among depressed 

veterans who also had a diagnosis of post-traumatic stress disorder (PTSD) compared to depressed veterans without this disorder. Depressed veterans with a concurrent diagnosis of PTSD had a suicide rate of 68.2 per 100,000 PY compared to 

a rate of 90.7 per 100,000 PY for depressed veterans who did not also have a PTSD 

diagnosis. We investigated further to examine whether specific subgroups of depressed veterans with PTSD had higher or lower suicide risks. We found that concurrent PTSD was more closely associated with lower suicide rates among older veterans rather than among younger veterans. This study does not reveal a reason for 

this lower suicide rate, but we hypothesize that it may be due to the high level of 

attention paid to PTSD treatment in the VA system, and the greater likelihood that 

patients with both depression and PTSD will receive psychotherapy and more intensive visits. In general, individuals with depression and PTSD diagnoses have higher 

levels of VA mental health services use than individuals with depression without 

PTSD. 

Interestingly, depressed veterans who did not have a service-connected disability 

were more likely to complete suicide than those with a service-connected disability. 

This may be due to greater access to treatments among service-connected veterans, 

or more stable incomes due to compensation payments. 

We hope our findings will help inform clinical treatment and policy initiatives to 

reduce suicide mortality among veterans with depression. 

Thank you for this opportunity to testify. I will be pleased to answer any questions you may have. 

f 

Statement of Michael Shepherd, M.D., 

Physician, Office of Healthcare Inspections, 

Office of Inspector General, U.S. Department of Veterans Affairs 

Mr. Chairman and Members of the Committee, thank you for the opportunity to 

testify today on suicide prevention and the Office of Inspector General (OIG) report, 

Implementing VHA’s Mental Health Strategic Plan Initiatives for Suicide Prevention. 

Background 

In 2004, suicide ranked as the 11th leading cause of death with a rate of 11.1 

per 100,000 in the general U.S. population and the 3rd leading cause of death withVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00091 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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in the 15–24 age range. It is estimated that each suicide intimately affects the lives 

of at least six other people. 

In any particular suicide, individual and collective proclivities tend to combine. 

Consequently, the attempt to make sense of the multiple potential contributions 

from identifiable psychiatric disorder(s), co-morbid medical illness and functional 

impairments, specific personal events, and sociocultural factors has been the work 

of and an ongoing challenge to mental health professionals, sociologists, and epidemiologists. This effort has increased knowledge about suicidal patients and provided information for utilization in their treatment. However, there has been little 

reduction in overall rates through the years, indicating there is more to learn. 

Suicidologists have struggled with standardization issues for many years. While 

it has long been held that the pursuit of valid and reliable suicide statistics is important to public health policy, establishing the validity and reliability of suicide 

rates has been a notable source of concern. In the U.S. it is widely assumed by mental health professionals that the actual suicide rate is higher than officially reported. Establishing the validity and reliability of suicide rates is complicated by 

stigma. Other sources of variability include limitations of death certificates, variability in the training of those tasked with certifying cause of death, use of differing 

guidelines for suicide determination, and the presence of equivocal causes such as 

single car accidents and drug overdoses. 

The 2001 Surgeon General’s National Strategy for Suicide Prevention identifies 

steps in a public health model for suicide prevention. Collecting data on rates of suicide and suicidal behavior is typically referred to as medical surveillance. Data may 

include information on how suicide rates vary by time, geography, age or special 

populations. In addition, data collection may include information on characteristics 

of individuals who suicide, circumstances surrounding suicide events, the presence 

and absence of possible precipitants, and the adequacy or accessibility of supportive 

factors and health services. 

For example, the National Violent Death Reporting System is a Centers for Disease Control and Prevention (CDC) effort to develop a nationwide, state-based monitoring system for violent deaths. State and local agencies use this system to input 

data from medical examiners, coroners, death certificates, police reports, toxicology 

studies, and other sources. At present 17 States are designated to participate in the 

system. Veteran status is one of several uniform data elements recorded for input 

into the system. The data is pooled with the hope that it can ultimately be used 

to answer fundamental questions about suicide and to aid participant States in the 

design and implementation of tailored suicide prevention and intervention efforts. 

Suicide is not a single illness with one true cause; it is a final common outcome 

with multiple potential antecedents, precipitants, and underlying causes. Interventions that may be more effective for one set of patients may differ from those of 

greatest benefit for a different set of patients. Comprehensive suicide prevention 

programs, those employing a portfolio of intervention elements, and particularly 

those that incorporate a range of services and providers, are thought to have a 

greater likelihood of reducing suicide rates. Selecting which interventions to implement includes consideration of the needs and characteristics of the target population, ways to integrate interventions into existing programs, efforts to strengthen 

collaboration, and an analysis weighing the resource requirements versus the potential effectiveness of individual interventions. 

Veterans Health Administration’s Mental Health Strategic Plan 

In 2003, a VA mental health workgroup was asked to review the President’s New 

Freedom Commission on Mental Health’s 2002 report, to determine the relevance 

to veteran mental health programs of the Commission’s goals and recommendations, 

and to develop an action plan tailored to the special needs of the enrolled veteran 

population. A 5-year action plan with more than 200 initiatives was ultimately developed and finalized in November 2004. Among the action items were a number 

specifically aimed at the prevention of suicide. In addition, endorsement and implementation of the goals from the Surgeon General’s 2001 National Strategy for Suicide Prevention, and recommendations from the Institute of Medicine’s 2002 report 

Reducing Suicide: A National Imperative, were incorporated into the VA Mental 

Health Strategic Plan (MHSP). 

OIG Report on VHA’s Implementation of Suicide Prevention Initiatives 

In response to a request from this Committee, the OIG undertook an assessment 

of VHA progress in implementing initiatives for suicide prevention from the MHSP. 

In our May 2007 report, individual MHSP initiatives for suicide prevention were 

categorized and consolidated into the following domains: 


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• Crisis Availability and Outreach. 

• Screening and Referral. 

• Tracking and Assessment of Veterans at Risk. 

• Emerging Best Practice Interventions and Research. 

• Development of an Electronic Suicide Prevention Database. 

• Education. 

We recommended that: 

• VHA make arrangements for 24-hour crisis and mental healthcare availability, 

either in person, or via a crisis line, and that at each facility an on-call mental 

health specialist should be available to crisis staff either in person or by phone. 

• All nonclinical staff who interact with veterans receive mandatory training 

about responding to crisis situations involving at-risk veterans inclusive of suicide protocols for first contact personnel. 

• Healthcare providers receive mandatory education about suicide risks and ways 

to address these risks. 

• The requirement of sustained sobriety should not be a barrier to treatment in 

specialized mental health programs for returning combat veterans. 

• VHA should facilitate bi-directional information exchange between VA and DoD 

for patients with mental illness coming into VHA healthcare and/or leaving 

VHA healthcare for re-deployment to active duty status. 

• VHA should establish a centralized mechanism to review ongoing suicide prevention strategies, to select among available emerging best practices for screening, assessment, and treatment, and to facilitate systemwide implementation, 

in order to ensure a single VHA standard. 

Crisis Availability 

Although we found that most facilities reported availability of 24-hour mental 

healthcare either through the emergency room, a walk-in clinic, or a crisis hotline, 

this initiative had not achieved systemwide implementation and a coordinated toll 

free hotline was not in place at the time of our report. On July 25, 2007, the Department of Veterans Affairs subsequently began operation of a 24-hour national suicide 

prevention hotline for veterans. The hotline has reportedly received greater than 

9,000 calls. Callers include veterans who previously would have called a non-VA suicide hotline, veterans who would not have utilized a non-VA hotline, family members and friends of veterans, and other distressed nonveterans. Several of the veteran calls have resulted in 911 emergency rescues and admission to VA hospitals. 

Hotline personnel facilitate referral of distressed nonveterans to a non-VA suicide 

prevention hotline through a partnership with the Substance Abuse and Mental 

Health Services Administration. 

I recently visited the hotline, located at the Veterans Integrated Service Networks 

(VISN) 2—Center of Excellence at Canandaigua, New York, on less than 24 hours 

notice. During my visit with hotline staff, the phone lines were in use throughout 

the duration. I observed a call from a young veteran who told the hotline clinician 

that she planned to take the bottle of pills that she had next to her. After assessment and a lengthy discussion with the caller, the hotline line clinician arranged 

for an emergency rescue. I also observed a call from a discouraged Vietnam era veteran who had recently become homeless and was calling from his car in which he 

was living. Hotline staff arranged for him to be met by the suicide prevention coordinator at the local VA facility. 

Suicide Prevention Coordinators 

The VA Office of Mental Health Services has been in the process of implementing 

suicide prevention coordinators at all VA medical centers. At present, dedicated staff 

are reportedly in place at approximately 85 percent of facilities and ‘‘acting’’ suicide 

prevention coordinators are in place at remaining sites. Hotline clinical staff told me 

that after requesting a consult for a caller at a VA facility, they contact the facility 

suicide prevention coordinator electronically and/or by phone. If they do not hear 

back within 24 hours, they contact the coordinator again. Within 48 hours of the 

call to the hotline, an update on the patient’s disposition is to be reported by the 

suicide prevention coordinator to hotline staff. At 2 weeks post call, hotline staff 

contact the suicide prevention coordinator for an update as to whether the caller has 

remained engaged in follow-up in the VA system. 


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Education and Training of VA Personnel 

In terms of initiatives for education on suicide prevention, at the time of our May 

report, we found that only 50 to 60 percent of facilities provided programs to train 

first contact nonclinical personnel about crisis situations involving veterans at risk 

for suicide. Only one-fifth of these programs included mandatory presentation of suicide response protocols. Almost all facilities provide education to health providers 

on suicide risks, ways to address these risks and best practices for suicide prevention. However, at only a small percentage of facilities were these programs mandatory. Since that time, the VISN 2 Canandaigua Center of Excellence has developed 

a CD and guide for training VA nonclinical personnel and a second CD and guidebook for community-based training. The training, titled Operation S.A.V.E. (Signs 

of suicidal thinking; Ask questions; Validate the veteran’s experience; Encourage 

treatment and Expedite referral) will reportedly be carried out by the facility suicide 

prevention coordinators. A copy of the CDs and guide were provided to me on my 

recent visit. The VISN 2 Center of Excellence leadership report plans to subsequently develop a guide and CD for VA clinicians. 

Treatment for Co-Morbid Mental Health and Substance Use Disorders 

In terms of eliminating sustained sobriety as a barrier to treatment in specialized 

mental health programs for returning combat veterans, on November 23, 2007, the 

Deputy Under Secretary for Health for Operations and Management issued a memorandum to Network Directors that states that ‘‘VHA facilities and providers must 

never take the position that a patient is untreatable because substance use or dependence precludes treating mental health conditions while mental illness makes it 

impossible to treat abuse or dependence. Instead, services must be designed and 

available to provide care for veterans with substance use disorders and mental 

health conditions, alone or together, regardless of acuity or chronicity.’’ 

Facilitation of Emerging Best Practice Implementation 

The OIG report recommended that VHA facilitate establishment of a centralized 

mechanism to select among emerging best practices for suicide prevention, the VISN 

2 Center of Excellence has subsequently been organized into a clinical core, an education and training core, a VACO initiatives core, and a research core. The clinical 

core group is responsible for the organized development of pilot and demonstration 

projects. The initiative core is responsible for implementation of VA Central Office 

suicide prevention initiatives. The research core is focused on performing program 

evaluation, health services research, and intervention effectiveness research in order 

to expedite the dissemination of promising approaches throughout VA. 

Bi-Directional Exchange of Health Information 

Bi-directional information exchange between VA and DoD which includes patients 

with mental illness coming into VHA healthcare and/or leaving VHA healthcare for 

re-deployment is an ongoing issue that has been discussed at other hearings. 

VHA Development of a Veteran Suicide Database 

At the time of our inspection, researchers at the VHA Serious Mental Illness 

Treatment Research and Evaluation Center (SMITREC) in a joint effort with researchers at the University of Michigan School of Public Health in Ann Arbor, 

Michigan, had been developing a methodology by which to create a database of veterans who had utilized VHA care in an index year and then stopped utilizing VHA 

care in subsequent years. This database would then be matched with data from the 

CDC National Death Index (NDI), to determine which of these veterans were deceased. This data would then be matched with an enhanced version of the National 

Death Index to determine which veterans no longer accessing VHA care had died 

from suicide. In early October, SMITREC researchers reported that they have subsequently calculated suicide rates for 2001 and 2002 among veterans who obtain 

care in VHA. In recent weeks, they reported working on data received from the NDI 

for calculation of rates from 2003–2005. 

At the time of the May OIG report, a template of data elements pertaining to suicides and suicide attempts had been piloted in Rocky Mountain Network (VISN 19) 

facilities. In the past few months, VHA has reportedly been expanding use of the 

template to VHA facilities nationwide. Clinical providers at VHA facilities nationwide have been asked to input data regarding attempts or completed suicides by 

their patients using a template which contains prompts for data elements including 

age, gender, diagnosis, date of attempt, method used, outcome, date last seen at VA 


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prior to attempt, among others. The facility suicide prevention coordinator is responsible for receiving and collating data inputted into the template by clinical providers 

and submitting a spreadsheet to the Center of Excellence at the Canandaigua 

VAMC on the 10th of each month. October was the first month for which data was 

submitted to the Canandaigua Center of Excellence. Most but not all VHA facilities 

submitted data and the extent of provider compliance with filling out the templates 

is presently unclear. 

Since October 2003, the Department of Defense (DoD) Defense Manpower Data 

Center has sent the VA Environmental Epidemiology Service a periodically updated 

personnel roster of troops who participated in Operation Iraqi Freedom (OIF) and 

Operation Enduring Freedom (OEF), and who had separated from active duty and 

become eligible for VA benefits. This data however does not include recently discharged or retired veterans who were not deployed in support of OEF/OIF or veterans who have served in other eras. 

The OIG LC Database 

During the past year, colleagues at the OIG Office of Healthcare Inspections have 

diligently pursued creation of a database to quantitatively characterize the care 

transition process from DoD to VHA. A September 2007, OIG Informational Report 

entitled Quantitative Assessment of Care Transition: The Population-Based LC Database, describes the creation of an analytical database derived from more than 30 

data files acquired from VA and DoD that incorporates details about all service 

members discharged from July 1, 2005 to September 30, 2006. The database includes veterans who were deployed, those who were not deployed, members of the 

Reserves and National Guard, those who have accessed care in VHA and those who 

have not. The paper discusses the methodology used to create the database, data 

confidentiality issues, its limitations, and analytic potential for research and other 

applications. This unique database may provide background for understanding and 

interpreting ongoing and planned studies pertaining to select medical conditions, 

causes of mortality, and/or healthcare access. 

Conclusion 

Suicide is an unequivocally tragic and often incomprehensible event. Preventing 

suicide is a complex, multifaceted challenge to which there is not one best practice 

but several promising but not proven approaches and methods. Since 2004, progress 

had been made toward implementation of the MHSP initiatives for suicide prevention. Progress has continued with greater integration and at an accelerated pace 

since the time of the OIG report in May and the enactment of the Joshua Omvig 

Suicide Prevention Act. The full array of suicide prevention initiatives has not yet 

attained systemwide implementation. It is therefore incumbent upon VA to continue 

moving forward toward full deployment of suicide prevention strategies for our Nation’s veterans. 

Mr. Chairman, thank you again for this opportunity to testify on this important 

issue. I would be pleased to answer any questions that you or other members of the 

Committee may have. 

f 

Statement of Joseph L. Wilson, Deputy Director 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

Thank you for this opportunity to present The American Legion’s views on Stopping Suicides: Mental Health Challenges within the Department of Veterans Affairs 

(VA). The VA has the Nation’s largest mental health program, which is continually 

implementing various programs to accommodate the growing demand for mental 

health services to all veterans. 

Unfortunately, during a time which greatly warrants the development of such programs, the increased scrutiny of VA’s mental health services and budget exist due 

to the increased demand for mental health services from veterans returning from 

combat in Iraq and Afghanistan, as well as veterans from previous eras. 

Mental Health Strategic Plan, Initiatives, and Other Recommendations 

Upon the completion of its Comprehensive Mental Health Strategic Plan (MHSP), 

the VA began implementation of mental health initiatives in 2005. The Mental 

Health Initiative (MHI) was instituted to provide funding to support the implemenVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00095 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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tation of the MHSP outside of the Veterans Equitable Resource Allocation (VERA) 

model. 

To effectively plan the funding for the MHI, the MHSP was divided into four main 

areas to include: enhancing capacity and access for mental health services; integrating mental health and primary care; transforming mental health specialty care 

to emphasize recovery and rehabilitation; and implementation of evidence-based 

care. Under these key categories are multiple funded programs, which are also currently attempting to accommodate increasing issues, to include suicide, amongst our 

Nation’s veterans. 

One of many indicators of increase in suicides is evident in recommendations 

made to VA by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), an organization formed in 1951 with a mission to maintain and elevate the standards of healthcare delivery through evaluation and accreditation of 

healthcare organizations, and its National Patient Safety Goal (NPSG). Implemented on January 1, 2007, JCAHO advised that all VA facilities take the following 

steps to comply with the NPSG: 

• Develop and implement strategies to properly assess, treat, and manage patients identified at risk for suicide. • Document the relevant risk factors for suicide in each patient’s medical record. • Document treatment and the treatment setting in a manner that addresses the 

presence of (or absence of) relevant risk factors that increase risk for suicide 

and features that may decrease risk for suicide. 

• Provide the appropriate telephone number(s) for telephone calls during working 

hours and other times, in writing, to at-risk patients and/or significant others. 

• Instruct patients and their significant others to call the facility’s Emergency Department or Urgent Care Center if they have a crisis situation. 

• Ensure that the local or regional mental health hotline knows about VA as a 

resource in case a veteran should contact them. 

• Ensure that the safety concerns in the design of the inpatient mental health 

unit (and its furnishings) are addressed. 

• Establish and implement a policy stating who is responsible for identifying and 

working with local agencies so that VA patients receive emergency support and 

referral to the VA as soon as possible. 

The American Legion supports directives established by the Mental Health Strategic Plan and JCAHO, and their intentions to prevent tragedies such as suicide. 

However, there are concerns of adequacy of funding for these programs, as well as 

accommodation, across the board, for veterans of previous eras and the ever-increasing number of veterans who are returning from Iraq and Afghanistan. The American Legion continues to urge the Congress to annually appropriate the necessary 

funds for the Department of Veterans Affairs to ensure comprehensive mental 

health services are available to veterans. 

Suicide 

The VA estimates that more than 5,000 veterans take their lives each year. Suicide rates are 35 percent higher for Iraq veterans than for the general population. 

Thirty-six percent of the 250,000 Iraq and Afghanistan veterans who have sought 

care in the VA system were treated for mental health problems. 

According to research, 283 Afghanistan veterans between 2001 and 2005 have 

taken their own lives. It was also reported that awareness was intensified nationwide when the United States Army reported the increase of its 2006 suicide rate, 

which rose to 17.3 per 100,000 troops. Within the past year the Army reported 23 

soldiers, then currently in Iraq and Afghanistan committed suicide with at least 

seven Iraq and Afghanistan veterans committing suicide since returning home. 

In July 2007, VA opened a 24-hour National Suicide Prevention hotline for veterans. Recently, the VA submitted an informative letter to veterans disclosing the 

National Suicide Prevention toll-free hotline number included with definitive/probable suicide warning signs. The passing of H.R. 327, also titled the Joshua Omvig 

Veterans Suicide Prevention Act, which requires VA to develop and implement more 

programs, such as outreach and education, more than suggests an impending crisis 

amongst the Nation’s veterans. During the development and implementation of 

mental health programs, there also arises the question of effectiveness. 

Signs of increase is also evident at VA’s National Suicide hotline center based in 

Canandaigua, N.Y., in which counselors have taken more than 9,000 calls since its 

inception this year. In addition, the VA recently announced plans to provide suicide 

prevention coordinators at each of its 153 medical centers. 

In 2004, VA completed a five-year action plan that included implementation of 

goals from the Surgeon General’s 2001 National Strategy for Suicide Prevention and 


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1Suicide Mortality Among Individuals Receiving Treatment for Depression in the Veterans Affairs Health System: Associations with Patient and Treatment Setting Characteristics. Zivin K, 

Kim M, McCarthy JF, Austin KL, Hoggat KL, Walters H, Valenstein, M. AJPH (2007) 

97(12):2193–2198. 

recommendations from the Institute of Medicine’s (IOM) 2002 report ‘‘Reducing Suicide—A National Imperative.’’ Afterward, the aforementioned were incorporated into 

the VA Mental Health Strategic Plan (MHSP). 

In addition, individual MHSP initiatives for suicide prevention were categorized 

and consolidated, to include: 

• Crisis availability and outreach; screening and referral. 

• Tracking and assessment of veterans at risk. 

• Emerging best practice interventions and research. 

• Development of an electronic suicide prevention database. 

• Education. 

The warranted emergence of such programs to prevent this dreadful tragedy is 

indicative of a more imminent crisis becoming worse, absent effective means of curtailment. The American Legion agrees these initiatives are steps in the right direction and continues to remain incessant on monitoring the efficiency and effectiveness of programs implemented in the MHSP. We also implore the Congress to mirror our sentiment as well. 

Conclusion 

In response to a call for help from this Nation’s veterans, programs related to crises such as suicide are continuously being implemented. However, in accordance 

with a 2006 Government Accountability Office (GAO) report, there are issues of adequacy and accountability in the areas of funding and assessment, which in turn 

leave gaps in this system, therefore allowing veterans in need to fall through the 

cracks. 

It is the insistence of The American Legion that a proactive effort be implemented 

with continuous oversight to ensure complete access is available to avert suicides 

amongst our Nation’s veterans. The American Legion also urges the Congress to 

provide annual oversight of VA’s mental health services to augment deterrence of 

such tragedies as the above mentioned. 

Mr. Chairman and members of the Committee, The American Legion sincerely appreciates the opportunity to submit testimony and looks forward to working with 

you and your colleagues to resolve this critical issue. Thank you for your continued 

leadership on behalf of America’s veterans. 

f 

Statement of Joy J. Ilem, 

Assistant National Legislative Director, Disabled American Veterans 

Mr. Chairman and Members of the Committee: 

Thank you for inviting the Disabled American Veterans (DAV) to provide testimony at this important hearing focused on preventing suicides and meeting other 

mental health challenges of veterans who receive their care from the Department 

of Veterans Affairs (VA). This hearing is especially timely given the series of disturbing reports that have appeared recently on these important issues. 

The Department of Defense (DoD) and VA share a unique obligation to meet the 

healthcare and rehabilitative needs of veterans who have been wounded during military service or who suffer from readjustment difficulties and other consequences of 

combat deployments. VA recently announced it has made suicide prevention a priority and has developed a focused program based on increasing suicide awareness, 

prevention, and training to improve the recognition of suicide risk by healthcare 

staff. A national suicide prevention hotline has been established and suicide prevention coordinators have been hired in each VA medical center. DAV welcomes these 

efforts but we believe they will be fruitless if VA fails to improve the effectiveness 

of treatment for post traumatic stress disorder (PTSD), depression, substance abuse 

and other mental health disorders—which together appear to create the greatest 

threat to rising suicide rates in veterans. 

Suicide is a significant public health problem and should be addressed by aggressive efforts in the veteran population. In the December issue of the American Journal of Public Health,1 VA investigators reported the results of their longitudinal 

study carried out from 1999–2004 using nationally representative data to determine 

suicide rates among veterans treated by VA for depression. Of the over 800,000 vetVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00097 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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2Gulf War Health: Volume 6. Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. The National Academy Press, Washington DC, 2007. 3Department of Veterans Affairs, VHA Office of Public Health and Environmental Hazards, 

‘‘Analysis of VA Healthcare Utilization Among U.S. Global War on Terrorism (GWOT) Veterans: 

Operation Enduring Freedom, Operation Iraqi Freedom,’’ October 2007. 4 An Achievable Vision: The Report of the Department of Defense Mental Health Task Force, 

June 15, 2007. 

erans studied, 1,683 or 0.21 percent committed suicide. Overall, the rates of suicide 

among depressed veterans were 7–8 times higher than the rate for the general population. However, suicide rates in depressed veterans were similar to rates found 

in men receiving care for depression in managed care systems. Unlike other studies 

that report higher rates in older adults, this VA study found that depressed veterans who were younger were at the greatest risk. One of the findings of the study 

confirmed that veterans with co-morbid depression and substance abuse are at very 

high risk for suicide. Veterans from the northeast and central U.S. had lower suicide rates than veterans from the south and west. This is consistent with the geographic and regional suicide rate variations. 

The findings of this study give clinicians important clues to characteristics that 

produce higher suicide risk in veterans suffering from depression. Youth, incidence 

of substance use and geographic location are all associated with suicide risk. DAV 

hopes that further studies of suicide risk can increase our understanding and reduce 

the impact on veterans who fought in Afghanistan, Iraq and previous conflicts. 

Research demonstrates a clear association between deployment to a combat zone 

and subsequent mental health problems, substance abuse, and psychosocial problems such as marital conflict and incarceration. Key to our discussion today is the 

recognition that combat service is associated with higher rates of suicide in the 

early post-deployment period. This information is summarized in a report from the 

Institute of Medicine (IOM) entitled Gulf War and Health: Volume 6 Physiologic, 

Psychologic, and Psychosocial Effects of Deployment Related Stress, published in November 2007.2 The IOM committee studied literature covering all deployments in 

the 20th and 21st centuries including World War II, the Korean War, the Vietnam 

War, the 1991 Persian Gulf War, and Operations Iraqi and Enduring Freedom (OIF/ 

OEF). This eminent group of experts reviewed the scientific evidence and determined that the evidence is sufficient to conclude that there is an association between deployment to a war zone and PTSD, other anxiety disorders, depression, alcohol abuse, suicide and accidental death in early years after deployment, and marriage and family conflict. In addition, the committee found that there was suggestive 

evidence of an association between deployment stress and drug abuse, chronic fatigue syndrome, fibromyalgia and other pain syndromes, gastrointestinal symptoms, 

skin disorders, increased symptom reporting and unexplained conditions and—and 

incarceration. The committee noted that there was insufficient investigation by VA 

and DoD to allow the Committee to draw cause-and-effect conclusions regarding deployment stress and later physiological, psychological and psychosocial conditions. 

The IOM report states very clearly that veterans, young and old, are at increased 

risk of suicide because of their presence in combat. 

Military deployments in Iraq and Afghanistan are among the most demanding 

since the Vietnam War over four decades ago. These deployments are causing heavy 

casualties in what are considered the ‘‘invisible’’ wounds of war: PTSD, depression, 

family dislocations and other distress, and a number of other social and emotional 

consequences for those who have served in OIF/OEF. VA reports that OIF/OEF veterans have sought care for a wide array of co-morbid medical and psychological conditions, including adjustment disorder, anxiety, depression, PTSD, and the effects 

of substance use. Through October 2007, VA reported that, of the 263,909 separated 

OIF/OEF veterans who have sought VA healthcare since the beginning of those hostilities, a total of 100,580 unique patients had received a diagnosis of a possible 

mental health disorder. More than 48,000 enrolled OIF/OEF veterans had a probable diagnosis of PTSD; almost 33,000 have been diagnosed with depression; and, 

more than 40,000 reported nondependent abuse of drugs.3

According to the recent report of the DoD Mental Health Task Force (Task Force), 

suicide rates have risen among OIF/OEF active duty members.4 In a finding that 

is key to this hearing, the Task Force also concluded that alcohol abuse contributed 

in 65 percent of the instances of suicidal behavior in military servicemembers. Depression and marital and relationship difficulties were seen as additional key contributors to suicidal ideology. After receiving these reports, DoD is beginning to reinforce suicide prevention efforts, and VA is targeting suicidal behavior in the veteran population, including establishing a veteran-specific referral procedure when 

veterans call 800–273–TALK, the National Suicide Prevention Hotline sponsored by 


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5 Brenda, BB. Gender Differences in Predictors of Suicidal Thoughts and Attempts Among 

Homeless Veterans That Abuse Substances. Suicide and Life Threatening Behavior, 35, (2005) 

106–116. 6 Ilgen, MA; Harris, A; Moos, R; et al. Predictors of Suicide Attempt One Year After Entry 

Into Substance Abuse Disorder Treatment. Alcoholism, Clinical and Experimental Research, 31, 

(2007) 635–642. And Ilgen, MA; Jain, A; Lucas, E; Moos, R. Substance Use Disorder Treatment 

and a Decline in Attempted Suicide During and After Treatment. J Stud Alcohol and Drugs, 

68, (2007) 503–509. 7Price, RK; Risk, NK; Haden, AH, et al. Post Traumatic Stress Disorder, Drug Dependence 

and Suicidality Among Male Veterans. Drug and Alcohol Dependence, 76S, (2004) S31–43. 8Kline, A., Falca-Dodson, M., Substance Abuse and Mental Health Problems in Returning 

Iraqi Veterans. VA New Jersey Healthcare System, New Jersey Department of Military and Veterans Affairs 2007, (unpublished). 9Wheeler, E. Self Reported Mental Health Status and Needs of Iraq Veterans in the Maine 

Army National Guard. Community Counseling Center, 2007 (unpublished). 10 Bray, R., Hourani, L., Olmstead, K., Witt, M., Brown, J., Pemberton, M., Marsden, M., Marriott, B., Scheffler, S., Vandermaas-Peeler, R., Weimer, B., Calvin, S., Bradshaw, M., Close, K., 

& Hayden, D. (2006, August). 2005 Department of Defense Survey of Health Related Behaviors 

Among Active Duty Military Personnel: A Component of the Defense Lifestyle Assessment Program (DLAP). Prepared for the Assistant Secretary of Defense for Health Affairs, U.S. Department of Defense, Cooperative Agreement RTI/7841/006–FR). Research Triangle Park, NC: Research Triangle Institute. 

the Substance Abuse and Mental Health Services Administration of the Department 

of Health and Human Services. Experts assert that any effective suicide prevention 

effort must offer ready access to robust mental health and substance abuse treatment programs, including components related to outreach, prevention, stigma reduction, improved screenings and early interventions. DAV concurs that these components, with the resources to fully support them, are critical to success of this prevention effort. 

In a study of 315 homeless male veterans and 310 homeless female veterans, VA 

researchers found that 27 percent and 37 percent, respectively, reported they had 

attempted suicide in the past 5 years, and an additional 44 percent and 49 percent, 

respectively, reported they had contemplated suicide. The study also found over 80 

percent of homeless veterans had mental disorders, prominently among them substance abuse, and that its degree of severity was a strong predictor of suicidality. 

In men, combat exposure and PTSD were predictive, and in women, recent sexual 

or physical trauma correlated positively with suicidality.5

The link between substance abuse and other mental disorders and suicide is 

strong. Earlier this year in a study of over 8,000 veterans who received substance 

abuse treatment, VA researchers found that nine percent had attempted suicide in 

the year prior to VA treatment, but only four percent had made suicide attempts 

in the year following treatment.6 This would seem to validate the premise that effective substance abuse treatment leads to reduction in suicide attempts. A 25-year 

study of 641 Vietnam veterans also found that over time, there was a strong correlation between suicidality, PTSD and substance abuse.7 Both these VA studies dealt 

predominantly with older veterans, but experts believe it would be reasonable to expect that similar studies focused on younger veteran cohorts, including OIF/OEF 

veterans, would show results consistent with these findings. 

Mr. Chairman, there are rising indications that the misuse of substances will continue to be a significant problem for OIF/OEF service members and veterans. In a 

recent study, VA New Jersey-based researchers examined substance abuse and mental health problems in returning Iraq veterans.8 These researchers noted that although increasing attention is being paid to combat stress disorders in veterans, little systemic focus has been made on substance abuse problems affecting this population. In the group studied (292 New Jersey National Guard members who had returned from Iraq within 12 months of data collection) nearly 47 percent of participants reported a mental health and/or substance abuse problem. Substance abuse 

problems were found to be higher among veterans with other mental health problems. Access to substance abuse treatment both during and after deployment was 

especially low for those needing it (among veterans with dual disorders, 41 percent 

received mental health treatment but only nine percent received treatment for substance abuse). Similarly, a study of returning Maine National Guard members found 

substance abuse problems in 24 percent of the troops surveyed.9 In the most recent 

DoD anonymous Survey of Health Related Behaviors Among Active Duty Personnel, 

23 percent of the respondents acknowledged a significant alcohol problem.10

Substance abuse—common as a secondary diagnosis among newly injured veterans and others with chronic long-term illness or injury—can often be overshadowed by more compelling acute care needs. Mental health experts agree that 

untreated substance abuse can result in a variety of negative health consequences 


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for the veteran with marked increases in healthcare expenditures, as well as social 

costs due to additional stresses on families from loss of employment and legal costs. 

In both the VA and DoD healthcare systems, current evidence-based treatment 

guidelines for substance use disorders confirm the substantial body of research supporting the effectiveness of a variety of treatments for these problems. VA must continue to educate its primary care providers about these proven techniques, including 

better detection of substance use disorders, to ensure that these problems are identified early and treated. 

We urge VA to provide a full continuum of care for mental health and substance 

use disorders including more consistent, universal periodic screening of OIF/OEF 

combat veterans in all its healthcare facilities and programs—especially in primary 

care. Outpatient mental health counseling and pharmacotherapy should be made 

available at all larger VA community-based outpatient clinics. Also, short-term outpatient counseling including motivational interventions; intensive outpatient treatment; residential care for those most severely disabled; detoxification services; ongoing aftercare and relapse prevention; self help groups; and, opiate substitution 

therapies and newer drugs to reduce craving, should be included in VA’s substance 

abuse and prevention services program. We believe further investment in a comprehensive package of substance-use services will help younger veterans during an 

often difficult readjustment period following combat deployments. Hopefully, VA can 

use preventive approaches that will help restore these veterans and to prevent 

chronic long-term mental health consequences that attend drug and alcohol addictions, and thereby also lower risks for suicide. These types of VA services could also 

be beneficial to older veterans struggling with chronic addictions. 

Mr. Chairman, war also places great stress on family and social relationships. Active duty service members currently are called on to make frequent deployments of 

long duration, in dangerous combat assignments. Time at home between these deployments is marked by intensive training in garrison and continuous preparations 

for redeployment. Active reservists and National Guard members face unanticipated 

redeployments that disrupt their families and strain their financial and employment 

security. 

We have substantial data and reports that document the strain the wars are putting on combat veterans’ mental health and their relationships with spouses and 

families. Interpersonal conflict is clearly increasing, and recent data suggest that 

the problems grow rather than diminish in the months after service members return 

home. Soldiers also reported more mental health problems and were referred at 

higher rates for mental health services. Of special concern are the high rates of alcohol use being reported by soldiers. DAV is very concerned about all these reports, 

and note that these findings do not even reflect the full impact of extended deployments, the third, fourth or even fifth deployments for some individuals, or the impact of redeployed service members who already may be actively suffering from untreated PTSD. 

We understand that VA medical centers and their community-based outpatient 

clinics do not routinely provide marital and family counseling services. VA’s Readjustment Counseling Service, through its community-based Vet Center program, is 

the only major source of marital and family counseling services in the VA healthcare 

system. Vet Centers are user-friendly and have high veteran satisfaction, but these 

vital services should be made more generally available at VA’s major medical facilities to increase access to these important services. Congress should ensure that 

marital and family counseling services are offered as a part of the healthcare benefits package, when needed in relationship to combat readjustment issues for veterans under care at VA. 

In addition to marriage and family counseling services, VA needs to improve it’s 

substance use treatment programs. Since the late 1990s, VA has seen unparalleled 

growth in veterans’ use of its healthcare system however, according to VA mental 

health staff, the number of veterans who received specialized substance abuse treatment services has declined since 1998 despite increasing demand from veterans 

with these problems. At a time when substance abuse care needs appear to be rising 

and suicide risk among OIF/OEF veterans is high and so troubling, we urge VA to 

ensure these programs are available to veterans who need them. 

These healthcare and psychosocial issues are complex. Therefore, VA’s approach 

must be comprehensive and involve long-term structural improvements in the care 

provided to these veterans. We see the need for the following actions by VA: 

• VA should immediately improve access to substance abuse treatment services, 

particularly early interventions for OIF/OEF veterans that are designed to prevent chronic conditions and more serious problems. 


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11 Noonan, ME; Mumola, CJ. U.S. Dept. of Justice, Office of Justice Programs, Bureau of Justice Statistics, ‘‘Veterans in State and Federal Prison, 2004,’’ May 2007. 

• DoD and VA must eliminate the stigma attached to service members and veterans seeking care for mental illness and substance abuse with the same urgency and sincerity that we give to ‘‘medical’’ illnesses. Otherwise, some veterans will not seek help and may fall into despair and be at risk for suicide. • VA must provide access for OIF/OEF veterans and their spouses to marital and 

family counseling, to help restore relationships that deteriorate as a consequence of military deployment and separation, and to strengthen the social 

support system these veterans need as they reintegrate into their homes and 

communities. • VA must assure that access to comprehensive age-appropriate mental health 

services is available to all OIF/OEF veterans, and develop services targeted to 

the new needs of the increasing cohort of women veterans who have been exposed to combat stress. VA must continue to enhance access to mental health, 

PTSD and readjustment counseling services for all veterans. Enhancements in 

these programs have been initiated, but we should remain vigilant to ensure 

that they are sustained and that state-of-the-art, quality healthcare services are 

delivered, irrespective of a veteran’s gender or geographic location. • VA should provide Congress its strategic plan, through its Office of Rural 

Health for OIF/OEF veterans living in rural areas far from VA facilities and 

essentially without access to any form of direct VA service in mental health and 

otherwise. We urge VA and this Committee to find acceptable ways for these 

veterans (many of whom served as called-up National Guard members) to gain 

access to the full continuum of healthcare services offered by VA, to address 

their mental health and readjustment needs, and help them restore their marital and family relationships after serving. 

Mr. Chairman, we bring to the Committee’s attention an issue that we believe is 

of great importance and directly affects veterans’ suicide risk. Earlier in this testimony, I indicated that a recent IOM report had shown that combat service was associated with veterans’ later incarcerations. Incarceration presents a life-altering 

consequence. There appears to be a link between combat and incarceration, mental 

health decline, substance abuse and elevated suicide risk for some veterans. 

The Committee may be aware of a recent front page article in the Washington 

Post concerning the pending prosecution under the Uniform Code of Military Justice 

(UCMJ) of Army Lt. Elizabeth Whiteside. As indicated in a Post editorial following 

publication of the original story, ‘‘the 25-year-old Army reservist had a stellar record 

of service but had a breakdown, possibly caused by her service in war-torn Baghdad. 

After a series of stressful incidents, she shot herself in the stomach. Despite the unequivocal judgment of psychiatrists that she suffers from significant mental illness, 

her commanders pressed criminal charges against her, and she’s now waiting to 

hear whether the Army will court-martial her.’’ We believe Lt. Whiteside’s case resonates with the rest of our testimony, and the challenges we face as a Nation in dealing with the mental health consequences of war. 

Earlier this year, the Department of Justice’s (DOJ) Bureau of Justice Statistics 

issued a report indicating that, while veterans are not disproportionately represented in Federal and State prison populations compared to nonveterans, OIF/ 

OEF veterans do constitute nearly five percent of the total population of incarcerated veterans.11 Since 2002 approximately 5,000 former military members who 

served in our ongoing wars, individuals who participated at some level in U.S. efforts to restore the freedoms of the Iraqi and Afghani peoples, have subsequently 

lost their own personal freedom after returning home. 

Depression, substance use disorders and other mental health issues are common 

in prison. Each of those imprisoned individuals’ stories deals with unique circumstances and convicted criminal behavior. In some instances, sadly, individual 

failures to readjust and to gain access to effective care and services spirals down 

into impulsiveness, emotional breakdown, loss of control, loss of employment, and 

even homelessness and criminal behavior. 

Mr. Chairman, there is another ‘‘hidden’’ veteran population, in prison and out, 

that is currently beyond reach of any VA program: these are veterans whose behavior while in service led to entanglement in the UCMJ, resulting in both imprisonment and/or so-called ‘‘bad paper’’ discharges. Veterans with less than honorable 

discharges are not defined as ‘‘veterans’’ under title 38, United States Code. Thus, 

they are ineligible for any service or benefit from VA. The DOJ report noted that 

31 percent of veterans in Federal and State prisons have dishonorable discharges 

from military service. 


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The DOJ report also indicated that more than 2,000 active duty personnel are 

currently imprisoned in military penal facilities. Once their sentences are served, 

most of them will be issued discharges under less than honorable conditions, or they 

will receive dishonorable discharges. In general these persons will not be able to 

avail themselves of federal benefits including VA’s programs for PTSD, mental 

health and other readjustment services. 

We believe these subjects should be added to the Committee’s concerns about 

mental health and suicide. At this juncture DAV offers no specific recommendations 

for legislation; however, we believe that DoD and VA share a responsibility to ensure that war-traumatized service personnel and veterans should not be 

criminalized before an effort is made to intervene with therapeutic remedies. We 

ask the Committee to investigate the circumstances of both military and civilian justice systems, and to work with your colleagues on the Committee on Armed Services, to determine whether DoD and VA are using all the tools at their disposal to 

divert military personnel and veterans in trouble to therapeutic solutions rather 

than allow them to be criminalized. 

In summary, many of our active duty service members, veterans and their families are experiencing the stressors we have noted in this testimony and are experiencing real emotional hardship in their lives. To address these challenges, DoD, VA 

and Congress need to work together—and the time to cooperate is now. For a small 

number of veterans, these stressors are having devastating consequences, including 

increased risk of suicide. Taking action now—before their problems become more 

complicated and severe, is in their best interests and in the best interest of the Nation. The resources we spend today, and the programs that Congress authorizes to 

promote better mental health, will have long term positive benefits for veterans and 

will reduce financial and social costs to the Nation. We owe them nothing less. 

Mr. Chairman, thank you for this opportunity for DAV to offer its views on these 

matters. I will be pleased to address your questions, or those from other Members 

of the Committee. 

f 

Statement of Todd Bowers, Director of Government Relations, 

Iraq and Afghanistan Veterans of America 

Mr. Chairman and members of the Committee, thank you for hearing me speak 

today. On behalf of Iraq and Afghanistan Veterans of America, I would like to thank 

you all for your unwavering commitment to our Nation’s veterans. The Committee 

originally invited our Executive Director, Paul Rieckhoff, to testify today. Unfortunately, Mr. Rieckhoff had a prior engagement that he could not reschedule and so 

he asked me to be here today on his behalf. I will do my best to fill his boots this 

morning. 

I would like to begin by thanking the Committee for the outstanding leadership 

you provided to ensure that legislation combating suicide among veterans made its 

way into law. Specifically, I would like to thank you for your efforts to pass the 

Joshua Omvig Suicide Prevention Act. IAVA wholeheartedly endorsed this groundbreaking legislation and we are excited about the positive impact it will have on all 

veterans. 

I was very excited to hear about the nomination of General Peake to be the new 

secretary of the Veterans Administration. General Peake is a combat veteran who 

holds dear the Army’s ‘‘Warrior Ethos.’’ The Warrior Ethos states that ‘‘I will always 

place the mission first, I will never accept defeat, I will never quit, I will never leave 

a fallen comrade.’’ I believe we can apply the lessons of combat, and the Warrior 

ethos, to improving suicide prevention at the VA. 

On my second combat tour in Fallujah, Iraq, I was on a patrol with my team of 

six Marines. As we moved through the city we made our way to Jolan Park, located 

in the northwestern portion of the city, to link up with our battalion’s Executive Officer. Once we arrived at the park we found ourselves alone. There were no other 

Marines in sight. As we surveyed the area, I noticed a group of Marines four blocks 

away waving their arms and jumping up and down. By the time I was able to figure 

out that they were telling us we were in danger, it was too late. I turned to inform 

my Captain and, just as I opened my mouth, the building next to us exploded. The 

blast was so strong that it threw me backward. Once the dust settled and the ringing in our ears subsided, the Marines who were waving at us from down the street 

made their way over to our vehicle. ‘‘What the hell is wrong with you guys!?’’ a 

Major screamed at us. Apparently they were utilizing a controlled blast to destroy 

a massive weapons cache used by the insurgents and had called in the grid coordinates over the radio to warn all Marines to stay clear of the area. We did not get 

the communication. Our radio had lost its encryption. 


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The failure to communicate that day in Fallujah nearly killed me and six of my 

fellow Marines. 

I believe communication is also key to success in suicide prevention. 

The Army’s Field Manual 6–22.5, ‘‘A Leader’s Guide to Combat and Operational 

Stress,’’ states that ensuring ‘‘communication lines are open’’ is one of the most ‘‘potent countermeasures to confront combat stress and to reduce psychological breakdown. . . .’’ 

Recently, the VA had made great strides to improve communications lines by creating a Nation-wide Suicide Prevention hotline. This hotline is available to veterans 

and their families 24 hours a day, seven days a week. This new program has had 

amazing results. The VA has highlighted many stories of veterans who have used 

the hotline to get the help they need. But after talking to many IAVA’s members, 

including those in the National Guard and Reserves, we have found that they do 

not know that this service is available. Better outreach is the only way to ensure 

that these new programs are available to all who need them. 

But outreach is a difficult task if you do not know where your targets are. A national registry of veterans would solve this gap in communication. 

The Gulf War Registry was established to inform veterans of changes in policy 

regarding issues specific to the war in the Gulf such as exposure to burning oil wells 

and Gulf War syndrome. Although this registry is newly available to Iraq veterans, 

its potential is still limited. Right now, the registry is not open to Afghanistan veterans, and is only made available to those who are in the VA system. Only about 

one-third of Iraq and Afghanistan veterans eligible for VA care have sought care, 

so the vast majority of veterans are not eligible for inclusion. 

We at IAVA believe that all veterans should be included in a registry upon discharge from the military. Currently the tracking system for veterans is almost nonexistent. Registering veterans, along with their deployments to specific conflicts, 

would help the VA reach out to veterans and family members who will benefit from 

their outstanding initiatives and programs, including the suicide hotline. 

Much of the work of suicide prevention, however, must occur much earlier in the 

process. IAVA has strongly endorsed the mandatory pre- and post-deployment mental health screening of our service members by mental health professionals. This 

will produce a more accurate assessment of the impact that combat has on a service 

member’s mental health. Making screening mandatory will reduce the stigma related to seeking mental health treatment. I would compare this to the mandatory 

drug testing that the Department of Defense conducts for all service members. If 

all are required to take part, then it becomes a part of daily routine and no longer 

singles individuals out. 

In addition to universal screening, a coherent national anti-stigma campaign will 

help ease the barriers keeping troops from early treatment. I am very pleased to 

announce that IAVA has partnered with the Ad Council for the next three years 

to implement a ‘‘Stigma Reducing’’ national ad campaign. This campaign will be in 

print, on television and radio and online, and will convey to the American public 

and our Nation’s veterans that treating mental health injuries is a routine step in 

reintegration. 

I’d like to close with another personal story of a family in Northern Virginia who 

have experienced first-hand the effects of suicide among the veterans’ community. 

They have become my friends and are almost like family to me. A few years ago, 

the father of the family, who served in the Army, took his own life. He left behind 

three children. Years later, his family still carries the tremendous emotional burden 

of unanswered and unanswerable questions. What more could have been done to 

save him? 

I ask you, today, to consider that question. What could have been done? Would 

a hotline have been enough? A flier in the mail about the signs of suicide? A call 

from his local Vet Center? 

My friend’s family will never know the answer. If we act now, we can implement 

measures that will be a crucial step in reducing suicide amongst veterans. 

On the battlefield, casualties are often unavoidable. What is avoidable is suicide. 

If we take the proper steps to combat suicide among the veterans community, we 

can and will win this battle. Thank you. 

f 

Statement of National Coalition for Homeless Veterans 

Mr. Chairman and Members of the Committee: 

We are assembled here to talk about the mental healthcare available to, and the 

reported increase in suicide among, this Nation’s veterans—and specifically, how the 

Department of Veterans Affairs (VA) is addressing these critical concerns. 


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1 National Institute of Mental Health, Washington, D.C. 

2 National Strategy for Suicide Prevention (NSSP), Office of the Surgeon General, 2001. 

The National Coalition for Homeless Veterans (NCHV) is honored to participate 

in this hearing for several reasons. NCHV, perhaps more than any other organization, recognizes the tremendous contributions this Committee has made in serving 

America’s former guardians in their greatest hour of need. We know that what our 

member organizations have accomplished on behalf of veterans in crisis—men and 

women who have lost everything but life itself—would not have been possible without this Committee’s guidance, support and courage to act. 

Most importantly, NCHV is proud to stand with you during what we believe is 

a defining moment in the history of this great Nation. 

Never before has the U.S. Congress, and the people it represents, been better prepared to address the future needs of America’s armed forces during a time of war. 

This Committee knows all too well that the cost of our freedom and prosperity necessarily includes tending to the wounds of the veterans who sacrifice some measure 

of their lives to preserve it. We understand the Committee’s purpose is to serve all 

veterans, but this dialogue most certainly embraces the men and women who have 

served in Iraq and Afghanistan, and all who will follow them. 

The Nation’s foremost authorities on mental health—the National Institute of 

Mental Health, National Alliance on Mental Illness and Mental Health America 

(formerly the Mental Health Association), agree that the warning signs of increased 

risk of suicide include histories of mental illness, extreme mood swings, changes in 

personality, withdrawal from family members and friends, feelings of hopelessness, 

and depression. Depending on the severity of a person’s health and economic hardships, self medication on alcohol or drugs increases the likelihood of suicide by 30 

to 70 percent.1

These behaviors, mental health issues, and emotional torments characterize the 

great majority of the clients NCHV organizations serve. Approximately 76% of the 

veterans we treat have histories of substance abuse and diagnosed mental health 

challenges; more than 90% of both male and female clients are unemployed. All of 

them are homeless. More than half of the calls we receive on our toll-free help line 

(1–800–VET–HELP) are from veterans who are sick, scared, socially isolated, or economically disadvantaged—or from family members asking how they can help their 

loved ones. 

Suicide, a tragic and irreversible act, can most simply be defined as the absolute 

absence of hope. 

The act of willfully ending one’s life is most often the result of prolonged and 

deepening mental and emotional stresses, the erosion of social supports such as 

friends and family ties, and the loss of intimate relationships.2 Veterans—particularly combat veterans—are called upon to endure all of these as necessary occupational hazards. 

War is arguably the most dehumanizing experience a person will ever encounter. 

Every action tears at the tenets of civilized society; and those who serve in a combat 

unit must disregard the most basic instinct of all—self preservation. But the intensity of military training, separation from one’s social supports, and the inescapable 

anxiety of knowing what their training is preparing them for can potentially be just 

as burdensome to those who serve, whether or not they ever engage in combat operations. 

The prospect of multiple deployments, their effect on personal finances, and repeated separation from one’s family now gripping half of the Reservists and National Guard troops serving in the War on Terror can only magnify the impact of 

these pressures. 

The overwhelming majority of America’s veterans who have answered the call to 

serve in the military return home to become successful business executives, community leaders, captains of industry, public servants, and even presidents. 

However, unlike other veteran policy advocates, NCHV is singularly concerned 

about those who do not—our sole purpose is to support the men and women who 

proudly serve but then find themselves unable to effectively cope with the challenges life throws at them without regard to social standing, economic status, ethnic 

heritage or personal conviction. 

Every day, at more than 280 service organizations across the country, we provide 

services to those who would have no hope were it not for the support of Congress, 

the federal agencies charged with helping our most disadvantaged citizens, and the 

multitude of community and faith-based organizations that transform policy into 

life-saving interventions and life-sustaining programs. 


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3 VA CHALENG Reports 2003–2006. 

4 Implementing VHA’s Mental Health Strategic Plan Initiatives for Suicide Prevention, Office 

of the Inspector General, Department of Veterans Affairs, May 10, 2007. 5 ibid. 

VA Mental Health Care 

NCHV is, therefore, well qualified to comment on the availability of mental health 

services through the Department of Veterans Affairs. The partnership between service providers that help veterans in crisis and the VA is vital to our mission to increase the capacity of service providers and to promote effective and cost-efficient 

collaboration in local integrated service networks. This partnership has been credited with decreasing the number of homeless veterans on the streets of America 

each night by more than 20% in the last five years.3

Virtually every community-based organization that provides assistance to veterans in crisis depends on the VA for access to comprehensive health services, and 

without exception their clients receive mental health screenings, counseling and necessary treatment as a matter of course. These services are well documented, and 

case managers report this information to the VA as prescribed in their grant reports. Follow-up services—counseling, substance abuse treatments, outpatient 

therapies, medication histories and family support initiatives—are also monitored 

closely and reported in client case files. 

Despite significant challenges and budgetary strains, the VA has quadrupled the 

capacity of community-based service providers to serve veterans in crisis since 2002, 

a noteworthy and commendable expansion that includes, at its very core, access to 

mental health services and suicide prevention. 

The development of the VA Mental Health Strategic Plan from 2003 through November 2004, and its implementation over the last three years with additional funding this Committee fought for, has increased the number of clinical psychologists 

and other mental health professionals within the VA healthcare system by nearly 

1,000 positions. The additional clinical staff have been noted at VA medical centers, 

community-based outpatient clinics (CBOCs) and VA Readjustment Counseling Centers (Vet Centers).4

Media attention to the fact that the VA did not expend the full amount of funding 

authorized to achieve the Mental Health Strategic Plan’s goals in 2006 did not fairly 

report that program expansion of this magnitude takes time to implement, with respect to both logistical and personnel matters. 

Veterans now have access to initial healthcare assessments and referrals to VA 

services through a network that includes 153 medical centers, nearly 900 VA community health clinics, 207 VA Readjustment Counseling Centers, and about 280 

community and faith-based veteran assistance programs nationwide—a network 

that did not exist at the close of the Vietnam War. Many of these points of access 

to mental health services have opened within just the last 10 to 15 years. From information in our database, we estimate there are more than 3,000 other organizations—both private and government agencies—that provide various services to veterans in need. 

The development of an interagency Suicide Prevention Hotline in May 2007, a collaboration between the Departments of Health and Human Services and Veterans 

Affairs and staffed by trained counselors on a 24/7 basis, is a valuable resource for 

both veterans in crisis and family members who are often the ones who call for help. 

The ongoing development of peer counseling initiatives at many VA facilities is 

a replication of successful interventions that have been utilized at many community 

organizations for decades. Plans to provide training for VA and community-based organization staffs on effective mental health support procedures and suicide prevention beginning in early 2008 are another testament to the agency’s commitment to 

ensure effective early mental health assessment and intervention strategies for veterans of Operation Iraqi Freedom and Enduring Freedom (OIF/OEF). 

VA officials publicly admit there is still considerable work to do.5 And no one who 

is professionally invested in this work would refute that point. NCHV has been a 

vocal advocate for enhanced VA mental health services for homeless, low-income 

and recent combat veterans since 2001. But a random survey of directors of several 

of our larger member organizations in preparation for this hearing produced three 

significant, and unanimous, conclusions: 

1. The incidence of suicide among veterans in a community-based program in 

partnership with the VA is ‘‘extremely rare,’’ even though these clients on admission are often regarded as among the highest risk segment of the population. 


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6 National Strategy for Suicide Prevention (NSSP), 2001. 

2. Because these programs immediately address a wide range of needs, and clients are more likely to receive proper mental health treatment, case management and follow-up, the sense of hopelessness and low self esteem often associated with suicide quickly subsides. 

3. Were it not for VA’s partnership with community and faith-based organizations—and specifically the availability of VA mental health services for their 

clients—the incidence of suicide among veterans would likely be much higher. 

Recommendations: 

1. Ensure full implementation of the VA Mental Health Strategic Plan—Specific 

recommendations of the Office of the Inspector General include: 

• 24-hour crisis and mental healthcare availability at all VHA facilities, either 

in person or through a manned suicide/crisis hotline. 

• 24/7 availability of on-call mental health specialists for crisis intervention 

staff. 

• Systemwide co-location of mental health services at primary care facilities to 

reduce the stigma associated with seeking mental health supports and to enhance service delivery. 

• Improve information sharing between the VA and Department of Defense for 

all personnel entering the VA healthcare system or leaving it to return to 

active duty. 

• Ensure adequate funding for VA mental health professionals to provide 

training to VA and community-based organization staffs on proper mental 

health supports and suicide prevention strategies. This training is critical for 

all persons associated with at-risk veteran populations—clerical staff, intake 

counselors, case managers, peer counselors, and clinical staff. 

2. Continue this Committee’s leadership role in support of, and authorize funding 

to the maximum extent possible for, the VA Grant and Per Diem Program. 

These community-based therapeutic programs, in partnership with the VA, 

provide a wide range of services that greatly reduce the risk of suicide among 

veterans with extreme mental, social and economic challenges. Most community-based organizations provide follow-up counseling long after clients successfully complete their recovery programs. This is widely viewed as a critical component of an effective suicide prevention strategy.6

3. Simplify and expand access to community mental health clinics for OIF/OEF 

veterans in communities not well served by VA facilities. While current practice allows a veteran to apply for a VA ‘‘Fee Basis’’ card to access services at 

non-VA facilities, the process is often frustrating and problematic, particularly 

for a veteran in crisis. Protocols should be developed to allow VA and community clinics to process a veteran’s request for assistance directly and immediately without requiring the patient to first go to a VA medical facility. 

4. Extend the period of eligibility for VA medical services for Reservists and National Guard troops who serve in Operations Iraqi Freedom and Enduring 

Freedom (OIF/OEF) from two years to a minimum of five years. Research indicates, and VA Grant and Per Diem client case files over the last 18 years 

prove, that many emotional and mental health challenges emerge or worsen 

over time. This extension would also allow for more precise diagnoses and more 

effective treatment regimens for combat veterans. 

5. Establish an interactive, 24/7, information and service referral website for military members, veterans and their families; and ensure that new recruits, Reservists and National Guard troops are advised of the site as part of their induction into active duty. This would virtually eliminate the problem of not 

knowing where to ask for help regardless of when a service member or veteran 

becomes aware that he or she may need assistance. 

Conclusion 

By any accounting, the work of the House Veterans Affairs Committee on behalf 

of this Nation’s most vulnerable former service men and women over the last two 

decades has inspired the development and expansion of a service provider network 

that performs miracles every day. Most of the accomplishments reflected in this report have occurred in just the last five to six years. 

Rekindling hope in those who have no hope is the surest safeguard against suicide. NCHV staff and program directors can personally attest to this Committee’s 

role in helping transform hopelessness into the will to live and prosper for hundreds 


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of thousands of our fellow combat veterans. We believe the same can be said of the 

Department of Veterans Affairs. 

On behalf of the veterans we all serve, we implore you to claim this moment in 

American history and make it part of your commendable legacy. No veteran should 

have to lose everything he or she has before we, as a nation, offer them a helping 

hand. Your leadership can make sure that doesn’t happen to the men and women 

who serve in Iraq and Afghanistan. 

f 

Statement of Richard F. Weidman, 

Executive Director for Policy and Government Affairs 

Vietnam Veterans of America 

Chairman Filner, Ranking Member Buyer, and other distinguished members of 

this committee, Vietnam Veterans of America (VVA) thanks you for the opportunity 

to present our views on suicide and PTSD among our Nation’s military personnel 

and veterans. We also want to thank you for your consistent concern about the mental health care of our troops and our veterans. I should note that Dr. Thomas 

Berger, Chair of VVA’s National PTSD & Substance Abuse Committee made substantial contributions to this statement, as did Ms. Marsha Four, Chair of VVA’s 

National Committee on Women Veterans. 

The subject of suicide is extremely difficult to discuss. It is a topic that most of 

us would prefer to avoid. Accurate statistics on deaths by suicide are not readily 

available because many are not reported or are misreported for insurance reasons 

as well as the desire of local officials to avoid the ‘‘stigma’’ of suicide in a family. 

Many of us, as veterans of the Vietnam War and as comrades and caregivers to our 

brother and sister veterans, have known someone who has committed suicide and 

others who have attempted to take their life. Unfortunately I have personally 

known many Vietnam veterans who were overtaken by despair induced by their 

deep and intractable neuron-psychiatric wounds from the war. 

But as uncomfortable as this subject may be to discuss, it must be confronted. It 

is a very real public health concern in our military and veteran communities. A 12- 

year study published in the June 2007 issue of the journal Epidemiology and Health 

clearly demonstrates that the risk of suicide among male U.S. veterans is more than 

two times greater than that of the general population after adjusting for a host of 

potentially compounding factors, including age, time of service, and health status. 

A report released this past May by the VA Inspector General noted that ‘‘veterans 

returning from Iraq and Afghanistan are at increased risk for suicide because not 

all VA clinics have 24-hour mental care available . . . and many lack properly 

trained workers.’’ 

Media reports of suicide deaths and suicide attempts among active duty OEF and 

OIF soldiers and veterans began to surface back in 2003 after a spate of suicides 

in Iraq during the first months of the war. Since then, both the military and the 

VA have stumbled and fumbled in their attempts to answer questions about the severity of this malady. For example, while all the military services maintain suicide 

prevention programs, the Army in its August 2007 Army Suicide Event Report acknowledged that soldiers committed suicide last year at the highest rate in 26 years, 

and more than a quarter did so while serving in Iraq and Afghanistan. The report 

noted ‘‘a significant relationship between suicide attempts and number of days deployed in Iraq, Afghanistan or nearby countries where troops are participating in 

the war effort.’’ The report added that there also ‘‘was limited evidence to support 

the view that multiple deployments are a risk factor for suicide behaviors.’’ It might 

be noted here that this report which was released only after a FOIA request. 

VVA believes that these deaths are among the most extreme failures by the U.S. 

military to properly screen, treat, and evacuate mentally unfit troops. Even a report 

by the Army released this past October suggests that the quality of care, as much 

as the number of providers, is a factor in the rising incidence of suicide among active-duty service members. This report notes that more than half the 948 soldiers 

who attempted suicide in 2006 had been seen by mental health providers before their attempt—36 percent within just 30 days of the event. Of those who committed suicide in 2006, a third had an outpatient mental health visit within three 

months of killing themselves, and 42 percent had been seen at a military medical 

facility within three months. Among soldiers who were deployed to Iraq or Afghanistan when they attempted suicide in 2005 and 2006, 60 percent had been seen 

by outpatient mental health workers before the attempts. Forty-three percent 

of the deployed troops who attempted suicide had been prescribed psychotropic 

medications. 


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The report offered no details on the type or duration of mental health care that 

troops received before they tried to kill themselves. A June 2007 Pentagon task force 

on mental health report, however, specifically notes the issue of quality of care, recommending that the military develop core training for all medical staff in recognizing and responding to service members ‘‘in distress.’’ This task force also concluded that mental health providers needed additional training in treating depression and combat stress. 

To its discredit, the Department of Defense has managed to keep what has clearly 

become what CBS News called a ‘‘hidden epidemic’’ under the radar of public awareness by concealing statistics about soldier suicides. They have done everything from 

burying suicides on official casualty lists as ‘‘accidental non-combat deaths’’ to outright lying to the parents of dead soldiers. Meanwhile the Army officially insists 

that they have yet to find a connection between PTSD, between the stresses of combat and the type of combat waged in Iraq and suicide. 

It may be true that, as Will Rogers once said, there are lies, there are damn lies, 

and there are statistics. But even the statistics the Pentagon admits to are telling. 

Unfortunately what is told is a grim story indeed, one of willful ignorance and recalcitrance to the point of malfeasance on the part of senior officials who do not move 

to correct these problems in both access to mental health care and quality of care 

when access is gained. 

Much of the problem that the VA will in fact be inheriting is caused by the failure 

of the Army Medical Department and the Navy Medical Department to properly address neuron-psychiatric wounds of war. More than four years into this war, one 

may well ask ‘‘how can this be?’’ 

Part of the problem with the military is lack of organizational capacity caused by 

the questionable decision to downsize the military medical departments as we were 

going to war. The former Secretary who had overall responsibility is now gone, and 

the Assistant Secretary for Health brought in because his entire experience was cutting costs by reducing services for HMOs and insurance companies, and who actually did the dirty work is also gone. However, the real architect of this outrageous 

and irresponsible policy that has cost soldiers their lives and/or their health continues on in his job as Under Secretary of Defense. VVA was asked if we hold LTG 

James Peake accountable for creating the situation of too many grievously injured 

soldiers needs chasing too few clinicians and case managers, and we said no, because we do not know how hard he fought on the inside. VVA continued in its communication with the White House that we do question why David Chu still has a 

job, after all of his public utterances of disdain for injured soldiers, survivors of KIA, 

and more importantly the total failure of his policies. 

While VVA now understands that as of early this calendar year the Army was 

given 3,000 additional persons/slots in the Army Medical Department, it takes a 

long time to ‘‘ramp up’’ and we wonder how successful this all will be as long as 

David Chu is driving this train, aided by his top consultants at the unit of Rand 

Corporation led by Bernard Rostker, who has already done so much damage to Gulf 

War I veterans. 

There is a solution. It requires data collection, training, leadership and a cultural 

mind shift from the military, as well as the network of consultants and hangers on 

that surround the civilian officials who are at the head of DOD. Military leaders 

at all levels, beginning with basic trainees, should be taught what their roles and 

responsibilities are when warriors come home. This training should be as structured 

and well thought out as fielding a new weapons system. This includes Field manuals, training circulars, incorporation of training into Common Test Training (CTT) 

and Mission Essential Task Listings (METL). 

If we change the culture in the military to deal openly and honestly about the 

rigors of war when service members come home, then we can begin to mitigate the 

suicide issue. We don’t have a lot of time. The longer we delay the worse the problem gets, and it becomes more devastating to the all-volunteer military. 

We’ve got the training for war part down cold. The missing component is training 

to come home. If we do it right, retention and recruiting will be high. Soldiers and 

families will grow and become stronger from their experiences. 

However, if we don’t put as much emphasis on coming home as we do in going 

to war the implications will be felt for the next 20 to 40 years. We can’t continue 

to try and force the warriors to figure this out on their own, with no help from the 

command structure and a ‘‘grateful Nation.’’ They have no reference point at which 

to begin recovery and become strong. 

When we begin teaching them how to come home it will become as ingrained as 

field stripping an M4. It will become reflexive instead of reactive; it will become 

proactive instead of passive. It will be something that a war fighter has to do as 

a natural part of going into and returning from battle. This will truly begin to reVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00108 Fmt 6604 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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move the stigma in the military that has led to situations like that experienced by 

Lt. Elizabeth Whiteside, where the Army is still contemplating whether to court 

martial her for attempting suicide after 10 months in Iraq treating grievously injured soldiers, and rendering exemplary service, when it all came crashing in on 

her. Her command structure in Iraq created a hostile work environment as opposed 

to trying to be supportive, and getting her counseling help. Compounding this is the 

Command here in the Military District of Washington who even as we speak today 

is still contemplating whether to be vindictive and try to punish this fine young soldier by means of a court martial, possible jail time, and stripping her of all Army 

and VA benefits, instead of helping her to receive proper treatment. This case exposes just how far we have to go to change the military culture in order to stop the 

punishing of war fighters for experiencing psychiatric wounds. 

Words alone won’t fix this problem. There is lots of hard work ahead. VVA asks 

that this distinguished panel partner with the Committee on Armed Services and 

others in the House to please convince someone in the Pentagon to start listening. 

The Service Chiefs need to launch a Nationwide Anti-Stigma Campaign, for start- ers. Active-duty soldiers, however, are only part of the story. One of the well-known 

characteristics of PTSD is that the onset of symptoms is often delayed, sometimes 

for decades. Vietnam veterans are still taking their own lives because new PTSD 

symptoms have been triggered, or old ones retriggered, by stories and images from 

these new wars. Their deaths, like the deaths of more recent veterans, are written 

up in hometown newspapers; they are locally mourned, but officially ignored because the VA does not track or count them unless they are part of the VA registry. Both the VA and the Pentagon deny that the problem exists and sanctimoniously point to a lack of evidence they have refused to gather. 

In yet another example of dancing around the issue, the VA announced last spring 

that it was setting up a ‘‘suicide prevention hotline’’ for veterans. This program is 

headquartered in Canandaigua, New York, in cooperation with the National Suicide 

Prevention Resource Center and the Substance Abuse and Mental Health Services 

Administration. As part of its anti-suicide effort, the VA announced that it was 

going to hire ‘‘suicide counselors’’ at each of its 153 medical centers. According to 

VA hotline administrators, as of late November 2007, 92 percent of the now-titled 

suicide coordinator positions had been filled and the national hotline center had 

handled more than 15,000 calls between July 1 and November 17—while also admitting that the tracking of calls is voluntary. The VA noted that 4,900 callers selfidentified as veterans, 164 as active-duty military; and that 600 calls came from 

concerned family and friends. Some 1,600 referrals were made to VA facilities, 100 

referrals to Vet Centers. 

At first glance, the call data are impressive and the VA is to be congratulated 

in this endeavor. Yet real questions remain: How many suicides have been prevented through this intervention, particularly in light of the fact that the hotline 

call tracking is voluntary? And is suicide prevention intervention and care available 

24/7 across the VA system, including both community outpatient clinics and medical 

centers? 

Finally, much has been made of the recent CBS News investigative report on suicides of veterans, especially of the data collection and analyses. VVA’s concern is 

not that the reported figures are too high or too low. VVA’s position on suicide, however, is clear: one soldier/veteran suicide is one too many, and there have been far 

too many. Let’s not quibble about how accurate the numbers are; rather, let’s focus 

on the issues of why veterans take their lives and what we, collectively, can do to 

get more veterans into the counseling that might save their lives. 

Congress recently passed, and the President signed, the ‘‘Joshua Omvig Veterans 

Suicide Prevention Act,’’ which mandates better suicide prevention training for VA 

staff, a referral system to make sure that vets at risk receive care, and the opening 

of a 24-hour veterans’ suicide hotline. While VVA lauds this bi-partisan effort, we 

implore you to revisit the situation with regularity, and ask hard questions that 

must be answered. With the exception of the creation of the suicide hotline, how 

are the other mandates being translated into suicide prevention programs, services, 

and training? What agency or entity is accountable for them? And can DOD and 

the VA be directed to provide truthful, accurate suicide statistics? 

The faceless IED-fueled sniping that is killing and maiming scores of our troops, 

is part of the root cause of the severe psychological wounds that grips too many of 

our troops and veterans. Further, far from being nothing like the Vietnam war as 

alleged by some officials who were too busy with other pursuits to join the rest of 

us who went to Southeast Asia, the Iraq war is, as one of our longtime members 

who served as an infantry platoon leader with the 199th Brigade ‘‘Red Catchers’’ 

in Vietnam: ‘‘Iraq is Vietnam without water.’’ You cannot tell who the enemy is in 


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most instances without an electric scoreboard, and then only after a particular action is finished. This uncertainty and constant pervasive danger causes deep and 

often chronic stress and often leads to Post Traumatic Stress Disorder later on. It 

is up to all of us, with your leadership, to do the very best that we can to mitigate 

the horrors of combat by providing enough help and guidance to the men and 

women who need it most. It is our obligation to continue to search for answers, and 

not utter the empty claims that combat has little or nothing to do with the suicides 

of troops who have experienced it. 

The Nation now clearly understands the gaps in care as outlined by multiple military commissions. The service chiefs have ensured that our service members were 

taught how to go to war and with the right equipment. What remains missing and 

what we are identifying as a fundamental gap in suicide prevention and all reintegration training is teaching the force the fundamental skills of ‘‘how to come 

home.’’ 

To truly address suicides we must change the way our Nation and the Military 

respond to the trauma of war and the complexities of deployment. Moreover, we 

need to evaluate the way we define and understand stress and trauma large scale. 

No veteran should ever feel so left behind that suicide feels like a viable option. 

We owe them so much more than rhetoric. Let’s start by training them to come 

home. Then they will be resourced to seek out existing service and programs and 

the stigma of seeking help will be minimized. 

The Army’s Creed, the Warrior Ethos, and even VVA’s motto of ‘‘Never again shall 

one generation of American veterans abandon another generation’’—are meaningless 

without the doing. And the doing requires that we live by and die by our beliefs 

and the only thing we hold on to is the knowledge that our country will be there 

for us if we need them. 

The Warrior Ethos: written in Soldiers Magazine, July 2006, by Peter J. 

Schoomaker talks about the common thread that has tied us all together throughout 

230 years of service to our Nation. Since 1775, American Soldiers have answered 

the call to duty. From Valley Forge to the battlefields of Gettysburg; from the Argonne Forest to the shores of Normandy; from the rice paddies of Korea and Vietnam to the mountains of Afghanistan and the streets of Baghdad; our military history is rich with the willingness of generation after generation to live by the Warrior 

Ethos. Service members will continue to live by these creeds, the question is does 

the creed extend to them when they come home, after the war. 

We thank you for the opportunity to speak to this issue on behalf of America’s 

veterans, and we will work with you to find answers that our mentally wounded 

warriors desperately need. I would be pleased to answer any questions you may 

have. 


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MATERIAL SUBMITTED FOR THE RECORD 

Department of Veterans Affairs 

Under Secretary for Health 

Washington, DC. 

In Reply Refer To: 

Dear Veteran, 

If you’re experiencing an emotional crisis and need to talk with a trained VA professional, the National Suicide Prevention toll-free hotline number, 1–800– 

273–TALK (8255), is now available 24 hours a day, seven days a week. You will 

be immediately connected with a qualified and caring provider who can help. 

Here are some suicide warning signs: 

1. Threatening to hurt or kill yourself. 

2. Looking for ways to kill yourself. 

3. Seeking access to pills, weapons or other self destructive behavior. 

4. Talking about death, dying or suicide. 

The presence of these signs requires immediate attention. If you or a veteran you 

care about has been showing any of these signs, do not hesitate to call and ask for 

help! 

Additional warning signs may include: 

1. Hopelessness. 

2. Rage, anger, seeking revenge. 

3. Acting reckless or engaging in risky activities, seemingly without thinking. 

4. Increasing alcohol or drug abuse. 

5. Feeling trapped—like there’s no way out. 

6. Withdrawing from friends and family. 

7. Anxiety, agitation, inability to sleep—or, excessive sleepiness. 

8. Dramatic mood swings. 

9. Feeling there is no reason for living, no sense of purpose in life. 

Please call the toll-free hotline number, 1–800–273–TALK (8255) if you experience any of these warning signs. We’ll get you the help and assistance you need 

right away! 

Sincerely yours, Michael J. Kussman, M.D., M.S., MACP 

VA Suicide Crisis Hotline (1–800–273–TALK) 

Who Should Call? 

• Anyone, but especially those who feel sad, hopeless, or suicidal. 

• Family and friends who are concerned about a loved one who may be having 

these feelings. 

• Anyone interested in suicide prevention, treatment and service. 

1–800–273–TALK 

• The service is free and confidential. 

• The hotline is staffed by trained counselors. 

• We are available 24 hours a day, 7 days a week. 

• We have information about support services that can help you. 

Crisis Response Plan 

When thinking about suicide, I agree to do the following: 

Step 1: Try to identify my thoughts and specifically what’s upsetting me. 

Step 2: Write out and review more reasonable responses to my suicidal thoughts. 

Step 3: Do things that help me feel better for about 30 min (e.g., taking a bath, 

listening to music, going for a walk). 

Step 4: If your suicidal thoughts persist, call 1–800–273–TALK 

Step 5: If the thoughts continue, get specific, and I find myself preparing to do 

something, call 911. 

Step 6: If I’m still feeling suicidal and don’t feel like I can control my behavior, 

I go to the emergency room. 

REMEMBER: The VA Suicide Hot Line is 1–800–273–TALK. 

Get Mental Health Follow-up 1–202–745–8267 for an APPOINTMENT. 

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POST-HEARING QUESTIONS AND RESPONSES FOR THE RECORD 

Committee on Veterans’ Affairs 

Washington, DC. 

December 14, 2007 

Honorable Gordon H. Mansfield 

Acting Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Mr. Secretary: 

In reference to our Full Committee hearing on ‘‘Stopping Suicides: Mental Health 

Challenges Within the Department of Veterans Affairs’’ on December 12, 2007, I 

would appreciate it if you could answer the enclosed hearing questions by the close 

of business on January 28, 2008. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full committee and subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively and singlespaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your response to Debbie Smith 

by fax at 202–225–2034. If you have any questions, please call 202–225–9756. 

Sincerely, 

BOB FILNER 

Chairman 

Questions for the Record 

The Honorable Bob Filner, Chairman 

House Veterans’ Affairs Committee 

December 12, 2007 

Stopping Suicides: Mental Health Challenges 

Within the Department of Veterans Affairs 

For Ira Katz, M.D., Ph.D. 

Question 1: The Walter Reed Institute of Research recently published a study 

assessing mental health problems among veterans returning from Iraq, which found 

that 42.4 percent of National Guard and Reserve-component soldiers screened by 

the Department of Defense required mental health treatment. Given the very real 

risk of chronic health problems and even suicide among this population, we cannot 

afford a business-as-usual approach. What has VA done to provide needed mental 

health treatment to these servicemembers? 

Response: The Department of Veterans Affairs (VA) has expanded its mental 

health programs dramatically since the start of the current conflicts. Mental health 

expenditures in medical centers and clinics increased from approximately $2 billion 

in fiscal year (FY) 2001 to over $3 billion in FY 2007. The Veterans Health Administration (VHA) developed its Comprehensive Mental Health Strategic Plan in 2004, 

and, by the end of FY 2008, it will have spent over $1 billion in its implementation, 

including hiring over 3,600 new staff to support specific programs. VA has established over 90 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) 

teams to establish post-deployment clinics in medical centers and to provide outreach and education in the community. 

In addition to the OEF/OIF teams, new initiatives have included improvements 

in access and capacity for mental health services throughout our system, integration 

of mental health services with primary care in over 100 facilities, transformation 

of specialty mental health services to focus on rehabilitation and recovery, implementation of evidence-based practices focused on specific psychotherapies, and establishment of a comprehensive national program for suicide prevention. 

In addition, VA has hired 100 peer staff for its Readjustment Counseling Service 

(Vet Centers) to provide outreach to returning veterans, and is in the process of expanding their staff and increasing the number of Vet Centers from 209 to 232. 

For returning veterans, VA provides outreach by sending staff to all post deployment health reassessments (PDHRA) and by providing education in Guard, Reserve, 


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and community settings. We aggressively encourage enrollment through the fiveyear post discharge period of enhanced enrollment opportunity for all returning veterans who served in the theater of operations whether or not these veterans require 

medical services at the time. Once veterans are enrolled, we provide screening for 

post traumatic stress disorder (PTSD), depression, problem drinking, and traumatic 

brain injury (TBI), and clinical evaluations of those who screen positive to support 

diagnosis and treatment planning. 

Question 2: What additional authority do you need from us to assist you in addressing the mental health issues of today? 

Response: VA strongly supported an extension to the post two-year enhanced enrollment opportunity for returning veterans who have service in the theater of operations. We are most pleased that the recently passed National Defense Authorization Act of Fiscal Year 2008 provided this by extending the enrollment timeframe 

to five years post discharge. 

Public information campaigns can serve a number of goals including increasing 

awareness of the symptoms of warning signs of mental health problems, 

destigmatizing mental health concerns and help-seeking, and providing information 

about the availability and effectiveness of mental health services in VA medical centers, clinics, and Vet Centers. The tools available to VA in public information campaigns include press releases, public service announcements, and outreach through 

community events. These effective mechanisms can all be continued, and, in fact, 

extended within existing statutory authority. 

Question 3: What is VA currently doing and what more could they be doing to 

reach out to veterans who are at risk for suicide and are not currently being seen 

within the VA healthcare system? 

Response: VA provides outreach to returning veterans through participation in 

PDHRA events, through activities of 100 OEF/OIF peer support specialists hired by 

Vet Centers, and through community-based outreach activities of staff from both 

Vet Centers and medical centers or clinics. One important type of outreach is 

through publicity for the 1–800–273–TALK hotline. Through this program, a number of veterans have been referred to local facilities where suicide prevention coordinators have helped them enroll in VHA. Another type of outreach is ‘‘guide’’ training 

from suicide prevention coordinators in medical centers. Through this program, the 

coordinators educate members of the community who have contact with veterans 

about symptoms of mental health conditions, warning signs and risk factors for suicide, and procedures for guiding veterans toward care. 

An important additional activity that is currently under development is collaboration with the Department of Defense (DoD) on follow-up for those who screen positive on post deployment health assessments (PDHA) or PDHRA assessments. There 

is, by now, good evidence that these programs allow the identification of returning 

veterans with symptoms of mental health conditions, and that they support referrals for those with mental health problems. However, it would be helpful to provide 

further follow-up to ensure that those veterans most in need were, in fact, receiving 

care. Providing follow-up to those who report symptoms could help to ensure that 

they receive effective treatment. 

Question 4: VA has recently expanded their suicide prevention activities to include suicide prevention coordinators at each facility as well as a 1–800 hotline. 

Could you give us a brief assessment on the effectiveness of the program? How are 

you tracking the effectiveness of the program? 

Response: VA’s comprehensive program for suicide prevention includes increased 

public awareness of the importance of mental health conditions, and both the availability and effectiveness of treatment; overall enhancements in the capacity and 

scope of mental health service; centers of excellence for research and technical assistance; and a specific prevention system including both the 1–800–273–TALK hotline, and suicide prevention coordinators in each medical center. 

The most significant way to evaluate the effectiveness of the program will be to 

follow suicide rates among veterans receiving VA healthcare, the entire Nation’s veteran population, and the population at large. Rates are currently being evaluated 

and will continue to be monitored in the future. Data on mortality and causes of 

death for veterans using medical centers and clinics are available by merging VA 

clinical and administrative records with data obtained from the Center for Disease 

Control and Prevention’s (CDC) National Death Index; on suicide rates in the entire 

veteran population in a subset of States are available through the CDC’s National 


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Violent Death Reporting System; and data on suicide rates for the U.S. population 

are available through the National Center for Health Statistics. Although no ‘‘gold 

standard’’ is available for evaluating the effectiveness of a suicide prevention program, the Air Force’s program may serve as a benchmark. It was viewed as successful when several years of operation led to a reduction in suicide rates by one-third. 

There are also a number of methods that we are using to evaluate the prevention 

system made up of the hotline and the suicide prevention coordinators. These include tracking the calls to the hotline, referrals to the coordinators, and subsequent 

care. In addition, VA has developed procedures that allow the coordinators to identify individuals at high risk for suicide and to track suicide attempts. Therefore, 

other ways to evaluate the impact of further developments in our system would be 

to follow rates of suicide attempts and deaths from suicide among high risk patients. 

Question 5: VA recently put out a press release stating that it is ‘‘accelerating 

its own research to prevent these tragedies.’’ Could you tell us what these activities 

involve? 

Response: VA has a significant infrastructure for the conduct of research on 

mental disorders and their treatment. This includes 10 mental illness research, education, and clinical centers (MIRECCs), the seven divisions of the National Center 

for PTSD, a Center of Excellence of Integrated Care and three on mental illness and 

PTSD, two centers of excellence on substance abuse treatment and education, and 

two quality enhancement research initiatives, one on mental health, and one on substance use disorders, as well as a robust program supporting investigator initiated 

research. The MIRECC at Denver and the Center of Excellence in Mental Health 

and PTSD at Canandaigua, New York, focus specifically on suicide prevention. 

Ongoing studies are addressing suicide risk factors, validation of suicide ideation 

screening instruments, structure/quality of mental healthcare and its relationship to 

suicide prevention, and risk factors for suicide as it relates to depression. Findings 

from two major studies were presented at the House Veterans’ Affairs Committee 

hearing on December 12, 2007. One, conducted by VA’s Office of Environmental Epidemiology, is an investigation of mortality and causes of death in returning OEF/ 

OIF veterans. Another, conducted by VA’s Serious Mental Illness Research Education and Clinical Center, is studying rates of suicide, risk factors, and local variability throughout the system. Research under development by the Center of Excellence at Canandaigua include clinical trials on the effectiveness of peer support for 

suicide prevention, and psychological autopsy studies involving linkages of VA medical centers with local coroners or medical examiners. 

VA plans to support several additional research programs and activities aimed at 

reducing and preventing suicide, including new research solicitations and a periodic 

update of a literature synthesis of best practices for suicide prevention. 

A new research solicitation will be issued shortly seeking studies to validate 

screening instruments and to identify successful strategies and interventions for suicide prevention. Of special interest in this solicitation are efforts to: improve the 

continuum of care for substance use disorders, improve earlier identification and 

treatment of post-traumatic stress disorders, and implement recovery-oriented treatment approaches, particularly evidence-based programs and peer support services. 

Examples of specific future research topics include: 

• Evaluating strategies to improve earlier identification and treatment of PTSD 

and related mental health disorders (e.g., substance use and depression), especially in returning OEF/OIF veterans. 

• Identifying risk factors and accuracy of assessment of suicidality and evaluating 

best practices for suicide prevention. Research on these topics will consider the 

suicide risks of veterans who are experiencing PTSD, especially among OEF/ 

OIF and elderly veterans. 

• Investigating the effectiveness of evidence-based recovery-oriented approaches 

to mental health treatment, such as cognitive-behavioral treatments, family 

psycho-education, supported employment, and social skills training. 

• Assessing symptomatic as well as functional changes in patients. 

• Evaluating evidence-based treatment strategies within the context of co-morbid 

social and medical issues. 

• Comparing strategies used in mental health services for implementing recoveryoriented treatment programs. 

• Assessing outcomes at the patient, provider, and system levels. 

• Assessing the effectiveness of peer-support programs in supporting recovery and 

community reintegration in veterans with mental illness. 

• Determining the appropriate mix and organization of services (e.g., detoxification, inpatient, residential, intensive outpatient, outpatient, psychosocial, and 


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pharmacological) that will ensure access to the full continuum of care for patients with substance use disorders and varying life circumstances and co-occurring conditions. 

• Evaluating methods of enhancing the integration and coordination of mental 

health services with substance abuse or medical (primary care and specialty) 

services, including the organization and management of services for patients 

with these co-morbid conditions. 

• Improving the effectiveness and efficiency of behavioral health screens in VA’s 

healthcare system. 

Question 6: Research has shown that the family is instrumental in the recovery 

of veterans with mental health concerns. Family members are affected by the mental health issues, as you heard in previous testimony from Mr. Bowman. Currently, 

VA’s authority to provide mental health services to veterans receiving readjustment 

counseling services under section 1712 A of Title 38, United States Code, is limited 

to mental health services that are necessary to facilitate the successful readjustment 

of a veteran to civilian life and limited to the provision of counseling, training, and 

mental health services described in 38 USC 1782 and 1783 (bereavement counseling) for the veterans immediate family. If eligibility to receive services were expanded for family members, what, in your professional opinion, would be the proper 

scope of these services? 

Response: Vet Centers are authorized to include families in readjustment counseling for combat veterans, and to provide bereavement counseling for families of 

fallen warriors. Family members also receive the services described in section 1782 

(i.e., counseling, training, and certain mental health services) when needed for the 

effective readjustment of the veteran. Those same services are available to immediate family members of veterans receiving VA medical treatment when needed in 

connection with the veteran’s treatment. Under current authorization, these services 

can begin at any time for veterans being treated for a service-connected disability, 

but it can begin only during an inpatient hospitalization for others (i.e., for treatment of a nonservice-connected disability). Both Vet Centers and medical facilities 

can include families in outreach and education, including education programs for 

veterans with serious mental illness. One modest extension to current authorization, 

included in S. 2162 and H.R. 4053, would be to allow the inclusion of families in 

care for veterans to begin whenever it is clinically appropriate, both for veterans 

with service-connected disability and others. 

Further consideration of caregiver support demonstrates a problem in defining an 

appropriate scope for the services that can be provided to families. For veterans 

with significant impairments in day-to-day functioning, family caregivers are often 

essential. Providing family members with caregiver effectiveness training, or counseling to reduce burn-out are appropriate services, with clear benefits for the veteran. Treating caregiver depression could also benefit the veteran, allowing a family 

caregiver to providing more effective support. However, this is not currently authorized. It is possible to view psychotherapy for depression as similar to counseling for 

burnout, and to make the case that it should be allowable. However, it is less clear 

if prescribing antidepressant medication should be allowable, or blood tests for thyroid disease to determine if there were medical causes for the depression, or changing medications for other conditions to reduce depression as a possible drug sideeffect, or . . . The point is that there may be no obvious boundary between support 

for the family as part of care for the veteran, limited care for a caregiver, and overall healthcare for family members. VA is currently addressing this issue through 

workgroups and funding of pilot studies on caregiver support. 

There is, however, one area in which additional authorization may help VA provide more effective outreach to returning veterans by working with their families. 

There are cases, like the Omvig’s, where families may be concerned about mental 

health problems, but where the veteran may not be willing to seek an evaluation 

or care. In these cases, it may be useful for VA to be able to meet with families 

to evaluate the situation and determine whether there is likely to be a mental disorder that requires treatment, to provide education and coaching to the family about 

how to manage problem behaviors, and to work with the family to develop a strategy to encourage the veteran to seek care. Much of this is being accomplished 

through programs for education and outreach using existing legislative authority. 

However, additional authorization may allow more intensive interactions between 

VA staff and families. 


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For Kara Zivin, Ph.D. 

Question 1: In your testimony, you talked a lot about research that VA is currently doing on mental illness and suicide. In your professional opinion, what are 

the gaps in the current research in these areas, particularly in how they relate to 

veterans? What more research should VA be doing in these areas? 

Response: VA has the unique opportunity not only to attempt to reduce suicide 

rates among veterans, but also to learn what suicide prevention strategies are effective, so that effective rather than ineffective strategies can use used for veterans 

and the U.S. population, and by doing so has the potential to advance the science 

of suicide prevention. VA is the only healthcare organization that regularly tracks 

suicide rates, is highly organized, and treats a large enough population so the effectiveness of prevention strategies can be determined. 

VA is currently making a tremendous effort to prevent suicide. There are new and 

ongoing programs such as those located at the Veterans Integrated Service Networks (VISN) 2 Center of Excellence in Canandaigua, New York, which encompasses the national VA hotline/crisis line active monitoring of suicide prevention initiatives (SPI) and extensions of suicide research and education. Research is being 

implemented to examine the hotline’s suicide outcomes and the health impact including treatment engagement and healthcare utilization. The SPI relate to a series 

of efforts that are unfolding, such as implementing suicide prevention coordinators 

at all VA medical centers, cognitive behavioral therapy among high risk inpatients, 

screening efforts pre- and post-deployment, among others. Finally, the Canandaigua 

Center of Excellence is designed to develop new knowledge regarding suicide prevention, and is currently focusing on older adults, women, people with alcohol problems, and now developing new efforts to engage returning OEF/OIF veterans. 

In addition to specific initiatives, the VA’s Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) in Ann Arbor, Michigan, is pursuing 

major research program and planning around suicide prevention. Research and research infrastructure are needed across the board, and VA’s efforts to promote collaboration across VISN boundaries in a coordinated way, and capitalizing on expertise in its centers of excellence and MIRECCs is well conceived. It is important for 

VA to conduct ongoing evaluations of these suicide prevention programs to refine 

and improve their effectiveness. 

In particular, we need to learn more about good surveillance tools to track 

changes over time in suicide attempt rates, or hot spots for intervention. We need 

to be able to identify risk factors, regional variation, differences in rates and characteristics associated with suicide between veterans treated in VA and veterans treated outside VA, as well as understanding more about veteran engagement in mental 

healthcare. Continued efforts are essential to educate veterans and their families 

about warning signs for suicide and educate providers on suicide prevention and assessment. We need to learn more about how to improve the means of suicide prevention as well as best practices following suicide attempts. VA is assessing the relative 

impact of specific treatment practices on suicide risks and relative risk periods for 

suicide deaths. VA should also evaluate the effectiveness of screening tools, treatment guidelines, incentives, and collaborative care models. Ideally VA researchers 

would assess the unique risk and protective factors of the cohort of interest and test 

interventions. 

With newer cohorts of OEF and OIF veterans, studies of smaller groups of veterans could include the National Guard and as well as enlisted personnel to better 

understand their most vulnerable periods, key risk factors, and what treatments 

seem most effective. Families should be involved in this research to understand 

their perceptions of risk and how they can be of most support. Evaluation of family 

and patient satisfaction with VA care should be included in this research. 

These efforts should be made in conjunction with VA’s research program and 

other well known suicide prevention researchers, so that serious efforts to reduce 

suicide can be accompanied by solid research that allows Congress and the U.S. 

public to determine and use the most effective approaches. 

These research efforts originating in VA will benefit both veterans and the general U.S. population, because there are few systematic studies of any U.S. individuals at risk for suicide over a period of time. Such research will help identify periods 

of vulnerability and helpful treatments that prevent suicide deaths or attempts, particularly among those who have experienced trauma. We know that restricted access 

to lethal means and physician education are effective treatments, as well as psychotherapy and medications for mental disorders such as depression and bipolar disorder. 


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Because the existing published research on suicide fatalities is limited, and conducting this form of research is difficult, VA is uniquely positioned to conduct this 

research and improve our understanding of how to best help veterans at risk for 

suicide. 

The Honorable Harry E. Mitchell 

For Ira Katz, M.D., Ph.D. 

Question 1: All documents which contain, refer, or relate to requests by any providers of mental health services for veterans, including, but not limited to requests 

by providers in the Veterans Integrated Service Network (VISN) to the Veterans 

Health Administration (VHA) for additional resources which were denied, or responded to with less than the amount of resources requested, where such resources 

would have been used for any of the following: 

1. The collection of information relating to veterans at risk for suicide; 

2. The tracking of suicides committed by veterans, including, but not limited to 

veterans who have sought assistance from VA; 

3. Outreach to veterans who are or may be at risk of suicide; 

4. Outreach to families of veterans relating to suicide prevention and/or benefits 

for families of veterans who have committed suicide; and 

5. Research into the causes of suicide and/or treatment for depression, post-traumatic stress disorder or any other diagnosable condition which may increase 

the risk of suicide among veterans. 

Response: During FY 2007, $306 million was allocated to the Mental Health Enhancement Initiative administered by Office of Mental Health Services to fund specific programs designed to advance the implementation of the Mental Health Strategic Plan and to respond to the needs of returning veterans. By the end of the year, 

substantially over $320 million was, in fact awarded. At the beginning of FY 2007, 

overall mental health expenditures for the year were estimated to be over $2.8 billion. By the end of the year, over $3.2 billion was spent. For FY 2008, approximately 

$370 million was allocated for the Mental Health Enhancement Initiative. All of this 

was committed for continuation of programs initiated in prior years. Based on current projections, a substantial increase in enhancement funding is anticipated for 

next year. The Office of Mental Health Services is currently developing plans for 

use of these funds to establish a uniform services package for mental health. Last 

year, $120 million was appropriated in emergency supplemental funding for mental 

health and substance abuse. These funds are still being allocated and a number of 

requests for funding are under consideration at this time. 

In general, requests for funding may come from providers or investigators to medical centers, centers of excellence, VISNs, or any of a number of offices in VA Central Office. Most of VA’s research on mental disorders and their treatment is funded 

through investigator initiated grant proposals submitted to the Office of Research 

and Development. I am not personally aware of all requests to entities and offices 

other than the Office of Mental Health Services. But as Deputy Chief Patient Care 

Services Officer for Mental Health and Director of the Office of Mental Health Services, I am not aware of any proposals for programs in any of the above categories 

for which funding was denied. 

f 

Congress of the United States 

U.S. House of Representatives 

Washington, DC. 

February 8, 2008 

The Honorable James Peake, M.D. 

Secretary 

Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Mr. Secretary: 

I am seriously concerned about the response I received today, more than a week 

after it was due, to my document request relating to the House Veterans’ Affairs 

Committee’s hearing on December 12, 2007. 


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I asked for documents referring or relating to any requests for additional resources to track veteran suicides and/or provide mental health services for veterans 

at risk for suicide. 

Instead of documents, I received a response from Deputy Chief of Patient Care 

Services for Mental Health Ira Katz stating that he was ‘‘not aware’’ of ‘‘proposals 

for any new programs . . . for which funding was denied.’’ 

I specifically asked for documents relating to ‘‘requests . . . for additional resources,’’ not just ‘‘proposals for new programs,’’ nor did I request a recap of how 

much funding Congress appropriated to the Mental Health Enhancement Initiative 

in FY 2007. 

I believe the response I received is incomplete. 

If, for example, Dr. Katz is aware of any requests for additional mental health 

counselors, facilities or equipment, I would like to know. I would also appreciate an 

opportunity to review any related documentation. 

I have an obligation as a member of the Committee on Veterans’ Affairs, and the 

Chairman of its Subcommittee on Oversight and Investigations, to help ensure that 

the Department of Veterans Affairs has the resources it needs to help veterans at 

risk for suicide. 

I hope the urgency with which the VA has treated my request is not a reflection 

of the priority the VA assigns to this issue. 

Enclosed are a copy of my request as well as the response I received. 

I look forward to a complete response as soon as possible. If you have any questions, or require further clarification, please do not hesitate to contact me. 

Thank you for your assistance. 

Sincerely, 

Harry E. Mitchell 

Member of Congress 

Enclosure (1) 

Cc: The Honorable Bob Filner, Chairman, House Veterans’ Affairs Committee 

David Tucker, Chief Counsel, House Veterans’ Affairs Committee 

The Honorable Harry E. Mitchell 

For Ira Katz, M.D., Ph.D. 

Question 1: All documents which contain, refer, or relate to requests by any providers of mental health services for veterans, including, but not limited to requests 

by providers in the veteran Integrated Service Network to the Veterans’ Health Administration (VHA) for additional resources which were denied, or responded to with 

less than the amount of resources requested, where such resources would have been 

used for any of the following: 

1. The collection of information relating to veterans at risk for suicide; 

2. The tracking of suicides committed by veterans, including, but not limited to 

veterans who have sought assistance from VA; 

3. Outreach to veterans who are or may be at risk of suicide; 

4. Outreach to families of veterans relating to suicide prevention and/or benefits 

for families of veterans who have committed suicide; and 

5. Research into the causes of suicide and/or treatment for depression, post traumatic stress disorder or any other diagnosable condition which may increase 

the risk of suicide among veterans. 

Response: During FY 2007, $306 million was allocated to the Mental Health Enhancement Initiative administered by Office of Mental Health Services to fund specific programs designed to advance the implementation of the Mental Health Strategic Plan and to respond to the needs of returning veterans. By the end of the year, 

substantially over $320 million was, in fact awarded. At the beginning of FY 2007, 

overall mental health expenditures for the year were estimated to be over $2.8 billion. By the end of the year, over $3.2 billion was spent. For FY 2008, approximately 

$370 million was allocated for the Mental Health Enhancement Initiative. All of this 

was committed for continuation of programs initiated in prior years. Based on current projections, a substantial increase in enhancement funding is anticipated for 

next year. The Office of Mental Health Services is currently developing plans for 

use of these funds to establish a uniform services package for mental health. Last 

year, $120 million was appropriated in emergency supplemental funding for mental 

health and substance abuse. These funds are still being allocated and a number of 

requests for funding are under consideration at this time. 


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In general, requests for funding may come from providers or investigators to medical centers, centers of excellence, VISNs, or any of a number of offices in VA Central Office. Most of VA’s research on mental disorders and their treatment is funded 

through investigator initiated grant proposals submitted to the Office of Research 

and Development. I am not personally aware of all requests to entities and offices 

other than the Office of Mental Health Services. But as Deputy Chief Patient Care 

Services Officer for Mental Health and Director of the Office of Mental Health Services, I am not aware of any proposals for programs in any of the above categories 

for which funding was denied. 

U.S. Department of Veterans Affairs 

Washington, DC. 

February 27, 2008 

The Honorable Harry E. Mitchell 

U.S. House of Representatives 

Washington, DC 20515 

Dear Congressman Mitchell: 

This is in response to your recent letter asking for more information about requests for additional resources relating to veteran suicides. This question has been 

reviewed once more, and no unfunded requests from Department of Veterans Affairs 

(VA) facilities or staff for resources directly related to suicide prevention were identified. 

Your more recent request for information about requests from the field for additional mental health counselors, facilities, or equipment beyond those specifically related to suicide prevention is more complex. In fiscal years 2005 through 2007, the 

Office of Mental Health Services issued a number of requests for proposals to enhance mental health programs. These proposals were competitively reviewed, and 

funding decisions were made at times on the basis of need, and at other times, on 

the basis of merit. The office also solicited requests for nonrecurring, maintenance 

funds for space-related needs that are being considered at this time. 

As part of its ongoing activities, VA’s Office of Research and Development regularly receives applications for research awards in mental health as well as other 

areas; these may include requests for mental health counselors or equipment to support specific research activities. 

Finally, there are mental health components included in a number of ongoing 

evaluations about major renovations and construction for facilities. I would appreciate it if you could provide additional details about the type of information you require to guide us in preparing documents for your review. 

I have been advised that my staff has contacted members of your staff to arrange 

a meeting to respond to any remaining questions or concerns. Thank you for your 

continued interest in our Nation’s veterans. 

Sincerely yours, 

James B. Peake, M.D. 

f 

Secretary 

Committee on Veterans’ Affairs 

Washington, DC. 

December 14, 2007 

John D. Daigh, Jr., M.D., CPA 

Assistant Inspector General 

Office of Healthcare Inspections 

U.S. Department of Veterans Affairs 

Washington, DC 20420 

Dear John: 

In reference to our Full Committee hearing on ‘‘Stopping Suicides: Mental Health 

Challenges Within the Department of Veterans Affairs’’ on December 12, 2007, I 

would appreciate it if you could answer the enclosed hearing questions by the close 

of business on January 28, 2008. 


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In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all Full Committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively and singlespaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your response to Debbie Smith 

by fax at 202–225–2034. If you have any questions, please call 202–225–9756. 

Sincerely, 

BOB FILNER 

Chairman 

U.S. Department of Veterans Affairs 

Office of Inspector General 

Washington, DC. 

January 24, 2008 

The Honorable Bob Filner 

Chairman 

Committee on Veterans’ Affairs 

United States House of Representatives 

Washington, DC 20515 

Dear Mr. Chairman: 

Enclosed are responses to questions from the December 12, 2007, hearing before 

the Committee on ‘‘Stopping Suicides: Mental Health Challenges Within the Department of Veterans Affairs.’’ 

Thank you for your interest in the Department of Veterans Affairs. 

Sincerely, 

JOHN D. DAIGH, JR., M.D. 

Assistant Inspector General for Healthcare Inspections 

Enclosure 

Questions from the Honorable Bob Filner 

For Michael Shepherd, M.D. 

Physician, Office of Healthcare Inspections 

Office of Inspector General, U.S. Department of Veterans Affairs 

Before the Committee on Veterans’ Affairs Hearing 

‘‘Stopping Suicides: Mental Health Challenges 

Within the Department of Veterans Affairs’’ 

December 12, 2007 

1. In your testimony you stress the need for a comprehensive suicide prevention program. 

• What is your assessment of the VA’s suicide prevention program? 

In our report, Implementing VHA’s Mental Health Strategic Plan (MHSP) Initiatives for Suicide Prevention, the extent of implementation was assessed along a spectrum of five stages: no action; in planning; evidence of ongoing or completed pilot 

or demonstration projects; implemented throughout an entire Veteran Integrated 

Service Network (VISN) or multiple facilities in multiple VISNs (VISN-wide); and 

systemwide implementation. 

Our findings can be summarized as follows: In terms of crisis availability and outreach, we found VISN-wide but not systemwide implementation. Initiatives related 

to referral and tracking of at-risk veterans were also at a VISN-wide stage. Those 

related to screening, assessment of at-risk veterans, emerging best practice interventions, education, and development of an electronic suicide surveillance system 

were at a pilot stage. Because the VISN 19 Mental Illness, Education, Clinical Center (MIRECC) is operational and has evidenced significant collaboration with other 

MIRECC’s, the MHSP initiative pertaining to research (support for a MIRECC focused on suicide prevention) was assessed as having achieved a systemwide level 

of implementation. 


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• In your estimation, what changes does VA need to make in ensuring 

an effective suicide prevention program as well as a comprehensive 

one? 

Whereas a public health approach has been applied to prevention of coronary artery disease (lowering cholesterol, aerobic exercise) or certain forms of cancer (smoking cessation) for more than a quarter century, approaching suicide prevention from 

a public health paradigm is a relatively recent development. Just as strategies to 

prevent lung cancer may differ from strategies to prevent cervical cancer, interventions that target a depressed elderly man with early cognitive impairment may differ from interventions that target a young returning veteran with post traumatic 

stress disorder (PTSD) and co-morbid alcohol use. Suicide prevention is thought to 

require integrated strategies, coordinated effort, and steadfast commitment to forward progress. In terms of changes VA could make, we would offer the following 

observations: 

Community-Based Outreach—In our report, we noted that while several facilities 

had implemented innovative community-based suicide prevention outreach programs, (e.g., facility presentations to New York Police Department officers who are 

Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans, participation by mental health staff in local Spanish radio and television shows) the majority of facilities did not report community-based linkages and outreach aimed at suicide prevention. In addition, less than 20 percent of facilities reported utilizing the 

Chaplain Service for liaison and outreach to faith-based organizations in the community (e.g., inviting faith-based organizations in the area to a community meeting 

at the VA Medical Center (VAMC) to explain Veteran Health Administration (VHA) 

services available, having a VA Chaplain accompany the OIF/OEF coordinator to 

post-deployment events in the community). Although facilities would need to tailor 

strategies to consider local demographics and resources, a systemwide effort at community-based outreach appears prudent. 

Timeliness from Referral to Mental Health Evaluation—In our report we noted 

that while most facilities self-reported that three-fourths or more of those patients 

with a moderate level of depression or PTSD who are referred by primary care providers are seen within 2 weeks of referral, approximately 5 percent reported a significant 4–8 week wait. These patients are at risk for progression of symptom severity and possible development of suicidal ideation. VISN leadership should work with 

facility directors to ensure that once referred, patients with a moderate level of depression or PTSD symptoms are seen in a timely manner at any VAMC and Community-Based Outpatient Clinic (CBOC) where significant waits are an issue. 

Coordination between VHA and Non-VHA Providers—When patients receive mental health treatment at both VHA and non-VHA providers and facilities, seamless 

communication becomes an increasingly complex challenge. This fragmentation of 

care is particularly worrisome in periods of patient destabilization or following discharge from a hospital or residential mental health program. The Office of Mental 

Health Services should consider development of innovative methods, procedures, or 

agreements, that improve flow of information for patients receiving simultaneous 

treatment at VA and non-VA sector but adhere to relevant privacy statutes. In addition, the Readjustment Counseling Service and Office of Patient Care Service should 

pursue further efforts to heighten communication and record sharing for patients receiving both counseling at Vet Centers and treatment at VAMCs and/or affiliated 

CBOCs. 

Co-Occurring Combat Stress Related Illness and Substance Use—Alcohol may contribute to the severity of a concurrent or underlying mental health condition such 

as major depression. In addition, the presence of alcohol may cause or exacerbate 

impulsivity and disinhibited behavior. Acute alcohol use is associated with suicide 

and suicide completers have high rates of elevated blood alcohol. A recent study 

published in the Journal of the American Medical Association (JAMA), Longitudinal 

Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning from the Iraq War, in which Milliken et al., found that soldiers frequently reported alcohol concerns on the Post Deployment Health Assessment and 

Reassessments (PDHA and PDHRA) ‘‘yet very few were referred to alcohol treatment.’’ Alcohol misuse has been a common factor in OIF/OEF suicide cases that we 

have reviewed. 

Regardless of why a patient begins to abuse alcohol, physiologic and psychologic 

drives become entrained with frequent and/or excessive use, until the alcohol misuse 

ultimately takes on a life of its own that is independent of patient history and circumstance. Functional ability and quality of life become dually impacted by both unVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00123 Fmt 6621 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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derlying anxiety and depressive symptoms and co-morbid substance use issues. For 

patients with concurrent conditions, an effective treatment paradigm may entail addressing the primacy of not only anxiety/depressive conditions but also of co-morbid 

substance use disorders. Augmenting services that address substance use disorders 

co-morbid with combat stress related illness should therefore be given due consideration for inclusion in a program aimed at suicide prevention. 

2. In your professional opinion, does VA have the resources to implement 

an effective program? 

The Office of Inspector General has not reviewed VHA’s resources and we cannot 

offer an opinion. 

3. In your report you made a number of recommendations about steps that 

VHA should undertake. 

• Are there any that you believe VHA has not yet undertaken? 

While the VA has begun action on the recommendations in our report, the following have not been completed: 

Education of Nonclinical Staff—Subsequent to the OIG report, the VAMC 

Canandaigua Center of Excellence has developed a CD and guide for mandatory 

training of all VA nonclinical staff who interact with veterans about responding to 

crisis situations involving at-risk veterans. However, the process of actually disseminating training to first line nonclinical personnel is only just beginning. 

Education for Healthcare Providers—Implementation of a mandatory education 

program for healthcare providers about suicide risks and ways to address these 

risks is reportedly in the planning stages but has not yet been developed. 

Bi-Directional Information Exchange—Bi-directional exchange of health information between VA and the Department of Defense (DoD), which includes patients 

with mental health issues coming into VHA care from DoD and/or those leaving 

VHA care for re-deployment, is an unresolved issue that has been discussed at previous hearings including the House Committee on Veteran’s Affairs October 24, 

2007, hearing ‘‘Sharing of Electronic Medical Records between Department of Defense and Department of Veterans Affairs.’’ 

Establishing a Coordinated Mechanism for Implementing Emerging Best Practices—We recommended that VHA should establish a centralized mechanism to review ongoing suicide prevention strategies, to select among available emerging best 

practices for screening, assessment, treatment, and to facilitate systemwide implementation, in order to ensure a single VHA standard. The VA Center of Excellence’s 

structural and philosophic organization aligns with the intent of this recommendation. The center’s capacity, in actual practice, to evaluate, select, and facilitate systemwide implementation of emerging best practices will only become discernible 

over time. 

4. I know you are aware of the report by CBS that the rate of suicide 

among veterans aged 20 to 24 is several times the rate among the same 

age group in the general population. 

• Do you know whether CBS’s numbers are accurate? 

In the absence of underlying data from CBS, which we were unable to obtain, we 

cannot reliably comment on the accuracy of CBS’s numbers. 

5. Have you been able to obtain the underlying data from CBS so you can 

determine whether CBS’s numbers are correct? If not, why not? 

We requested the underlying data but were not able to obtain it. CBS informed 

us that they could not provide the data to us because of contractual arrangements 

and privacy protection agreements that CBS had made with various State vital statistic offices from which it had received the data. 

6. What are the data that one would need to determine the rate of suicide 

among veterans as compared to the general population? 

One would need to reliably determine who died by suicide, who is a U.S. veteran, 

and the number of general population at risk. If an electronic death certificate system were created that had a field for inputting cause of death; fields for salient epidemiologic factors; allowed for input from multiple sources including medical examVerDate Aug 31 2005 00:08 Oct 15, 2008 Jkt 039647 PO 00000 Frm 00124 Fmt 6621 Sfmt 6621 E:\HR\OC\39647.XXX 39647

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iners, a decedent’s physician, police reports, etc.; and was standardized across 

States, one might ascertain more accurate and timely data regarding who and how 

many have died by suicide. In addition, from a public health perspective, an electronic death certificate system could enhance epidemiologic analysis of other causes 

of mortality. This data could be matched to existing data bases of qualified U.S. veterans to determine a rate of suicide among more recent veterans. We are not aware 

of the existence of a reliable electronic database that would include qualified U.S. 

veterans who separated prior to 1973–74. Determining the number of veterans who 

separated before the mid-1970’s and also the total number of veterans in the U.S. 

would therefore require merging of various databases combined with the use of estimative models. 

7. Do you know whether the VA in fact collects the necessary data to be 

able to determine suicide rates among veterans and to compare those 

rates to the general population? 

VHA does not collect data that would enable calculation of a suicide rate for all 

U.S. veterans or that would enable comparison to nonveterans on a national basis. 

VHA collects data to determine suicide rates among veterans who receive healthcare 

at VHA facilities, a population that can be accurately quantified using VHA databases. 

For 12 of the 17 States that participate in the National Violent Death Reporting 

System, VHA reported having indirectly calculated suicide rates among nonveterans 

in these States by subtracting veteran suicide rates from the rates for the general 

population. The derived nature of this calculation imposes limitations on the reliability of this measurement. 

f 

Committee on Veterans’ Affairs 

Washington, DC. 

December 21, 2007 

The Honorable James B. Peake, M.D. 

Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Secretary Peake: 

On December 12, 2007, the House Committee on Veterans’ Affairs held a hearing 

to assess the programs that the Department of Veterans Affairs (VA) provides for 

veterans who are at risk for suicide. This hearing raised concerns regarding the discrepancy between the numbers of veteran suicides reported by VA as compared to 

those reported by CBS News on November 13, 2007. 

Accurate data is crucial in identifying risk factors and providing better treatment 

and suicide prevention programs. For this reason, we respectfully request that the 

Department of Veterans Affairs share their data on suicide among veterans with the 

Committee. 

Specifically, we request to have the number of veteran suicides for each year from 

1995 through 2006, reported by year of death, age, race, gender and manner of suicide. Additionally, we ask for the methodology the Department uses to collect data 

on veteran suicides. 

Undoubtedly, you share our desire to ensure that every measure is taken to prevent our Nation’s veterans from committing suicide. We would greatly appreciate 

your willingness to share any information you may have regarding this issue with 

the Committee. 

Thank you for your prompt consideration and attention to this request. Should 

you have any questions, please feel free to contact either Committee Staff Director, 

Malcom Shorter, at 202–225–9756 or Republican Staff Director, Jim Lariviere, at 

202–225–3527. 

Sincerely, 

Bob Filner Steve Buyer 

Chairman Ranking Member 


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The Secretary of Veterans Affairs 

Washington, DC. 

February 5, 2008 

The Honorable Bob Filner 

Chairman 

Committee on Veterans’ Affairs 

U.S. House of Representatives 

Washington, DC 20515 

Dear Mr. Chairman: 

This is in response to your letter requesting data on suicide rates among veterans 

and the methodologies used by the Department of Veterans Affairs (VA) to collect 

data on veteran suicides. 

The enclosed information and worksheet contains data on veteran suicides from 

two separate projects. One is an ongoing study of mortality in Operation Enduring 

Freedom and Operation Iraqi Freedom (OEF/OIF) veterans being conducted by VA’s 

Office of Environmental Epidemiology. Identification of veterans is based on information from the Department of Defense and includes all OEF/OIF servicemembers 

who were separated from active duty including National Guard and Reserve personnel. The second project is an ongoing study of suicide in veterans who have used 

Veterans Health Administration services from 2000 onward and who were alive at 

the start of 2001. The study includes veterans of all eras. 

For both projects, information about the time and causes of death was derived 

from the National Death Index. Information contained in data files on causes of 

death from the National Death Index is only available through the end of 2005. I 

have also enclosed the methodology used for both projects. 

Your interest in our Nation’s veterans is appreciated. A similar letter is being 

sent to Congressman Steve Buyer. 

Sincerely yours, 

James B. Peake, M.D. 

Enclosures 

Study of Operation Enduring Freedom/Operation Iraqi Freedom Veterans 

Methodology 

Population: As part of our mortality study of veterans who served in Operation 

Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF), the Department of Veterans Affairs (VA) obtained the identities of 490,346 OEF/OIF veterans who served 

as part of either OEF or OIF and were separated or deactivated from military service between October 2001 and December 2005. This study will assess both overall 

mortality risk as well as cause-specific mortality risk. Among the cause specific mortality of particular interest are deaths due to motor vehicle accidents and suicides. 

Data Sources: The identities of the 490,346 OEF/OIF veterans, military service 

characteristics, and various demographic data were provided to VA by the Department of Defense Manpower Data Center. Vital statistics data pertaining to OEF/OIF 

veterans was determined by using VA’s database, Beneficiary Identification and 

Records Locator Subsystem, and deaths reported to the Social Security Administration Death Master File. The Beneficiary Identification and Records Locator Subsystem file has the identities of all veterans who have applied for VA benefits (including death benefits), and the Social Security Administration Death Master File 

includes all deaths reported to that agency. All veterans were matched against the 

Beneficiary Identification and Records Locator Subsystem and Social Security Administration files using Social Security numbers. Cause of death data was obtained 

from the National Death Index. Since 1979, the Office of Vital Statistics in each 

State has reported deaths, including cause of death data to the National Center for 

Health Statistics, where the National Death Index is compiled. Causes of death 

were recorded using International Classification of Diseases codes 10th Revision 

(ICD–10). For traumatic deaths, including suicide, part of the ICD–10 codes records 

the method of injury. For suicides, the ICD–10 codes report the method of suicide. 

At the time this study began, the National Death Index had cause of death data 

through December 31, 2005. Using the aforementioned databases, VA identified a 

total of 818 deaths to include 144 suicides. 

The attached table has demographic and military service characteristics as well 

as death certificate data and method of suicide for the 144 suicides identified in this 

study. 


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CHARACTERISTICS OF 144 SUICIDES AMONG 

OEF/OIF * VETERANS THROUGH 2005 

Characteristic Frequency Percentage 

Age at death 

20–29 78 54.1 

30–39 39 27.1 

40–49 14 9.7 

50–59 13 9.1 

Year of death 

2002 7 4.9 

2003 21 14.6 

2004 48 33.3 

2005 68 47.2 

Method of suicide 

Poisoning 7 4.9 

Hanging 30 20.8 

Firearm 105 72.9 

Jumping 1 .7 

Sharp Object 1 .7 

Sex 

Male 141 97.9 

Female 3 2.1 

Race 

White 118 81.9 

Non-White 26 18.1 

Ever seen at VAMC 

Yes 33 22.9 

Branch of service 

Army 73 50.7 

Marines 15 10.4 

Air Force 33 22.9 

Navy 23 16.0 

Rank 

Officer 8 5.6 

Warrant Officer 1 0.7 

Enlisted 135 93.7 

Unit component 

Active 68 47.2 

Reserve 35 24.3 

National Guard 41 28.5 

* These suicides were identified among a cohort of 490,346 OEF/OIF 

veterans selected for mortality follow-up through 2005. 


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Study of Veterans Using Veterans Health Administration 

Methodology 

Population: The Veterans Health Administration defined the population of VA patients at risk for suicide in each fiscal year as those who were alive at the start 

of the year, and who had received VA services during either that year or the prior 

one. This approach to identifying VA’s patient population was developed in consultation with VA mental health leadership and assumes that patients seen in VA settings in the prior year would still be considered to be in active VA care and part 

of the at-risk patient population in the following year. 

Data Sources: This study used data from VA’s National Patient Care Database to 

identify all veterans with inpatient or outpatient services utilization in any VA facility during the relevant years. Measures of vital status and cause of death were 

based on information from the National Death Index. The National Death Index is 

considered the ‘‘gold standard’’ for mortality assessment information and includes 

national data regarding dates and causes of death for all U.S. residents. This information is derived from death certificates filed in the Office of Vital Statistics for 

each State. National Death Index searches were performed for cohorts of VA patients who received any VA services during the relevant years, and who had no subsequent VA services through June 2006. This cost-efficient method for conducting 

National Death Index searches enables comprehensive assessment of vital statistics 

and cause of death among all veterans in the VA patient population. The National 

Death Index data request included Social Security number, last name, first name, 

middle initial, date of birth, race and ethnicity, sex, and State of residence. National 

Death Index search results often include multiple records that are potential 

matches. ‘‘True matches’’ were identified based on established procedures. 

Veterans’ age and gender were identified from VA administrative files included 

in the National Patient Care Database. Age at the start of Fiscal Year 2001 was 

categorized as being either less than 30, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 

to 79, or greater than or equal to 80 years. Information regarding race and ethnicity 

was not consistently available in the National Patient Care Database for all VA patients. VA identified dates and causes of death using National Death Index data. 

Suicide deaths were identified using International Classification of Diseases codes 

X60 through X84, and Y87.0 (World Health Organization 2004). 

VA is conducting a comprehensive program for preventing veteran suicides, and 

is conducting ongoing research to guide its prevention strategies. The VA Office of 

Mental Health staff is available to provide additional briefings to the Committee on 

rates, risks factors and strategies. 


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Number of Suicides Among VHA Veterans for Fiscal Years 2001–2005 

Characteristic 

FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 

N % N % N % N % N % 

Total * 1403 100 1737 100.0 1600 100.0 1702 100.0 1784 100.0 

Total, age 20 

and over 1401 100 1734 100.0 1598 100.0 1701 100.0 1781 100.0 

Sex 

Male 1360 97.1 1682 97.0 1559 97.6 1647 96.8 1720 96.6 

Female 41 2.9 52 3.0 39 2.4 54 3.2 61 3.4 

Age Group 

20–29 yrs 26 1.9 44 2.5 38 2.4 50 2.9 38 2.1 

30–39 yrs 108 7.7 119 6.9 111 6.9 105 6.2 105 5.9 

40–49 yrs 240 17.1 283 16.3 272 17.0 256 15.0 254 14.3 

50–59 yrs 359 25.6 437 25.2 407 25.5 424 24.9 470 26.4 

60–69 yrs 202 14.4 261 15.1 264 16.5 272 16.0 291 16.3 

70–79 yrs 320 22.8 393 22.7 345 21.6 381 22.4 380 21.3 

80+ yrs 146 10.4 197 11.4 161 10.1 213 12.5 243 13.6 

Race 

White Hispanic 30 2.1 25 1.4 32 2.0 24 1.4 29 1.6 

Black Hispanic 2 0.1 1 0.1 1 0.1 2 0.1 2 0.1 

Native 

American 2 0.1 6 0.3 3 0.2 2 0.1 7 0.4 

African 

American 55 3.9 80 4.6 47 2.9 62 3.6 78 4.4 

Asian/Pacific 

Islander 0 0.0 4 0.2 2 0.1 3 0.2 16 0.9 

Caucasian 895 63.9 1078 62.2 894 55.9 814 47.9 1142 64.1 

Unknown 417 29.8 540 31.1 619 38.7 794 46.7 507 28.5 

* Includes age <20 years old. 


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Number of Suicides Among VHA Veterans for Fiscal Years 2001–2005 

Characteristic 

FY 2001 FY 2002 FY 2003 FY 2004 

N % N % N % N % 

Total * 1403 100.0 1737 100.0 1600 100.0 1702 100.0 1Total, age 20 and over 1401 100.0 1734 100.0 1598 100.0 1701 100.0 1Mechanism of Suicide X60 Intentional self-poisoning (suicide) by and exposure to non-opioid analgesics, 

anti-pyretics, and anti-rheumatics.

5 0.4 4 0.2 8 0.5 5 0.3 

X61 Intentional self-poisoning (suicide) by and exposure to antiepileptic, sedativehypnotic anti-parkinsonism, and psychotropic drugs, not elsewhere classified. 39 2.8 49 2.8 38 2.4 43 2.5 X62 Intentional self-poisoning (suicide) by and exposure to narcotics and 

psychodysleptics (hallucinogens), not elsewhere classified.

26 1.9 42 2.4 30 1.9 27 1.6 

X63 Intentional self-poisoning (suicide) by and exposure to other drugs acting on 

the autonomic nervous system.

1 0.1 3 0.2 1 0.1 0 0.0 

X64 Intentional self-poisoning (suicide) by and exposure to other and unspecified 

drugs, medicaments, and biological substances.

100 7.1 97 5.6 103 6.4 112 6.6 

X65 Intentional self-poisoning (suicide) by and exposure to alcohol. 2 0.1 2 0.1 5 0.3 0 0.0 X66 Intentional self-poisoning (suicide) by and exposure to organic solvents and 

halogenated hydrocarbons and their vapors.

2 0.1 3 0.2 1 0.1 6 0.4 

X67 Intentional self-poisoning (suicide) by and exposure to other gases and 

vapors.

34 2.4 62 3.6 35 2.2 59 3.5 

X68 Intentional self-poisoning (suicide) by and exposure to pesticides. 1 0.1 1 0.1 1 0.1 0 0.0 X69 Intentional self-poisoning (suicide) by and exposure to other and unspecified 

chemicals and noxious substances.

3 0.2 6 0.3 4 0.3 3 0.2 

X70 Intentional self harm (suicide) by hanging, strangulation, and suffocation. 163 11.6 214 12.3 189 11.8 207 12.2 X71 Intentional self harm (suicide) by drowning and submersion. 17 1.2 19 1.1 12 0.8 10 0.6 X72 Intentional self harm (suicide) by handgun discharge. 192 13.7 248 14.3 255 16.0 227 13.3 


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discharge. 

145 10.3 174 10.0 150 9.4 171 10.1 

X74 Intentional self harm (suicide) by other and unspecified firearm discharge. 566 40.4 726 41.9 675 42.2 728 42.8 X75 Intentional self harm (suicide) by explosive material. 0 0.0 0 0.0 0 0.0 0 0.0 X76 Intentional self harm (suicide) by smoke, fire, and flames. 6 0.4 4 0.2 6 0.4 14 0.8 X77 Intentional self harm (suicide) by steam, hot vapors, and hot objects. 0 0.0 0 0.0 0 0.0 0 0.0 X78 Intentional self harm (suicide) by sharp object. 34 2.4 33 1.9 33 2.1 35 2.1 X79 Intentional self harm (suicide) by blunt object. 0 0.0 0 0.0 0 0.0 0 0.0 X80 Intentional self harm (suicide) by jumping from a high place. 31 2.2 18 1.0 30 1.9 27 1.6 X81 Intentional self harm (suicide) by jumping or lying before moving object. 14 1.0 10 0.6 7 0.4 12 0.7 X82 Intentional self harm (suicide) by crashing of motor vehicle. 1 0.1 4 0.2 5 0.3 4 0.2 X83 Intentional self harm (suicide) by other specified means. 7 0.5 6 0.3 3 0.2 4 0.2 X84 Intentional self harm (suicide) by unspecified means. 5 0.4 6 0.3 4 0.3 4 0.2 V87 Sequelae of intentional self harm. 7 0.5 3 0.2 3 0.2 3 0.2 

* Includes age <20 years old. 


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128 

Committee on Veterans’ Affairs 

Washington, DC. 

December 21, 2007 

Mr. Rick Kaplan 

Executive Producer 

CBS Evening News With Katie Couric 

524 West 57th Street 

New York, NY 10019 

Dear Mr. Kaplan: 

On December 12, 2007, the House Committee on Veterans’ Affairs held a hearing 

to assess the programs that the Department of Veterans Affairs (VA) provides for 

veterans who are at risk for suicide. This hearing raised concerns regarding the discrepancy between the numbers of veteran suicides reported by VA as compared to 

those reported by CBS News on November 13, 2007. 

Accurate data is crucial in identifying risk factors and providing better treatment 

and suicide prevention programs. For this reason, we respectfully request that CBS 

News share their data on suicide among veterans with the Committee. 

Specifically, we request data on the number of veteran and nonveteran suicides 

for each year from 1995 through 2005 reported by State with year of death, age, 

race, gender and manner of suicide. Additionally, request the data that CBS News 

used to define the at-risk populations (e.g., veterans/nonveterans, men/women) by 

age group. 

Undoubtedly, you and the entire CBS Evening News staff, share our desire to ensure that every possible measure is taken to prevent those who have worn the uniform from succumbing to the tragedy of suicide. As such, we would greatly appreciate your willingness to share the information you have accumulated with the Committee. 

Thank you for your prompt consideration and attention to this request. Should 

you have any questions, please feel free to contact either Committee Staff Director, 

Malcom Shorter, at 202–225–9756 or Republican Staff Director, Jim Lariviere, at 

202–225–3527. 

Sincerely, 

Bob Filner Steve Buyer 

Chairman Ranking Member 

CBS News 

New York, NY. 

May 16, 2008 

The Honorable Bob Filner, Chairman 

Committee on Veterans’ Affairs 

United States House of Representatives 

One Hundred Tenth Congress 

335 Cannon House Office Building 

Washington, DC 20515 

Dear Congressman Filner: 

This is in reply to your letter of last December to Rick Kaplan, Executive Producer of the CBS Evening News. It appears that your letter was originally lost within CBS and only came to light when a copy of it was given to Armen Keteyian, CBS 

News’ Chief Investigative Correspondent, at last week’s hearing of the House Committee on Veterans’ Affairs. I apologize for the delay. 

In your letter you request that CBS News provide ‘‘data on numbers the veteran 

and nonveteran suicides for each year from 1995 through 2005 reported by . . . 

[and] data that CBS News used to define the at-risk populations (e.g., veterans/nonveterans, men/women) by age group.’’ 

You are quite right, Congressmen, in stating that we at CBS News share your 

desire to ensure that every possible measure is taken to prevent veteran suicide. 

We believe, however, that the respect in which we are best able to serve the interests of veterans and of all other segments of the American public is to preserve our 

ability to do effective news reporting; and that to be effective reporters, we must 

maintain our journalistic independence. For that reason we must respectfully decline to provide the data you request. 


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129 

Insofar as the Committee’s request derives from its need for the raw data on 

which CBS News based its reporting, that data is readily available to the Committee from State agencies, which are public. If the Committee’s goal is to review 

the editorial process by which we arrived at our reports’ content, we respectfully 

urge that it would be quite wrong of CBS News to submit voluntarily to such governmental oversight. Indeed, doing so would fundamentally compromise the editorial independence on which we and all news organizations depend. 

I should also point out that obtaining suicide data from the various States involved more than just a basic public records request. Initially, several States refused 

to provide their data to CBS News out of a concern for the privacy of the veterans 

involved and their families. These States believed that the suicide numbers in some 

categories are small enough so that individuals could be identified and their privacy 

compromised. In order to obtain the data, CBS News had to give these States our 

assurance that we would keep the raw data confidential. Some States insisted upon 

written agreements to this effect. Accordingly, we are constrained not only by principle, but by these specific undertakings, from providing the Committee with the 

data you have requested. 

I hope you will appreciate Congressmen, that we take the work of the House Committee on Veterans’ Affairs very seriously and that we withhold our cooperation only 

out of deference to our own responsibilities as journalists. 

Respectfully, 

Linda Mason 

Senior Vice President 

Standards and Special Projects 

cc Rick Kaplan 

Armen Keteyian 

Æ 


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