U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office,

http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,

U.S. Government Printing Office. Phone 202–512–1800, or 866–512–1800 (toll-free). E-mail, gpo@custhelp.com.

58–058 2011

EXAMINING THE PROGRESS OF SUICIDE 

PREVENTION OUTREACH EFFORTS AT THE 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

JULY 14, 2010 

Serial No. 111–91 

Printed for the use of the Committee on Veterans’ Affairs 

( 


ebenthall on DSK9Q6SHH1PROD with HEARING
ii 

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 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

ANN KIRKPATRICK, Arizona 

GLENN C. NYE, Virginia 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

DAVID P. ROE, Tennessee 

MALCOM A. SHORTER, Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

HARRY E. MITCHELL, Arizona, Chairman 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

JOHN J. HALL, New York 

DAVID P. ROE, Tennessee, Ranking 

CLIFF STEARNS, Florida 

BRIAN P. BILBRAY, California 

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. 


ebenthall on DSK9Q6SHH1PROD with HEARING
iii 

C O N T E N T S 

July 14, 2010 

Page 

Examining the Progress of Suicide Prevention Outreach Efforts at the U.S. 

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

OPENING STATEMENTS 

Chairman Harry E. Mitchell ................................................................................... 1 

Prepared statement of Chairman Mitchell ..................................................... 50 

Hon. David P. Roe, Ranking Republican Member ................................................ 3 

Prepared statement of Congressman Roe ....................................................... 51 

Hon. Timothy J. Walz .............................................................................................. 4 

Hon. John H. Adler .................................................................................................. 4 

Hon. Rush D. Holt ................................................................................................... 7 

WITNESSES 

U.S. Department of Defense, Colonel Robert W. Saum, USA, Director, Defense 

Centers of Excellence for Psychological Health and Traumatic Brain Injury 31 

Prepared statement of Colonel Saum ............................................................. 64 

U.S. Department of Veterans Affairs, Robert Jesse, M.D., Ph.D., Principal 

Deputy Under Secretary for Health, Veterans Health Administration ........... 32 

Prepared statement of Dr. Jesse ..................................................................... 67 

American Legion, Jacob B. Gadd, Deputy Director, Veterans Affairs and 

Rehabilitation Commission ................................................................................. 19 

Prepared statement of Mr. Gadd .................................................................... 58 

Bean, Linda, Milltown, NJ ...................................................................................... 7 

Prepared statement of Ms. Bean ..................................................................... 53 

Cintron, Warrant Officer Melvin, USA (Ret.), Manassas, VA ............................. 5 

Prepared statement of Warrant Officer Cintron ............................................ 51 

Iraq and Afghanistan Veterans of America, Timothy S. Embree, Legislative 

Associate ............................................................................................................... 17 

Prepared statement of Mr. Embree ................................................................ 54 

Vietnam Veterans of America, Thomas J. Berger, Ph.D., Executive Director, 

Veterans Health Council ..................................................................................... 21 

Prepared statement of Dr. Berger ................................................................... 61 

SUBMISSIONS FOR THE RECORD 

American Foundation for Suicide Prevention, Paula Clayton, M.D., Medical 

Director, statement .............................................................................................. 72 

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

Disorder, Suicide, and the Lessons of War, statement ...................................... 74 

Oregon Partnership, Portland, OR, statement ...................................................... 81 

MATERIAL SUBMITTED FOR THE RECORD 

Post-Hearing Questions and Responses for the Record: 

Hon. Harry E. Mitchell, Chairman, and Hon. David P. Roe, Ranking 

Republican Member, Subcommittee on Oversight and Investigations, 

to Hon. Robert M. Gates, Secretary, U.S. Department of Defense, letter 

dated July 28, 2010, and DoD responses .................................................... 82 

Hon. Harry E. Mitchell, Chairman, and Hon. David P. Roe, Ranking 

Republican Member, Subcommittee on Oversight and Investigations, 

to Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs, letter dated July 28, 2010, and VA responses .................................. 86 


ebenthall on DSK9Q6SHH1PROD with HEARING

ebenthall on DSK9Q6SHH1PROD with HEARING
(1) 

EXAMINING THE PROGRESS OF SUICIDE 

PREVENTION OUTREACH EFFORTS AT THE 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

WEDNESDAY, JULY 14, 2010 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:00 a.m., in 

Room 334, Cannon House Office Building, Hon. Harry E. Mitchell 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Mitchell, Walz, Adler, Hall, and Roe. 

Also present: Representative Holt. 

OPENING STATEMENT OF CHAIRMAN MITCHELL 

Mr. MITCHELL. Good morning and welcome to the hearing on Examining the Progress of Suicide Prevention Outreach Efforts at the 

U.S. Department of Veterans Affairs (VA) for July 14, 2010. 

The Committee on Veterans’ Affairs’ Subcommittee on Oversight 

and Investigations will now come to order. I ask unanimous consent that all Members have 5 legislative days to revise and extend 

their remarks and that statements may be entered into the record. 

I also ask unanimous consent that the statements of Dr. Paula 

Clayton of the American Foundation for Suicide Prevention and 

Penny Coleman from New York be entered into the record. Hearing 

no objection, so ordered. 

I appreciate everyone being here today and for your interest and 

concerns on the progress of suicide prevention outreach efforts. 

Before we begin, I want to acknowledge a positive step that the 

VA has taken recently to help veterans suffering from post-traumatic stress disorder, or PTSD. The VA recently announced it is 

easing the evidentiary hurdle that veterans must clear to receive 

treatment for PTSD. This is a step in the right direction. I am glad 

they are doing it. However, to be truly effective in reaching all veterans who need help, not just those who are already showing up 

at the VA and asking for it, the VA also needs an effective outreach 

strategy. 

We have 23 million veterans in this country, only 8 million of 

which are enrolled to receive care at the VA. The VA has an obligation to the 15 million who are not enrolled for care, not just the 

8 million who are already enrolled. If these other veterans have 

PTSD or are at risk for suicide, the VA has an obligation to reach 


ebenthall on DSK9Q6SHH1PROD with HEARING
2 

out to them as well and let them know where they can turn for 

help. 

Last year upwards of 30,000 people took their lives by suicide in 

the United States. Twenty percent of these deaths were veterans. 

Each day, an estimated 18 veterans commit suicide. By the time 

this hearing concludes between one and two veterans will have 

killed themselves. These statistics are startling. 

As you know, many of our newest generation of veterans, as well 

as those who served previously, bear wounds that cannot be seen 

and are hard to diagnose. Proactively bringing the VA to them as 

opposed to waiting for veterans to find the VA is a critical part of 

delivering the care they have earned in exchange for their brave 

service. No veteran should ever feel that they are alone. 

As Chairman of this Subcommittee, I have repeatedly called 

upon the VA to increase outreach to veterans who need mental 

health services and are at risk of suicide, and Members on both 

sides of the aisle have urged the same. 

In 2008, the VA finally reversed its longstanding self-imposed 

ban on television advertising and launched a nationwide public 

awareness campaign to inform veterans and their families about 

where they can turn for help. As part of this campaign, the VA produced a public service announcement featuring Gary Sinise and 

distributed it to 222 stations around the country, aired it more 

than 17,000 times. The VA also placed printed ads on buses and 

subway trains. 

According to the VA’s own statistics, the effort proved successful. 

As of April 2010, the VA had reported nearly 7,000 rescues of actively suicidal veterans which were attributed to seeing ads, PSAs 

(public service announcements), or promotional products. Additionally, referrals to VA mental health services increased. 

However, despite the success late last year, the public service announcements stopped airing. I don’t understand this. If anything, 

it seems to me we need to be increasing outreach to veterans at 

risk for suicide, not stopping it. It is my understanding that VA is 

planning to produce a new public service announcement, which will 

be ready by the end of this year. 

However, the question remains, why did the VA stop running the 

first public service announcements while they worked on the second one? How does this help veterans to go dark for more than a 

year? 

While I commend the additional expansion in outreach that has 

grown in the way of brochures and other useful steps, I do not 

think the VA should suspend, even temporarily, outreach efforts 

like the public service announcements that have proven so successful. It is also imperative for the VA to utilize and adapt to technology, including the use of Facebook and Twitter, to reach the latest generation of veterans. Doing so I believe will help transform 

VA into a 21st Century organization and, most importantly, save 

lives. 

Today, the Subcommittee is assessing the suicide prevention outreach program on national implementation and achievements. We 

have a wide range of testimony that will be presented today, and 

I look forward to hearing all that will be said on this vitally important issue. We appreciate our panelists’ dedication to the formulaVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
3 

tion of a more comprehensive and targeted suicide prevention outreach program. These struggling veterans deserve our help. We 

must continue to work on breaking the stigma associated with asking for help. We cannot wait for veterans to go to the VA. The VA 

needs to go to them. Additionally, we must work in a bipartisan 

way to ensure the VA delivers the resources our veterans have 

earned. 

Before I recognize the Ranking Republican Member for his remarks, I would like to swear in our witnesses. I ask that all witnesses stand and raise their right hand, from all three panels. 

[Witnesses sworn.] 

Mr. MITCHELL. I now recognize Dr. Roe for opening remarks. 

[The prepared statement of Chairman Mitchell appears on p. 50.] 

OPENING STATEMENT OF HON. DAVID P. ROE 

Mr. ROE. Thank you, Mr. Chairman. I appreciate your calling 

this hearing today to review what the VA has done in the area of 

outreach to veterans in our communities who are feeling vulnerable 

and uncertain of their future. 

I cannot imagine what goes through the mind of someone seeking 

to end their life, but we must do anything we can to ease their pain 

and to help them through this crisis that they find themselves in 

so that they can move forward and heal the wounds from which 

they are suffering. 

Public Law 110–110 was signed on November 5, 2007, by President Bush. This law, as part of the comprehensive program of suicide prevention among veterans, provided that the Secretary may 

develop a program for a toll-free hotline for veterans available and 

staffed by appropriately trained mental health personnel at all 

times and also designated that the Secretary would provide outreach programs for veterans and their families. 

As part of this outreach, the VA contracted with the PlowShare 

Group, Inc., to distribute, promote, and monitor a public service announcement featuring actor Gary Sinise, who played Lieutenant 

Dan in the movie Forrest Gump and also performs with the Lieutenant Dan Band. This moving PSA, which can still be found on 

YouTube, encourages veterans to contact the toll-free national suicide hotline in an emotional crisis. 

According to PlowShare, their work on this campaign was successful as they were able to generate nearly $4 million in donated 

media and the suicide hotline saw an increase in activity during 

the campaign, as the Chairman mentioned. 

The VA also piloted outreach advertising right here in the metro 

area of Washington, DC, driving around the city and on the metro 

bus system, and signs could be seen in various locations promoting 

the hotline to veterans. 

What I look forward to learning in the hearing today is the following: Have we seen a reduction in the number of veteran suicides 

since the inception of PSAs, whether the plan is there to continue 

the PSAs now that the contract for the previous PSA has expired, 

and how has the national suicide hotline helped in the reduction 

of veteran suicides, and where do we go from here? 

I am pleased that the witnesses from our veteran community are 

here today as well as the VA so that we can hear from everyone 


ebenthall on DSK9Q6SHH1PROD with HEARING
4 

how useful the previous PSAs were and what other kinds of outreach efforts need to be made to reach not just our older veteran 

population, but our new veterans coming out of Iraq and Afghanistan, and how the VA is using new media to get information out 

to our new set of veterans who may not be aware of all the services 

that the Department provides. We need to review and evaluate the 

successes of outreach efforts on an ongoing basis and see where 

they can be improved and enhanced as well as how frequently they 

are being broadcast to the general public. 

And again, Mr. Chairman, I thank you for holding this hearing 

and I yield back my time. 

[The prepared statement of Congressman Roe appears on p. 51.] 

Mr. MITCHELL. Mr. Walz. 

OPENING STATEMENT OF HON. TIMOTHY J. WALZ 

Mr. WALZ. Well thank you, Chairman and Ranking Member Roe, 

and I appreciate your continued commitment to providing the oversight and responsibility that this Subcommittee has. I thank all of 

you for being here today. But I know no one in this room needs to 

be reminded, but I said here looking at the picture of Sergeant 

Coleman Bean and his mother who is going to speak to us in just 

a moment, this is the face of why we are here. There is no higher 

calling that we do here in the protection of these warriors that are 

willing to go and protect our freedoms, and I think that obligation 

and that responsibility is very apparent on everyone here that this 

is a zero sum game. One Coleman Bean is too many, and we need 

to get this right. 

I am very encouraged to see we have in this room, and it is 

something many of you have heard me talk about often, we have 

U.S. Department of Defense (DoD) here, we have VA here, we have 

veterans service organizations (VSOs) here, we have the private 

sector here, we have the Congressional oversight here. We are 

starting to understand that this is a very complex project. It is 

going to have to be multidisciplinary across all these agencies, we 

have to get seamless transition right. We have to bring to bear on 

this problem all the resources this Nation can have. It is a moral 

responsibility, and it is a national security responsibility. 

A mother lost this beautiful young man. We as a society lost one 

of our best and brightest. The world is weaker and worse for this, 

and we can do something about it. 

So I am encouraged that we are here. I am, like many of you, 

searching for ways we can do this better, but the commitment 

amongst all of you here, I know, is unwavering. And I am personally very appreciative of it. And when we get to that zero sum, that 

has to be our goal. We may never get there, but we have an obligation to try. So thank you, Mr. Chairman, and I yield back I look 

forward to hearing from our witnesses. 

Mr. MITCHELL. Thank you. Mr. Adler. 

OPENING STATEMENT OF HON. JOHN H. ADLER 

Mr. ADLER. Thank you, Mr. Chairman. I share your comments, 

those of Dr. Roe and Sergeant Walz. I want to particularly direct 

my attention with gratitude to Linda Bean of New Jersey, my 

State. It would have been enough just to let your son serve in the 


ebenthall on DSK9Q6SHH1PROD with HEARING
5 

military and serve two tours in Iraq, serve our country valiantly, 

heroically, and to have lost him is a loss you can’t ever get back. 

You could then go away and not talk out, but instead, Ms. Bean, 

you choose to keep your son’s memory alive by helping other people, by reaching out to other folks returning from Afghanistan, 

from Iraq and from missions around the world to keep us safe here 

at home, and that is an ongoing patriotism consistent with your 

love for your own son and his own patriotism. So I am grateful to 

you, to all the experts, the DoD, VSOs, private sectors, as Sergeant 

Walz said, but particularly Ms. Bean you take the time to share 

with us your own experience, Coleman’s experience so that we can 

learn from it and avoid recurrences. 

Thank you. I yield back. 

Mr. MITCHELL. At this time I would like to welcome panel one 

to the witness table. 

And joining us on our first panel is retired Warrant Officer Mel 

Citron, a Gulf War and Operation Iraqi Freedom (OIF) veteran 

from Woodbridge, Virginia, and Mrs. Linda Bean, a mother of an 

OIF veteran from Milltown, New Jersey. If both of you would 

please come and sit at the table. 

I ask that all witnesses stay within 5 minutes of their opening 

remarks. Your complete statements will be made part of the public 

record. 

Mr. Citron, you are recognized for 5 minutes. 

STATEMENTS OF WARRANT OFFICER MELVIN CINTRON, USA 

(RET.), MANASSAS, VA (GULF WAR VETERAN AND OIF VETERAN); AND LINDA BEAN, MILLTOWN, NJ (MOTHER OF OIF 

VETERAN) 

STATEMENT OF WARRANT OFFICER MELVIN 

CINTRON, USA (RET.) 

Mr. CINTRON. Thank you. Mr. Chairman, distinguished Members 

of the Committee on Veterans’ Affairs. My name is Melvin Cintron. 

I was a flight medic conducting forward area medical evacuation in 

support of U.S. and enemy wounded personnel, civilian, military 

and enemy prisoners of war. 

I am also a veteran of Iraq Freedom War on Terrorism. I am extremely proud of my service to our country. I have been submitted 

for Combat Air Medal in Desert Storm and the Army Bronze Star 

Medal, which I did receive for my services in this last tour as an 

aviation maintenance officer. 

I have no regrets for answering the call and would proudly do so 

again, despite the fact that it came at a great cost to me and my 

family financially, physically, socially and mentally. 

However, I am often ashamed to enter the VA for help, having 

seen so many of my fellow soldiers that have paid an even much 

higher price for their service. I am here today in hopes that my testimony will help improve the support for them. 

I would like to make clear that I personally know that the VA 

has many caring and committed professionals. My testimony is reflective of the system, not of the dedicated and committed personnel of the Veterans Administration. 


ebenthall on DSK9Q6SHH1PROD with HEARING
6 

When I entered the VA medical center, I see a poster saying, it 

takes the courage of a warrior to ask for help. But the poster 

should read, it takes the courage of a warrior to ask for help from 

the VA. 

There are numerous examples of failures our veterans encounter 

when seeking help from the VA. But this Committee is seeking specific input on the VA’s suicide prevention efforts and hotline. 

Make no mistake, I consider myself extremely blessed. I have the 

ability to provide for my loved ones, two arms to hug my children, 

full sight to see my family, two legs which led me here to testify, 

not for my own need, but as stated, in hopes that in some way I 

can contribute to providing better support for others who may not 

be as blessed. 

Their need for timely help from the VA should never be compromised. I feel strongly that the VA suicide prevention efforts and 

hotline are not working since it is too much of a last alternative 

with little else in between before getting there. 

Have you heard the recording when veterans call the VA? Either 

you don’t have enough of a problem and you can wait, sometimes 

for weeks for an appointment, or you’re suicidal. 

Distinguished ladies and gentlemen, I believe that there is a 

large void that exists between the no problem type strategy and the 

suicidal stigma strategy. Not having that void filled with intermediate prevention tools and mitigation strategies will only continue to fuel the need for the forensic type strategy of concentrating 

only on the suicidal hotline. I could easily be wrong, but I believe 

that by the time a veteran is desperate enough to call the suicide 

hotline, it may already be too late. 

In my 19 years since coming back from Desert Storm, and my 

5 years coming back from Iraq, I have met many veterans who 

have broken down while talking to me about their experiences, experiences they held for a long time. I have asked them, why don’t 

you go to the VA for help, knowing the answer. I have advised 

them to call the VA, but they don’t, because they are not suicidal 

and do not want to risk that label for fear of the effect on their 

jobs, their family, or social circles. 

I have interacted with the VA regularly for many years, and I 

am aware of the suicide prevention hotline. However, I do not know 

of a readily or easily accessible intermediate or nonsuicide hotline. 

I apologize for my ignorance if such a system does exist. But if it 

does, and so many don’t know of it, then the system obviously 

needs better marketing, promotion, and outreach, or at least as 

much as is done with the suicide hotline. 

Instead of just suicide hotline, we should provide support long 

before a veteran considers suicide. Veterans need and deserve a 

system of continuing support, a dignified program that addresses 

basic needs of a soldier to talk without the stigma or label of being 

considered a suicidal risk. 

Please help our veterans ask for help in dignity, not in fear, apprehension or labeling. Thank you very much. 

[The prepared statement of Warrant Officer Cintron appears on 

p. 51.] 

Mr. MITCHELL. Thank you. At the time I would like to introduce 

Congressman Holt. You are recognized to introduce Ms. Bean. 


ebenthall on DSK9Q6SHH1PROD with HEARING
7 

OPENING STATEMENT OF RUSH D. HOLT 

Mr. HOLT. Chairman Mitchell, Ranking Member Roe, and Members of the Subcommittee, thank you very much for holding this 

hearing and for allowing me the courtesy and giving me the honor 

of introducing my remarkable constituent, Linda Bean of East 

Brunswick, New Jersey. Linda and her husband Greg are accomplished communications professionals who have lived in central 

New Jersey for many years. For nearly 2 years now, Linda and 

Greg have waged a battle openly and courageously to prevent other 

military families from suffering the kind of loss that they endured 

when their son, Coleman, tragically took his own life in September 

2008 after serving two grueling tours in Iraq. This is Linda’s story 

to tell, and I ask you to give her your full attention. 

I was astounded to learn that servicemembers who are in the Individual Ready Reserve (IRR), as Coleman was, do not receive the 

kind of suicide outreach protection they need and deserve. As the 

Bean family and I discovered, our current suicide prevention efforts 

simply do not encompass these reservists and a number of others. 

I have sent a letter to Secretaries Gates and Shinseki asking 

that to the extent possible under law they implement the kind of 

Individual Ready Reserve suicide prevention program that I have 

advocated and which is included in the House version of the Fiscal 

Year 2011 National Defense Authorization Act. The very least we 

can do for the veterans of Iraq and Afghanistan who are still in the 

Reserve rolls but not in units is ensure that someone from the DoD 

or VA checks in with them periodically over the course of a year. 

If we can afford to send them to war, we can certainly afford a few 

regular phone calls to make sure that they are doing okay, that 

they are readjusting to civilian life and, if necessary, that they get 

the help quickly that they need when they need it, not after it is 

too late. 

I ask for the Subcommittee’s support in this effort and I now ask 

you to turn your attention to someone who can speak far more eloquently than I can about the need for action, Linda Bean. 

Mr. MITCHELL. Thank you, Mr. Holt. Ms. Bean, you are recognized for 5 minutes. 

STATEMENT OF LINDA BEAN 

Ms. BEAN. Mr. Chairman and Members of the Subcommittee, 

thank you for allowing me to appear before you today. Representative Holt, thank you for all your support to my family and for me 

and for your leadership on this issue. 

I testify today because my son, Sergeant Coleman Bean, 25, a 

veteran of two tours of duty in Iraq, shot and killed himself on September 6, 2008. 

I am so grateful for this opportunity. 

Coleman was an amazing man, and he was a proud soldier. I owe 

a duty to my son, and I owe a debt to the men with whom Coleman 

served. 

It is my hope that the observations drawn from a shared experience of loss will be useful to you as you oversee the development 

and the implementation of suicide prevention strategies for the VA. 

First, I would encourage you to accept some facts. Men and 

women come home from service to towns and cities and families 


ebenthall on DSK9Q6SHH1PROD with HEARING
8 

that are far removed from a VA hospital or a Vet Center. Many 

veterans who are at risk for suicide would never call themselves 

suicidal. And some veterans, as I think you well know, either will 

not or cannot use VA services. 

I believe it is crucial for the VA to assume immediately, identify 

and publicize civilian counseling alternatives, including the Soldier’s Project, GiveAnHour and the National Veterans Foundation; 

partner with civilian organizations to assure that all vets have the 

immediate access to the widest possible range of mental health 

care; and encourage media outlets in your district to publicize local 

information on mental health resources for veterans. 

Second, I believe it is critical to implement a simple, straightforward public information campaign that is geared specifically to 

veterans’ families and their friends. It may fall to a grandmother 

or a best friend or a favorite neighbor to seek out help for a veteran 

who is in trouble. Make information on available services easy to 

find, easy to understand, and publish that information broadly. The 

suicide hotline number, as you have already heard, is not enough. 

Finally, I would encourage you to help veterans help each other. 

The VA is confronting PTSD and suicide with new programs and 

new research, and that is all good and important work. But that 

has not always been the case. And there are plenty of veterans who 

will tell you that they have had to scrap and fight for every service 

they have received from the VA. 

In addition to the official patient advocacy complaint resolution 

program, please establish a separate body, one made up of your 

most feisty and tenacious veterans, to help ensure that no one 

gives up because it was too hard or because it took too long to get 

the service that they needed. 

My son joined the Army when he was 18 on September 5, 2001. 

The terrifying tragedy of September 11 confirmed for my son the 

rightness of that commitment. When he came home on his first 

leave, he took a pair of socks, lovingly folded by his mother, and 

he unfolded them and refolded them to Army specifications. It was 

his intention, he said, to be a perfect soldier. 

In the days following Coleman’s death, our family had the humbling experience of meeting with the men with whom Coleman had 

served. They traveled from all over the country to be with us and 

to be with each other, and it was clear to us then that many of 

these men were carrying their own devastating burdens. 

In the days after Coleman’s service, I spent hours on the telephone trying to identify for some of these young men services that 

would assist them as well, and I reached out first to the VA hospitals in the States where those young men lived. I have to tell you 

my inquiries netted some mixed results. 

A VA representative in Texas was horrified when I described for 

him my fear for our young veterans. And he said, Ms. Bean, just 

tell me where he is, I will get in my car, I will go there right now. 

Just tell me where he is and I will go to him. 

By contrast, a man in Maryland told me, if they don’t walk 

through the door, we can’t help them. 

Now, I know that is not correct. Of course we can help them. And 

it is our duty to figure out how, not theirs. 

Thank you. 


ebenthall on DSK9Q6SHH1PROD with HEARING
9 

[The prepared statement of Ms. Bean appears on p. 53.] 

Mr. MITCHELL. Thank you. Ms. Bean, I am very sorry for your 

loss. 

Ms. BEAN. Thank you. 

Mr. MITCHELL. And I want to thank you for your son’s service. 

Ms. BEAN. Thank you Mr. Chairman. 

Mr. MITCHELL. In your testimony you described how you would 

like to see the VA identify and describe, identify and publicize civilian counseling alternatives. 

How do you think the VA should go about this? 

Ms. BEAN. There are a number of established organizations, most 

of them have developed since 2003, that use the services of civilian 

therapists in local communities to help augment whatever services 

the VA has available. The services are confidential, they are free 

of charge, they help veterans and they help the families, and I suspect if the VA posted a notice saying we would be interested in 

hearing what you do they would come to the VA. I am not sure the 

VA is going to have to look that hard to find community-based organizations that want to help soldiers. 

In our own State of New Jersey, there is a hotline for veterans 

staffed by veterans that developed out of the events of September 

11, a similar program, Cop to Cop. I know that there are vet to vet 

programs in a number of States and if somebody wanted to throw 

out the welcome mat and say tell us what you do, I know those 

people would come to you. But if you need a list of resources, Mr. 

Chairman, I have a list and I would be happy to provide that to 

your office. 

Mr. MITCHELL. Thank you. Also from your testimony it is clear 

that you continue to be in contact with other veterans and their 

families as they try to navigate the government bureaucracy in 

search for help. 

Can you tell the VA on how to make information easier and more 

accessible to veterans and their families? 

Ms. BEAN. Veterans who are already in the system know how to 

navigate the VA Web site and they understand the jargon and they 

know how to get from point A to point B. But it isn’t always the 

veteran who is going to be looking for the services. So somewhere 

within that dense content on both the DoD and the VA Web sites, 

there needs to be, and I think I said, a welcome mat. There needs 

to be a notice that says, if you know a veteran in trouble, if you 

have questions, if you think someone is suffering PTSD, click here, 

and make those resources easy to read and easy to understand. 

It is daunting to go through the VA Web site in search of help. 

Mr. MITCHELL. Mr. Cintron, in your testimony you say that the 

VA’s suicide prevention hotline and suicide prevention efforts aren’t 

working. 

Can you please elaborate on why you think that? 

Mr. CINTRON. Yes, sir. I believe, Mr. Chairman, that—and I am 

an aviation safety professional. I have a responsibility for safety. 

The things that we try to do is never go to an accident site but 

rather prevent the accident from happening. But the suicide hotline the way it is, and you are either don’t have a problem serious 

enough to consider and you can wait and make a appointment 3, 

4 weeks down the road, or you are suicidal. There is no intervenVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
10 

tion in between. There is no prevention. There is no strategy there 

to say how do we keep our soldiers and our veterans from getting 

to that stage. 

I am very glad that the hotline is there. Please don’t misunderstand. I think it is needed. However, by not having something in 

the program that allows somebody to just talk or just keep them 

from going to the next level, because they don’t have an outlet, that 

now they will get there, and by the time they reach the suicide hotline it is too late. We could have prevented them from even getting 

there. 

The numbers that you stated today are stunning to me, both in 

the soldiers that we are losing, the veterans that we are losing, and 

in the good way, the ones that we are preventing. But I say we 

could prevent so many more if there was a prevention strategy of 

keeping them from getting to a suicide hotline. 

One of the things that I would like to say, Mr. Chairman, is that 

programs such as are out there for our folks to interact with, are 

critical. But it also has to be part of the military’s program. And 

I will share this example with you. When I came out of Iraq the 

second time around, we were in Fort Dix being outprocessed. As we 

are being given all our out briefings, a sergeant steps up and says 

who here needs to talk to somebody for anything you have seen or 

done? And nobody raised their hand. Nobody said here. He said 

okay, if you want to do it confidentially, we will have a board, a 

tablet that you can sign up on. The day before we left Fort Dix, 

same sergeant stood in an auditorium with that board and read 

those names and said, do you still need to talk to somebody? 

I was one of those soldiers. I did not need to talk to somebody 

at that time. 

So there has to be an interlacing, collaborative effort to also get 

the services involved in having peer-to-peer training in identifying, 

you know we have the buddy system, we have the life saver program for a soldier that doesn’t have to be a trained medic to be 

able to provide that first aid lifesaving technique. They have that. 

We can have the same thing, but we are talking about saving a soldier’s mind and saving their life. 

Mr. MITCHELL. Thank you. 

Dr. Roe. 

Mr. ROE. Thank you all for being here, and Ms. Bean, especially 

you. I have a unique perspective being a veteran and being a physician to have worked with these types of issues during my medical 

career and I can’t tell you how courageous it is and how much I 

appreciate you being here and sharing your testimony. 

Ms. BEAN. Thank you. 

Mr. ROE. I think you and actors like Gary Sinise who have 

stepped up and done an incredible job have more credibility than 

anyone, and I want you to comment certainly on some of the PSAs. 

It brings back to me breast cancer awareness, how we used public 

service announcements to raise awareness among women, and I 

think that has done a great deal in decreasing the incidence of 

breast cancer. And I think the VA, if we talked about suicide or 

talked about suicide ideation, that somehow we would increase the 

incidence. I think it does just the opposite. 


ebenthall on DSK9Q6SHH1PROD with HEARING
11 

And I wanted to hear your comments and both of you, Mr. 

Cintron also, on how you believe that just making people aware 

and then having some place to go, and I could not agree more with 

you, having that in between is very important because I as a physician had patients who said, you couldn’t determine from even sitting down in a fairly long conversation whether they really were 

suicidal. And it is not easy. This is a very difficult diagnosis to 

make. 

So I will be quiet. I want to hear what Ms. Bean has to say about 

that. 

Ms. BEAN. I think that there are families like mine who have experienced the homecoming of a much loved child who is now out 

of harm’s way and you are so grateful that they are back with you 

that you may overlook the fact that they are drinking too much or 

that they are irritated or that they insist on being isolated. And 

you are not empowered, as a mother or a sister or a wife, to go to 

the VA and say, my veteran is in trouble. 

I don’t even know that I would have known how to do that. 

I think, in the way that Mr. Cintron described, we need to make 

sure that people understand there are places to go before you hit 

the suicide hotline. There are veterans who are not, who may in 

the end be alone in a room with a gun to their heads but the day 

before would not describe themselves to you as suicidal. 

So I guess I would go back to my very strong feeling that as part 

of that, in addition to the messaging, we need to make sure that 

there are community-based programs that are easily accessible, 

and we need to make sure that the information that the VA has 

is geared to families and friends in a friendly and accessible way, 

made easily available so people can find it, and that the VA is willing to say, look, if you won’t come here, that is okay, we will help 

you find help somewhere else. 

Is that what you were looking, the answer? 

Mr. ROE. The public service announcements, I think you and the 

public service announcement in New Jersey would be an incredible 

statement for people. 

Ms. BEAN. I guess if you are saying, are there other kinds of public service announcements that would be workable. 

Mr. ROE. Yes. 

Ms. BEAN. I think it would be the public service announcement 

that said, you know, you’re home, you’re drinking too much, you’re 

fighting with your wife, you can’t get along with your boss, you 

need help. 

That is a message that resonates with people who are in that position. The message that says you are home and you are suicidal, 

not so much. 

Mr. ROE. I agree. I agree. 

Mr. Cintron. 

Mr. CINTRON. Yes, sir. I agree. I think there has to be peer counseling both on the family side and on the soldier side. I once read 

in a magazine that had a copy, had a picture of a wall that was 

used as a firing squad wall, and in it, it said, you have never lived 

until you have almost died. For those who fight for it, life has a 

flavor to protect it we will never know. For the veterans, it also has 

a price for that flavor. They cannot just go to a family member and 


ebenthall on DSK9Q6SHH1PROD with HEARING
12 

talk about what that family member would never know. They cannot just go and talk to anyone. 

So even that, in itself, is something that also needs to be addressed so that they feel that a mother is not nagging when they 

say, hey, I think you’re drinking too much or a wife isn’t nagging. 

So those are awareness things that also need to be out there. 

I think there are so many good outreach programs that can be 

done. You have groups here that you must interact with and reach 

those folks that can be reached. The other thing that I would ask 

is that consider the unreached soldier, the person that doesn’t go 

to the VA, the person that doesn’t go to AVA, the person that 

doesn’t think they need help. And all it takes is a simple outreach 

from someone saying, hey, let’s talk about what you did. 

Mr. ROE. I think your comment, Mr. Chairman, and then I will 

yield back, your comment about when you had the sergeant stand 

up is at least a move further than when I ETSed 36 years ago 

when nobody did and I am a Vietnam era veteran and served overseas, and we are doing better, and I think we have to do a lot better. But I know that then there was no outreach or anything, and 

that has steadily improved because of people like yourself being 

willing to stand up and saying something needs to be done. I thank 

you for doing that, and I yield back my time. 

Mr. MITCHELL. Thank you. 

Mr. Walz. 

Mr. WALZ. Thank you and, Ms. Bean, again I echo the comments 

of my colleagues and thank you again for being here, Mr. Cintron, 

and thank you both. You are making a difference and you are continuing your service. And I truly appreciate that. 

I would also mention what Dr. Roe said, it may be a little bit of 

a move forward, but as a senior NCO myself I am just appalled by 

that. I think it goes to a deeper cultural issue. It is mental health 

parity in this Nation and how we view mental health issues. I 

think the good news is, and I would like to say a deep heartfelt 

thank you to my colleague from New York, Mr. Hall, on Monday 

when we got the notice from the VA on the issue of PTSD in trying 

to make this easier for folks, this is a huge step forward on the 

issue we are talking about today. I think we are starting to attack 

this from multiple perspectives. Monday was a very gratifying day 

for me because of that ruling coming down and I was in Hennepin 

County in Minneapolis where we established our State’s first vets’ 

court, which we all know is a way we start to see these things, a 

progression, exactly what you are all talking about is stop it before 

we get to that point, stop it before it escalates from driving on the 

wrong side of the road, drinking and driving, domestic violence 

down the road to these types of things. So I appreciate obviously 

because of your experience and unfortunately in your case, Ms. 

Bean, your personal experience. You are incredibly insightful on 

what needs to happen and I think we are starting to see that happen. I want to hit on one thing with you, Ms. Bean, and I know 

Mr. Holt just left but he mentioned and you explained a little of 

your concern with the IRR, and dropping back, I understand your 

son was on active service his first tour, then he was called back 

through the IRR on the second one. I am concerned with this as 

a former National Guardsman and coming from a State where we 


ebenthall on DSK9Q6SHH1PROD with HEARING
13 

have put a lot of time and thought in the beyond the yellow ribbon 

campaign on when these folks come back, of how we capture them 

in that seamless transition in that care. What did you see in your 

experience where there was a drop-off, both of you, as you see this, 

is it fair for me to say that it is, and Ms. Bean, you mentioned it 

about your view in Texas versus Maryland, those types of things. 

Do you think we are not capturing it as a whole and that it is spotty across the country as you come back on how that care is? 

I would like each you to take a stab at that because we have 

talked about this, of nationalizing this beyond the yellow ribbon 

campaign, to make sure that no matter where you go into service 

or how you go in either active service or IRR, you are still going 

to have that support net. So if you have a comment on that of how 

that affected you. 

Ms. BEAN. Coleman’s first tour of duty was with the 173rd, and 

when they returned from Iraq to Vicenza, Italy, they had mental 

health musters on a regular basis. They were on a base. They were 

together. They had each other. They had shared the same sort of 

experiences, and they had that opportunity to talk things through. 

He was home for I think almost 18 months, recalled to duty 

through the Individual Ready Reserve, and he was assigned to a 

unit of the Maryland National Guard. When they came back out 

of Iraq, the Maryland National Guard went home to Frederick, 

Maryland. Coleman came home to New Jersey. I know that they 

had regular musters in Frederick, mental health musters, health 

musters, weapons checks, all the kinds of things that you would do 

to keep a unit running. Mental health was a part of that. Coleman 

participated in none of that. 

And I know that when the men from that National Guard unit 

came to Coleman’s service and we talked later, they were heartbroken. They didn’t know. And they didn’t know how they could 

have known how to reach out. There wasn’t, for them, for the leadership of that unit, there wasn’t a way for that leadership to reach 

these men who served under their flag but lived in a different 

State. 

And I would say to you, Mr. Walz, it is very, very hard to get 

numbers of soldiers in that circumstance. I don’t think we have a 

clear number of how many IRR soldiers or how many individual 

augmentees may be at risk for suicide. But I think the numbers 

are big. And I think it is a shame that if a man from Wyoming 

serves with the National Guard from California, he should get the 

same help those boys get. 

Mr. WALZ. You are absolutely right. 

Mr. Chairman, I would suggest and I think Ms. Bean has hit on 

something that has troubled me for quite some time is how we 

disaggregate that data and find that out. We see this also with active forces coming back in ones and twos to our States. I have to 

be honest that I see that in Minnesota. You are far better off to 

go with a National Guard unit from Minnesota and be part of that 

community than you are not to. And I bet, I am willing to, anecdotal, but I bet if we disaggregate that I bet you we are seeing better prevention measures amongst that and that would be something that would be very interesting to know. 

Mr. Cintron, before my time is up, any comments? 


ebenthall on DSK9Q6SHH1PROD with HEARING
14 

Mr. CINTRON. Yes, sir. I am your poster child also because I was 

in the IRR, and after 6 years of not being in uniform I got a letter 

in the mail saying that I have been called up. I served my country 

proudly. And I was put in with a National Guard unit from Maryland and New Hampshire and sent to Iraq as an IRR soldier. 

When I came back, I didn’t have any of that support that they 

had. Nobody reached out or said, hey, you are part of this unit, you 

did this, you did that, no, nobody did. 

Mr. WALZ. Did you get a call from a first sergeant or anything? 

Mr. CINTRON. No, I did not, sir. No, I did not, and so if you are 

part, at least my personal experience, being the IRR, having been 

called back, having served, you are done, we are done with you, you 

are not part of the unit. So you don’t get this, you are not part of 

that unit. 

I will even share you with an issue coming back, one of the programs was, which I think would have been an excellent program 

if it continued, was that when the soldiers came back you could actually go with your family to a retreat, to a retreat, you could go 

with your family. After 19 months and countless phone calls because I was not attached to a unit, and I could not get a first sergeant to approve this or a commander to approve that because I 

am not attached to a unit, my wife, who is extremely patient, we 

gave up after 19 months of the bureaucracy because we were not 

part of a unit. 

Mr. WALZ. I know I have gone over my time but I want to hit 

on this. This is something I brought up back home often on this. 

They will not cut you travel orders, they will not pay for you to 

come back. These soldiers would come back if we were paying for 

them to come back, get them a hotel room, let then attend the 30, 

60, 90, 120-day out processings on these retreats. This has been an 

ongoing problem. 

I think it comes back to, and I will leave it at this, very frustrating on this. People like these two folks here and others have 

been talking about this for a long time. We know this is an issue 

and now we just need to address it. So I thank you both. 

Mr. MITCHELL. Thank you. 

Mr. Adler. 

Mr. ADLER. Mr. Chairman, thank you. I want to follow up on 

what Mr. Walz was saying. I am very grateful for the two of you 

to make this so real for me. I think that the panelists and at least 

for me to give me some takeaways so that I can go do things starting today. 

Mr. Cintron, you mentioned Fort Dix. I have the privilege of representing Fort Dix. I plan to call the base commander today, not 

to find out who the sergeant was a few years ago who was a little 

insensitive with respect to you and some other folks, but maybe to 

alert her so she can alert the various folks, people who are deploying and returning that show sensitivity for individual needs and on 

a discreet, confidential basis because folks aren’t going to raise 

their hands in a big crowd and say I need help with something. 

Ms. Bean, thank you for being a New Jersey person. We have 

fantastic yellow ribbon clubs throughout New Jersey, certainly at 

least in my area. Every soldier, sailor, Marine, Coast Guardsman, 

Navy person who returns from overseas from anywhere has a welVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00018 Fmt 6633 Sfmt 6633 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
15 

come home party. That is great. But maybe some of these organizations could also followup people afterwards 30 days, 60 days, 90 

days, if somehow they are falling through the cracks governmentally, there are lots of very caring people who really want to 

celebrate the human being, not just somebody that wore a uniform 

and went overseas but the actual human being that did this mission for America. And I think some of those folks would be very 

willing to schedule followups so it is not just one parade and then 

forgotten but actually treating each person holistically, even episodically, the way Tim said first sergeants might want to call. 

There are volunteers who would be just as committed in terms of 

helping individuals. 

So I thank you for at least giving me ideas of what I can do in 

New Jersey to help avoid Coleman Bean’s situation for the next 

tier that comes back from overseas. 

And I thank both of you. 

Mr. MITCHELL. Mr. Hall? 

Mr. HALL. Thank you, Chairman Mitchell and Ranking Member 

Roe, and thank you to our witnesses for graciously appearing and 

testifying before us today. 

I will submit a statement for the record. 

[No statement was submitted.] 

But I would just like to ask Ms. Bean, first of all to thank you 

for your strength and clarity, appearing and speaking before us. I 

know how difficult that is but I think I can imagine how difficult 

that must be to speak about your son and I commend you for being 

willing to put that aside to help other veterans and their families. 

It has been obvious to many of us that when a person joins the 

military they should also be automatically enrolled in the VA and 

members of the Armed Forces and their families should have access to information or education about assimilating back into civilian life, into their families, into their communities before, during 

and after deployment. 

One of the problems, as I see it, is that the Veterans’ Affairs 

Committee has one piece of jurisdiction, the Armed Services Committee has another one, on the Executive side the DoD has one 

piece and then the VA has another piece, and there is not that 

overlap and that seamless transition that we have talked about in 

so many ways, not just medical records, but mental health followup. 

So perhaps, Ms. Bean, you can start a little bit about what kind 

of information or resources were available to you and to your son 

before he took his life and what kind of outreach was there. And 

you have told us a little about what you would like to see available, 

but was there anything of substance? 

Ms. BEAN. We have a strong VA system in New Jersey. When 

Coleman came home from his second tour of duty, VA services were 

certainly available to him. Mental health care is at a premium, and 

it is difficult to get an appointment in a timely fashion. 

I don’t know when or how Coleman called the VA to seek out 

mental health assistance, but it is something that we learned of 

only after Coleman had died. 

I didn’t know, and this is a gap in my own understanding as 

much as anything else, I didn’t know what else was available. I 


ebenthall on DSK9Q6SHH1PROD with HEARING
16 

didn’t go looking for something else to be available. And it wasn’t 

until Coleman had died that I learned that there were many other 

programs that could have been available. 

I keep going back to the idea that our local newspapers run Little League box scores, we run the Butterball Turkey hotline on 

Thanksgiving, we put out notices about bowling leagues. I think 

our local newspapers and radio stations could run a little box of resources; if you are a vet, if you are a soldier, if you are family, you 

can go to these places for help, and that list could include the VA 

hospitals and the Vet Centers, but it needs to go beyond that to 

include civilian resources, localized civilian resources. 

And I am not sure I am answering your question. 

Mr. HALL. That is helpful. Thank you. 

Mr. Cintron, would you discuss the kinds of prevention that 

might help a veteran from reaching the point where they take their 

own life? We have heard about how Coleman and other veterans 

had not exhibited or used the word ‘‘suicide’’ and had not exhibited 

those tendencies until it is too late. And so what kind of outreach 

would you suggest could reach a veteran before they get to that 

point? 

Mr. CINTRON. I think there are a few outreach efforts that can 

be done. But the first effort has to be to have the people to reach 

out to, and that can reach out to the folks, and they have to have 

some minimal training, not a lot. All it takes oftentimes, and like 

I said, I have encountered many veterans and for some reason they 

start talking to me and share their experience, and it is like, wow, 

you don’t know that weight that was on me. And it just lingers 

with them and all they wanted to do was get it out at least once 

with someone that can understand, not to judge, but just to listen 

to them. That is what is needed. 

Those outreaches, I think when you get with some of the groups 

that are available to us, if there is a combined effort with the 

groups, find the synergy with them and with the governmental organization, so that we all own part of the solution. It is not just 

the VA solution, it is not just the DoD solution, it is not just the 

solution of any individual program. It is a combined solution. We 

all own part of it. 

So the outreach would be obviously training and identifying personnel who are willing to take a call at anybody. I give my phone 

to friends and to veterans that I meet and I say hey, if you ever 

have an issue give me a call, and I have actually received calls in 

the middle of the night. Man, I can’t sleep tonight, I was just 

thinking about this, and we talked through, and we are done. But 

having that available, that outreach, the ability to call somebody, 

and it doesn’t have to be somebody that they really know but somebody that knows what it is they are going through. 

Mr. HALL. Thank you. I know I am over my time, but I would 

just mention that this Committee has—the full Veterans’ Affairs 

Committee on the House side has voted to give funding not just for 

PSAs, as Ranking Member Roe mentioned, but for paid advertising 

and Iraq and Afghanistan Veterans of America (IAVA), who we will 

hear from shortly, partnered with the Ad Council in one effort to 

put together an ad that is more powerful than the average PSA. 

Public service announcements run in the middle of the night usuVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
17 

ally because that is when the time is cheapest and the TV station 

will give it up to do their public service, whereas what we really 

need I believe is advertising during the Super Bowl, during American Idol, during the highest rated shows during prime time where 

the half hour—I mean the 30-second spot or the 1-minute spot 

costs the most money. But we are willing to do that, to advertise 

be all that you can be or the few, the proud, the Marines, you know 

the lightning bolt coming down into the sword. So if we want to 

attract and recruit people to go into the armed services and go fight 

for our country we will spend the money for prime time advertising, but when it comes time to help them find the resources they 

need to stay healthy after they come home, we want to do it on the 

cheap and just do it at 3:00 in the morning on a PSA, and I think 

that needs to change to something we in Congress should fund so 

that the outreach is just as strong afterwards as it is before they 

were recruited. 

I yield back. 

Mr. MITCHELL. Thank you. 

And again, Ms. Bean, I am very sorry for your loss and I want 

to thank you for your son’s service and for you being here today. 

Mr. Cintron, same with you, thank you for your service and I 

think you have both done a terrific job today to help further try to 

solve this big problem. So thank you very much. 

Mr. CINTRON. Thank you, Mr. Chairman and Members of the 

Committee. 

Mr. MITCHELL. At this time, I would like to welcome Panel two 

to the witness table. 

For our second panel we will hear from Tim Embree, Legislative 

Associate for the Iraq and Afghanistan Veterans of America; Jacob 

Gadd, Deputy Director for Veterans Affairs and Rehabilitation 

Commission of the American Legion; and Dr. Thomas Berger, Executive Director of the Veterans Health Council for Vietnam Veterans of America (VVA). 

And like the other panelists, I ask that you please keep your 

comments to 5 minutes. Your complete statement will be entered 

into the record. 

I would first like to recognize Mr. Embree for 5 minutes. 

STATEMENTS OF TIMOTHY S. EMBREE, LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA; 

JACOB B. GADD, DEPUTY DIRECTOR, VETERANS AFFAIRS 

AND REHABILITATION COMMISSION, AMERICAN LEGION; 

AND THOMAS J. BERGER, PH.D., EXECUTIVE DIRECTOR, VETERANS HEALTH COUNCIL, VIETNAM VETERANS OF AMERICA 

STATEMENT OF TIMOTHY S. EMBREE 

Mr. EMBREE. Thank you, sir. 

Mr. Chairman, Ranking Member, and Members of the Subcommittee, on behalf of Iraq and Afghanistan Veterans of America’s 180,000 members and supporters, I would like to thank you 

for inviting us to testify before your Subcommittee. 

My name is Tim Embree. I am from St. Louis, Missouri, and I 

served two tours in Iraq with the United States Marine Corps Reserves. Veteran suicide is an issue that resonates with all of our 


ebenthall on DSK9Q6SHH1PROD with HEARING
18 

members, and we are grateful that you are holding this hearing 

today. This issue is of particular importance to me because I lost 

one of my Marines to suicide in 2005. 

Last year, more U.S. servicemembers died by their own hands 

than in combat in Afghanistan. Most Iraq and Afghanistan Veterans of America, or veterans, know a fellow warfighter who has 

taken their own life since coming home. 

As the suicide rate of our servicemembers and veterans continues 

to increase without any signs of abating, we must acknowledge 

that suicide is only one piece of the mental health epidemic plaguing our returning warfighters. Left untreated, mental health problems can and do lead to substance abuse, homelessness, and suicide. 

For a veteran considering suicide, the act of reaching out to those 

close to them can often seem overwhelming. The act of a simple 

anonymous call to the VA’s National Suicide Prevention Lifeline 

might be enough to save the life of a veteran who is struggling, 

feeling alone, and hopeless. IAVA proudly supported the Joshua 

Omvig Veteran Suicide Prevention Act, which established this important hotline, and we are encouraged to see some of the new programs the VA has implemented to help returning veterans. 

The heavy stigma associated with mental health care stops many 

servicemembers and veterans from seeking treatment. More than 

half the soldiers and Marines in Iraq who tested positive for psychological injury reported concerns that they would be seen as 

weak by their fellow servicemembers. 

To end the suicide epidemic and forever eliminate the stigma associated with combat stress, the VA and DoD must declare war on 

this problem and must launch a nationwide campaign to combat 

stigma and promote the use of DoD and VA services, such as the 

Vet Centers and the National Suicide Prevention Lifeline. This 

campaign must be well funded, research tested, and able to integrate key stakeholders such as veteran service organizations and 

community-based nonprofits. 

Through our own historic public service announcement with the 

Ad Council and the help of some of the world’s best advertising 

firms, IAVA has learned a lot about stigma busting and veteran 

outreach campaigns. Millions of Americans continue to see our uncomplicated, yet iconic PSAs, such as the one featuring two young 

veterans shaking hands on an empty New York street. These TV 

ads are just one component of this ground-breaking campaign. 

They are complemented by billboards, radio commercials, and Web 

ads, which have blanketed the country and touched countless 

Americans. 

This cutting-edge campaign directs veterans to an exclusive online community, communityofveterans.org. This exclusive community shows our Nation’s new veterans that we have your back. 

Once inside a community of veterans, these vets are directed to 

a wide range of mental health, employment and educational resources operated by private, nonprofits, and the Department of Veterans Affairs. This campaign is an example of the innovation coming out of the VSO and nonprofit communities, which the VA 

should treat as an asset. Innovative, aggressive outreach programs 

like this should become part of the new VA culture and they can 


ebenthall on DSK9Q6SHH1PROD with HEARING
19 

fuel inject outreach efforts. IAVA is learning what works, and we 

want to share our knowledge. 

Additionally, IAVA supports creative solutions for rural veterans. 

We support contracting at the local community mental health clinics and extending grants to groups that provide programs such as 

peer-to-peer counseling. Veterans must be able to receive mental 

health care near their personal support system, whether that system is in New York City or Peerless, Montana. 

Our veterans are facing a mental health epidemic. Unless we address the overall issue of mental health stigma, we will never be 

able to stem the growing tide of suicides. The VA and DoD have 

created many programs that are extremely effective in helping 

servicemembers and veterans who are hurting, but great programs 

are worthless if servicemembers and veterans don’t know they 

exist, cannot access them, or are ashamed to use them. 

IAVA is proud to speak on behalf of the thousands of veterans 

coming home every day. We will continue to work tirelessly so veterans know we have their back. Thank you for your time today, 

and I look forward to answer any questions you may have. 

[The prepared statement of Mr. Embree appears on p. 54.] 

Mr. MITCHELL. Thank you. 

Mr. Gadd. 

STATEMENT OF JACOB B. GADD 

Mr. GADD. Mr. Chairman and Members of the Subcommittee, 

thank you for this opportunity to submit the American Legion’s 

views on the progress of suicide prevention efforts to the Subcommittee today. 

Suicide among servicemembers and veterans has always been a 

concern. It is the position of the American Legion that one suicide 

is too many. The tragic and ultimate result of failing to take care 

of our Nation’s veterans’ mental health illnesses is suicide. 

Turning first to VA’s efforts in recent years with mental health 

care, the American Legion has consistently lobbied for budgetary 

increases and program improvements to VA’s mental health programs. Despite the increased funding, the number of 

servicemembers and veterans with PTSD and traumatic brain injury (TBI) continues to grow. VA has seen more mental health patients with fewer resources and staff. 

Of the 30,000 suicides reported among the general population 

every year, VA reports 20 percent of those suicides are veterans. 

In a recent AP article, it was cited that there have been more suicides than servicemembers killed in Afghanistan. 

In regards to suicide prevention outreach efforts, VA founded the 

National Suicide Prevention Hotline where veterans are assisted by 

a dedicated call center in Canandaigua, New York. VA also hired 

local suicide prevention coordinators at all 153 VA medical centers. 

One of the primary responsibilities of the local suicide prevention 

coordinators is to track and monitor veterans who are placed on 

high risk of suicide. A safety plan for that individual veteran is created to ensure they are not allowed to fall through the cracks. 

In 2009, VA also instituted an online chat center for veterans to 

further reach those veterans who utilize online communications. 

And as was mentioned earlier, VA has also targeted outreach camVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00023 Fmt 6633 Sfmt 6633 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
20 

paigns, which has included billboards, signage on buses, and PSAs 

to encourage veterans to contact VA for assistance. 

The American Legion has been at the forefront of helping to prevent military and veteran suicides in the community. Last year 

during our national convention, we adopted Resolution 51, the 

American Legion’s Policy on Suicide Prevention and Outreach. And 

Dr. Janet Kemp, who is with us today, also provided training to 

our VA and our commission members. And then after the training, 

American Legion State, district and post volunteers have established programs to refer veterans in distress with the suicide prevention hotline. 

Also, in December, 2009, the American Legion took the lead in 

creating the Suicide Prevention Assistant Volunteer Coordinator 

position description under the auspices of VA’s Voluntary Service 

Office. 

Despite the recent suicide prevention efforts, more still needs to 

be done as the number of suicides continues to grow, and as we all 

know, the challenges still exist. The American Legion’s System 

Worth Saving program conducts site visits to VA medical center facilities annually, including this year going to Canandaigua, New 

York to report firsthand on some of the progress that is being 

made. 

One of the first problems we wanted to discuss was recruiting 

psychologists. The VA has a goal to recruit from their current level 

of 3,000 psychologists to 10,000 to meet the demands for mental 

health services. 

Second, the budget. The American Legion applauded Congress 

for passing advanced appropriations, but delays still persist within 

VA itself in allocating budget funds from VA’s Central Office to the 

Veteran Integrated Service Networks, and down, finally, to the VA 

medical center. So the American Legion continues to advocate for 

additional funding to meet the demand for mental health care and 

urges Congress to provide oversight that those mental health dollars are being used to their full intent. 

Additionally, the issue of a lack of interoperable medical records 

between DoD and the VA, which is currently being addressed by 

the lifetime virtual electronic medical record, still exists. In addition, the American Legion recommends VA take the lead in developing a joint database with DoD, the National Center for Health 

Statistics, and the Centers for Disease Control to track suicide 

trends nationally, and have the numbers for the military as well 

as for veteran suicides. 

The American Legion continues to be concerned about the delivery of health care to rural veterans. No matter where a veteran 

chooses to live, VA must continue to expand and bring needed medical services to the highly rural veteran population through telehealth, virtual reality exposure therapy, and online technologies. 

The American Legion has seven recommendations to improve 

suicide prevention efforts: First, that Congress exercise oversight 

on VA and DoD programs to ensure maximum efficiency and compliance. 

Second, Congress should appropriate additional funding for mental health research and a standardized DoD and VA screening diagnosis and treatment protocols. 


ebenthall on DSK9Q6SHH1PROD with HEARING
21 

Third, DoD and VA expedite development of a joint medical 

record to better track and flag veterans with mental health illnesses. 

Four, that Congress allocate separate mental health funding for 

VA’s recruitment and retention incentives for behavior health specialists. 

The rest of my recommendations are included in the written testimony. 

In conclusion, Mr. Chairman, VA has increased its efforts in support for suicide prevention but must continue to work with veteran 

service organizations, such as the American Legion, to improve outreach. The American Legion is committed to working with DoD and 

VA in providing assistance to increase involvement. 

Thank you for allowing me to submit testimony today. 

[The prepared statement of Mr. Gadd appears on p. 58.] 

Mr. MITCHELL. Thank you. 

Mr. Berger. 

STATEMENT OF THOMAS J. BERGER, PH.D. 

Dr. BERGER. Chairman Mitchell, Ranking Member Roe, and distinguished Members of the Subcommittee on Oversight and Investigations, Vietnam Veterans of America thanks you for the opportunity to present our views on examining the progress of suicide 

prevention outreach efforts at the VA. We also want to thank you 

for your overall concern about the mental health care of our troops 

and veterans. 

Suicide is most often the result of unrecognized and untreated 

mental health injury, including depression, post-traumatic stress 

disorder, and traumatic brain injury. Those are three of the most 

common mental health injuries and conditions that can lead to suicide, and these three conditions in particular are medical conditions that can be life threatening. 

In more than 120 studies of a series of completed suicides, according to our colleagues at the American Foundation for Suicide 

Prevention, at least 90 percent of the individuals involved were suffering from a mental illness at the time of their death. The most 

important interventions are recognizing and treating those underlying illnesses, such as depression, alcohol and substance abuse, 

post-traumatic stress, and traumatic brain injury. 

Many veterans, and obviously active military people, resist seeking help because of the stigma associated with mental illness or 

they are unaware of the warning signs and treatment options. 

These barriers must be identified and overcome. 

But I think we need to also put this hearing or the call for this 

hearing in the proper historical context, and that is, in May 2008, 

then Secretary of the VA, General Peake, chartered the Blue Ribbon Work Group on Suicide Prevention in the Veteran Population. 

Its function was to provide advice and consultation to him on various matters relating to research, education and programs, as well 

as improvements relevant to the prevention of suicide in the veteran population. Subsequently, on September 16, 2008, the House 

Veterans Subcommittee on Health held an oversight hearing on the 

VA’s suicide hotline. As part of the press release for this hearing, 

VA announced that Secretary Peake had received recommendations 


ebenthall on DSK9Q6SHH1PROD with HEARING
22 

from this Blue Ribbon Panel, eight recommendations and findings, 

as well as a series of 14 other elements. While all those recommendations and findings are contained in my written report, I 

will just read to you panel finding number six: 

‘‘Efforts to improve accurate media coverage and disseminate 

universal messages to shift normative behaviors to reduce population suicide risk are not being fully pursued.’’ 

Now, suicide prevention of course starts with leadership, but it 

has been almost 2 years now since the Blue Ribbon Work Group 

finished its work and we have yet to see any formal action plan 

that addresses each of the group’s findings and recommendations 

in a comprehensive, prioritized fashion. In fact, no one outside a select group of bureaucrats at the Veterans Health Administration 

(VHA) has probably ever seen this complete report, which of course 

was funded with taxpayer dollars. 

This Committee must ensure that our veterans and their families 

are given access to the resources and programs necessary to stem 

the tide of suicide. We have heard of some attempts to do that. 

Where is the plan, the overall plan to do it? The first step in the 

process is knowing what has been recommended by the best medical scientists the VA could assemble to study the problem, and 

that is the report I referenced earlier. What is being done to implement those recommendations and address the findings of those experts? 

Once again, on behalf of VVA, I thank you for your leadership 

in holding this hearing on this topic, and I also thank you for the 

opportunity speak to this issue directly. I will be glad to answer 

any questions later on. 

[The prepared statement of Dr. Berger appears on p. 61.] 

Mr. MITCHELL. Thank you, Dr. Berger. 

Mr. Embree, I am very impressed by the PSA campaign that the 

IAVA ran with the Ad Council. You did this on a fraction of the 

budget that the VA has, and you clearly saw a vision and wanted 

to air it. Why do you think the VA has such a hard time recreating 

what the IAVA has done? 

Mr. EMBREE. Sir, thank you for the question. I think one of the 

major problems is that we understand that vets help vets. Young 

vets coming back from Iraq and Afghanistan right now can speak 

to each other. If you are a first sergeant that served in Iraq, you 

can talk to a PFC that served in Iraq because you have a lot of 

the same experiences, you understand what is going on. Vets help 

vets, and we can talk to each other. And we understand that feeling, like in our first PSA, of that young soldier walking to the airport felt alone; in fact, that is the title of the commercial, it is 

called ‘‘Alone.’’ Because a lot of us vets have come back, we know 

that feeling, we remember that feeling very strongly, that first time 

when you are sitting there in a crowd and you feel like it is just 

you. We can speak to that. And we also understand what it is like 

when another veteran comes up and shakes your hand or just talks 

to you, how all of a sudden the world comes alive again, you feel 

part again, you feel part of something bigger. 

I think the VA for too long has been dealing with issues that 

have affected past generations, and they haven’t recognized that 


ebenthall on DSK9Q6SHH1PROD with HEARING
23 

those issues are affecting this new generation of veterans just in 

different ways and we are dealing with them in different ways. 

So I think that the VA is treating some of the old problems and 

not recognizing that those are the same problems just in different 

forms now. So I think the VA needs to reach out to the veteran 

service organizations, such as Afghanistan and Iraq Veterans of 

America, Student Veterans of America, and some of the other larger veterans service organizations to talk to the newer vets and to 

find out what is affecting us. 

Because I remember when I saw the VA PSA, it was about 2:00 

in the morning, I think it was actually one of those nights when 

I couldn’t sleep because I came from a deployment and I had no 

idea what was going on. There was a bunch of World War II memorabilia around, and Lieutenant Dan from Vietnam with Forrest 

Gump was talking to me. That didn’t speak to me, it didn’t make 

any sense to me. But when I see two young veterans walking up 

to each other and shaking hands and the world coming back to life, 

that made sense to me, that hit me, I understood what was going 

on with those guys. 

Mr. MITCHELL. The IAVA has secured $50 million in donated 

media, reaching millions of veterans and their families. What lessons learned can the VA gain from your experiences in creating a 

new energy and new support? Maybe you just mentioned it. 

Mr. EMBREE. Yes, sir. But also I think it means they need to 

work with a lot of these cutting-edge firms, some of these advertising firms that their job is to market products to people, to help 

you understand how to talk to the families, how to get mom to see 

a commercial or to see an ad at a bus stop or on Facebook and then 

go and talk to their son or daughter who may be dealing with these 

issues, or the wife or husband of a soldier or Marine or airman or 

sailor. 

So I think it has to be more than just we put ads on a bus. I 

mean, if you have seen the VA ad on a bus, it is very hard to read; 

it is a lot of words, and unfortunately buses are mobile, so trying 

to read the small print is very hard to catch. 

So I think that the need to listen to the private side and also the 

nonprofit world and find out what works, how do you get to your 

customers, how do you get to your members? 

Mr. MITCHELL. And one last one to you, Mr. Embree: What actions can the DoD do to facilitate the VA’s mission to prevent suicide? 

Mr. EMBREE. Yes, sir. With the DoD, I think it is an even larger 

issue. I think they need to help with the stigma campaign, but I 

think they also need to implement training for your junior officers 

and your young noncommissioned officers. The way I like to explain 

it is, if you are a young Marine and you roll your ankle on a run, 

you come back to the squad bay, you don’t just keep walking 

around on a swollen ankle, you go to the doc, you go to the corpsman and you say, hey, doc, something is wrong with my ankle, I 

need to figure out how to get better, how to get back in the fight. 

It needs to be the same thing with mental health injuries. We need 

to make sure that that platoon sergeant or that corporal as a squad 

leader or that platoon commander can recognize these injuries and 

say, hey, private so and so, it looks like something is going on with 


ebenthall on DSK9Q6SHH1PROD with HEARING
24 

you, we need to go get you treatment so you can get better and 

make our fighting force stronger, so you can come back in the fight, 

get back to the platoon. 

So we need to teach our young leaders in the military how to recognize these injuries and treat them before they get too far. 

Mr. MITCHELL. And one last question I have with what little time 

I have, Dr. Berger: What suggestions do you have on how the VA 

can best provide the outreach to at-risk veterans? 

Dr. BERGER. Thank you, sir, it is a good question. Certainly the 

suggestions that have been made by everyone who has already 

been here at the table, but I do believe that any kind of comprehensive plan, as was hinted at by Representative Roe, is a plan. There 

has got to be parts that involve Facebook, the new communication 

technology. There has got to be parts of it that are messages on our 

transportation system. The list goes on. Let’s see a plan so we don’t 

have gaps in the message getting out there. 

Furthermore, it has to be tailored to the various segments of our 

population. As you know, Vietnam veterans comprise the largest 

cohort of American veterans, and we still have, as I am sure Dr. 

Kemp can provide statistics, a significant number of Vietnam vets 

taking their own lives. We must not forget about them as well. 

Thank you. 

Mr. MITCHELL. Thank you very much. 

Dr. Roe. 

Mr. ROE. Thank you, Mr. Chairman. 

Just a couple of things. And then to all of you, for me, what I 

have had problems getting my hands—this is a huge problem when 

you are talking about thousands of people. As a doctor, you try to 

identify the person that would be at risk, and it is very hard in this 

situation to do. I have looked at it, and we have two issues, I think. 

We have active-duty veterans who are taking their lives and we 

have a much larger number of veterans who are taking their lives. 

So we have two separate issues. And when I started thinking about 

this, I read all this testimony, and it looks like we need to look at 

is there a trend here? How old is the veteran? Are they homeless? 

Do they have a job? Do they have family members? You can do that 

and get that information and look and see which one of those specific groups—and Dr. Berger, I know you are well aware of this— 

that you can identify. I thought about how many of them are unemployed? Are they Vietnam-era veterans? My personally, in the 

last few months, in my own district, in my own hometown, a patient of mine’s husband committed suicide who is a Vietnam veteran. And there was an attempt by somebody I know extremely 

well just in the last 2 weeks, it was unsuccessful, thank goodness, 

and didn’t commit suicide and now has a chance to get help and 

hopefully turn his or her life around. 

Mr. Embree, your point was an incredible point you made. Both 

of those ads made a difference to me because I have the idea of 

looking at it both of not being welcomed home and of also being 

welcomed home. So I saw a different view of it than you did, and 

you can only see it through the experience you have had. But I can 

tell you that Dr. Berger will tell you in a Vietnam-era veteran, both 

of those ads hit home. 


ebenthall on DSK9Q6SHH1PROD with HEARING
25 

I want to know how we use, because I think the younger generation—I mean, how the Chairman and I Twitter is we shake hands, 

that is our Twitter. But Facebook and Twitter and the new media, 

how do you see that helping? I think it can be tremendous because 

you have access to someone in California or New York or around 

the world, a friend, with the new media. Could you comment on 

that? 

Mr. EMBREE. Yes, sir. And thank you for asking about this. This 

is something that our organization, IAVA, takes very seriously because we recognize that our members are all over the country. One 

of the biggest successes of communityofveterans.org has been because a veteran in Tennessee can talk to a veteran in Florida securely, knowing they are both vets. They can talk about what is 

going on and what they are experiencing, and also those hundreds 

of miles go away and they help each other deal with these issues. 

But I think one of the biggest problems is the VA is making 

steps, they are trying to use Facebook, they are trying to use Twitter, but they are using it as press releases, saying this is great, this 

is what we have done, and it is very regimented. But the vets want 

to hear more about what is going on. It needs to be a breathing 

organization they feel bought into. So when they are sending out 

tweets or Facebook updates, it needs to be stuff that is not just, 

hey, this new hospital has 20 new doctors because that doesn’t 

make any sense to the vet, they are like, okay, that is great. But 

if one of the folks that runs the program tells a little bit about 

their life and about dealing with these programs and about their 

ideas and what they would like to do, it gives a face to the VA. I 

think that is what is so important. Folks want to know a little bit 

more; they don’t just want press releases. 

Mr. ROE. Let me give you an example of what one local sheriff 

in my district does, small county, mountain county, Unicoi County, 

Tennessee, Sheriff Harris has his officers call 130 people, elderly 

people who live alone every day to check on them and see how they 

are doing. Every single day they get a phone call. If they have a 

medical problem, they call the next morning and say, how are you 

getting along, did you have a good night? And they listen for that. 

I am wondering when our veterans—because we had a group, the 

278s, just got home to Greenville, Tennessee, Friday night. I was 

out, they got home at 8:00 at night. And my question is, how hard 

would that be? It doesn’t take, no offense, a Ph.D. to talk to someone, how are you getting along, are you having a tough day? I wonder if we can’t do that, especially for our veterans that are in rural 

areas or anywhere. And I see this new media as being a real resource to do that, just pick this up right here and get on it, and 

it doesn’t take you 30 seconds to do it. That may be a lifeline to 

somebody. If they are having a tough day, they can get pointed in 

the right direction if they know what direction to go in. 

Dr. Berger, one other thing, and I want to know before my time 

runs out, this data that I mentioned here, has that been done with 

this Blue Ribbon Panel? Is there a way I can sit down and look at 

that and say, when I am talking to someone, and look at their experiences, are they 20 years old within a combat unit? Did they go 

through Fallujah? What experience did they have? Is that data out 

there? 


ebenthall on DSK9Q6SHH1PROD with HEARING
26 

Dr. BERGER. There are data contained in the final report—at 

least the copy of it that I have—and I would be glad to share that 

with you and you will have to look at it. 

I would like to comment on what you said just a few minutes ago 

about looking at the veterans audience out there because what you 

said hinted at what suicide really is, and that is, suicide is a process where you lose hope. There are proximal events, whether it be 

a bad marriage, a drinking bout, some other kind of situation, losing a job, what have you, that may push the individual over the 

edge, but it is a process that 99 percent of the time people are 

thinking about as they lose hope. The point being that in the campaign, it needs to bring these elements in. It is not just taking your 

life, that is the ultimate, but what impact does losing your job 

when you can’t get a mental health service, when your wife says, 

all right, go to the substance abuse clinic or I am taking the kids 

and leaving. It has to be thought out so that is addressed in the 

campaign. 

Thank you, sir. 

Mr. ROE. Thank you. I yield back. 

Mr. MITCHELL. Thank you. 

Mr. Walz. 

Mr. WALZ. Well, thank you. I thank all of you for your great advice. You have all been great partners and great resources to help 

us get this right. 

I keep coming back to this, and I think our first panel made this 

very clear. We have to get to the front end of this instead of chasing our tails on the back end forever. I come at this from an education perspective. I am a teacher, and it just drives me nuts. We 

talk about closing the achievement gap. Every piece of research 

shows that by the time these kids get to be 18 it is virtually impossible to close the achievement gap. So we spend billions of dollars, 

tons of things, we don’t get it done. We know that if we attack 

them between preschool, age two to five, our success rates are 

much greater. 

This still comes back to the seamless transition. We are not 

going to get this right until it is all part of the same thing, until 

that culture changes, Tim, as you said amongst that, until we 

group all our veterans together and we understand that once they 

get in there. 

My question to each of you is somewhat subjective, but I trust 

your opinions on this, you get this. Are we getting any closer? Is 

the virtual lifetime record moving us there? Are we getting any 

closer on seamless transition? 

Tom, do you want to take it first and then we will just work our 

way down. 

Dr. BERGER. Seamless transition. We need to change that to 

something that really better represents what we are trying to do. 

I think there have been very good efforts made, but again, as you 

can hear, they are disjointed, the right hand doesn’t necessarily 

know what the left hand is doing. 

Mr. WALZ. It is not for lack of good intention. 

Dr. BERGER. It is certainly great intentions, but let’s get all the 

parties together and sit down and say, okay. And then ask, ask our 

veterans, the ones who are coming out, what do you need? What 


ebenthall on DSK9Q6SHH1PROD with HEARING
27 

I need is not the same thing that Tim needs or that Mr. Gadd 

needs. It has to be individualized as well, in my opinion. And certainly we heard earlier about the retreat kind of approach. Certainly that should be considered as well, where you can bring all 

these elements together in a nonthreatening kind of situation. 

When my colonel walked in and said you are not going to commit 

suicide, that is a lot different than me sitting down with Tim and 

saying, you know, I have some things I need to talk about, buddy, 

can you help me? 

Mr. GADD. Thank you for the question. 

Does the American Legion believe it is moving fast enough? We 

do not. They have been talking about this for several years, we just 

want them to make it happen. The AHLTA system and the VistA 

system, the architecture is very complex, but they have teams 

working on it and it is just not moving quick enough. We are here 

today talking about suicide and veterans falling through the 

cracks, and that is a byproduct of the system not being designed 

too effectively, once that servicemember goes in the first day of active duty, tracking him until he comes back to his community and 

returns from the service. 

But also, I just wanted to point out too, VA did make some 

strides with the TBI screening and how if you go in for a podiatry 

appointment, something completely unrelated, they will ask you 

about the TBI screening, they have that questionnaire. There is 

nothing of that sort for mental health, and there should be. They 

have integrated mental health into primary care in the hospitals 

and in the clinics, but the American Legion would like to see more 

tracking there. 

Thank you. 

Mr. EMBREE. Yes, sir. There are a lot of different programs going 

on. I think one thing that is extremely important is there must be 

more VA contact. There is actually a model already out there, and 

it is your average college university alumni association. Everyone 

knows when you are a freshman and you get that first intro to college, there is a rep from your alumni association to meet you, to 

tell you about all the events going on campus, and then they are 

going to contact you throughout your whole 4 years—or in some 

people’s case, 5 or 6 years. 

Mr. WALZ. And then the rest of your life for donations. They will 

be there. 

Mr. EMBREE. Exactly, sir. And that is the thing, they make those 

touches, they make those touches while you are there so you become bought in, you become part of that alumni association. And 

in that way, throughout the rest of your life they stay in contact 

with you. The VA needs to be the DoD’s alumni association. They 

need to make that contact when you come into the fleet, when you 

are that young lance corporal or PFC or young sailor or a young 

soldier or airman, they need to make that contact with you. And 

they need to keep making that contact with you and your family 

throughout your time in uniform. So when you leave, it is that actual simple transition into the VA because you already understand 

everything they do, you already understand the programs that are 

available. 


ebenthall on DSK9Q6SHH1PROD with HEARING
28 

Mr. WALZ. Well, thank you. And I couldn’t agree more with all 

of you. I think that is absolutely the key to this. The systemic 

change to help us prevent suicides, that is what we are trying to 

get at. So I yield back. 

Mr. MITCHELL. Thank you. 

Mr. Hall. 

Mr. HALL. Thank you, Mr. Chairman. 

Earlier this week, as Mr. Walz referred to, the VA announced a 

new rule change which went into effect yesterday morning which 

gives veterans who served in a combat zone, servicemen or women, 

a presumed service-connection for PTSD and removes the necessity 

of proving a particular incident that was the trigger of that trauma. This Committee, the full VA Committee, voted unanimously for 

legislation that basically did the same thing. It was on its way to 

the floor when the President and the Secretary, General Shinseki, 

moved in and did a rule change to basically accomplish that piece 

of it. 

What impact do you see this as having on veterans being willing 

to come forward and seek treatment for possible mental injuries before they reach the point where they could harm themselves or others? And how best can the knowledge of this rule change be spread 

far and wide in the veterans community so that those who are 

afraid of rejection or afraid of stigma can have less of that fear and 

take advantage of this new opportunity? 

Tim, do you want to start that? 

Mr. EMBREE. Yes, sir. I think with the new rules for PTSD, what 

it does is it makes it easier for the veterans to get the care that 

they need. There are very good counselors within the VA system 

and there are very good doctors that have very effective treatment 

to help these folks, but unfortunately the process was so long before with the old rule, it was very hard. Say if you were a female 

veteran who had served in a forward operating base in al Anbar 

Province in Iraq and you got mortared on a regular basis, or you 

served as a machine gunner on multiple convoys, but you walked 

into a VA system that didn’t understand that women are in combat 

and you had to sit there and prove these horrible things that happened to you and relive it every time you are trying to prove your 

case, that was awful. It was very unfair to the former 

servicemembers. Something now that the rules have changed and 

we are making it easier for folks to get to that care. That has been 

a major step forward and we are very pleased to see that. We think 

a lot more servicemembers and veterans are going to be able to get 

the care they need because they are not going to have to go 

through that 6-month, 9-month process to say, yes, I got blown up, 

or, yes, I was shot at, or, yes, I watched my buddy die right in front 

of me, be it man or woman in uniform. This eliminates one more 

barrier for those folks seeking treatment. 

Mr. GADD. Yes, sir. The American Legion is supportive of any 

law that can be relaxed such as that to make the process simpler. 

Our veterans come home and have to fight another war to get their 

benefits. Our 1,400 accredited service officers help them with the 

claims, and this will make it a lot easier for the veteran. We hope 

to see more of them file for their benefits and use their 5 years of 

free care at the VA and knowing about this. 


ebenthall on DSK9Q6SHH1PROD with HEARING
29 

So thank you. 

Dr. BERGER. Good question. VVA certainly agrees with that. And 

as you may remember, Congressman, we strongly supported the 

initiative. The one area where we have some difficulties is the VA’s 

requirement that it only be a VA clinician, meaning a psychiatrist, 

psychologist or clinical social worker’s diagnosis that is acceptable. 

We find that rather difficult. It does impose a burden on people 

who live far away from a VA facility. And let’s suppose that there 

were no VA in Topeka, Kansas, you mean the VA is going to turn 

down the opinion of a psychiatrist from Menninger Clinic who has 

been practicing for 30 years? That is going to be a problem. That 

is going to be a problem. And it could create some backlogs in 

terms of complaints down the road. But overall, as has been indicated by my colleagues here, it certainly will ease the process. 

Mr. HALL. I would agree with that. And I think in my written 

comments last fall to the VA on the proposed rule was that they 

include private psychiatrists and psychologists’ diagnoses equal to 

VA docs. But at any rate, this is, nonetheless, I think a big step 

forward. 

I wanted to ask, in your own experience, and as a matter of what 

you would suggest, how active duty or soldiers who are going 

through basic training who are entering the military could be prepared for this? The reason I ask is because West Point, which is 

in my district and where my nephew just graduated a few weeks 

ago, had a year and a half ago a spate, a rash of suicide attempts, 

half of them unsuccessful I am happy to say. But the stress and 

the manifestation of this caused a stand down and a teach-in and 

a buddy system all in an academy predeployment. 

So the question is, should this not just be done in the military 

academies that are producing the officer corps, but also is it being 

done to any extent, and should it be done more as part of the basic 

training of all of our servicemen and women? 

Dr. BERGER. Certainly, Congressman Hall. I am aware, it was 

announced in the press that the Army has instituted a resiliency 

program down at Fort Stewart. Now, what is the resiliency program? I don’t know, I haven’t been able to get a hold of the copy 

of the curriculum. I don’t know who is teaching it, I don’t know 

anything about it. And obviously there is no data on the outcomes. 

But if it is happening and it follows those standards, principles and 

practices that some of us in the clinical side know about resiliency, 

then that is a great step forward for our folks who are in basic 

training. 

Mr. HALL. I am out of time, but Mr. Chairman, if you would like 

to allow the other two witnesses to answer if they wish. 

Mr. GADD. I will go ahead. Sir, the American Legion, in our recommendations, had said training, education and outreach are all 

important components there. 

I think having the suicide prevention coordinator on the DoD installation side is going to be helpful, too, like VA has them in all 

of 153 hospitals, something to that sort. And part of the testimony 

we talked about psychologists and the shortage, 3,000 moving to 

10,000, there is still a shortage in DoD as well with psychologists, 

but just having that training component at the installation level 

will be helpful in helping this problem. 


ebenthall on DSK9Q6SHH1PROD with HEARING
30 

Mr. EMBREE. Yes, sir. Thank you for the question because I think 

one of the things that is very important, like I mentioned before, 

I do think that there needs to be a training for your corporals 

course, your sergeants course, your staff NCOs, your lieutenants 

and your captains because these are the folks that, for a young Marine or soldier just coming to the military world, these folks are 

like God to them. They tell them when to get up in the morning 

and when to go to sleep at night. They tell them when they are getting paid, they tell them when they are going to eat chow. So these 

folks need to be the ones that can recognize private—I am trying 

to refrain from using military terminology or Marine Corps terminology, at least—Private Smith, let’s say, if Private Smith is acting 

funny, the platoon sergeant or the squad leader is going to be the 

first one to recognize this, and they are going to be the ones that 

say you need to go get treatment for your mental health because 

that way you make the fighting force stronger. Because we PT to 

make sure our legs are strong so we can run across the battlefield. 

We lift weights to make sure we can throw our buddy over our 

shoulder when we need to get him out of harm’s way in a kill zone. 

We need to make sure that we are also exercising our minds and 

that we can recognize injuries. You can recognize when someone 

rolls an ankle or blows out a knee. You need to be able to recognize 

if they are having a mental health issue, be it depression, be it 

combat stress. 

So I think we need to make sure that the folks that have the everyday interaction with our young soldiers, sailors, airmen and Marines, need to be the ones that—they don’t have to be taught to be 

a clinician by any way, shape or form, they need to be taught just 

to recognize that someone needs to go get that mental health treatment. 

Mr. HALL. Thank you, Mr. Chairman. 

Mr. MITCHELL. Thank you very much. 

I want to again thank you on behalf of all of us for the service 

that you have given to this country. Thank you. 

I would now like to welcome Panel three to the witness table. For 

our third panel, we will hear from Colonel Robert Saum, Director 

of Defense Centers of Excellence (DCoE) for Psychological Health 

and Traumatic Brain Injury, U.S. Department of Defense; and Dr. 

Robert Jesse, Principal Deputy Under Secretary for Health, U.S. 

Department of Veterans Affairs. Dr. Jesse is accompanied by Dr. 

Janet Kemp, the National Suicide Prevention Coordinator for the 

Department of Veterans Affairs. 

Colonel Saum, you are recognized for 5 minutes. 


ebenthall on DSK9Q6SHH1PROD with HEARING
31 

STATEMENTS OF COLONEL ROBERT W. SAUM, USA, DIRECTOR, 

DEFENSE CENTERS OF EXCELLENCE FOR PSYCHOLOGICAL 

HEALTH AND TRAUMATIC BRAIN INJURY, U.S. DEPARTMENT 

OF DEFENSE; AND ROBERT JESSE, M.D., PH.D., PRINCIPAL 

DEPUTY UNDER SECRETARY FOR HEALTH, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS; ACCOMPANIED BY JANET KEMP, RN, PH.D., NATIONAL SUICIDE PREVENTION COORDINATOR, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

STATEMENT OF COLONEL ROBERT W. SAUM, USA 

Colonel SAUM. Thank you, Chairman Mitchell, Ranking Member 

Roe, and the Subcommittee Members. Thank you for the invitation 

to talk about the Department of Defense suicide prevention programs and related outreach efforts. 

I am not here only today as the Director of the Defense Centers 

of Excellence for Psychological Health and Traumatic Brain Injury, 

but also as the father of an Army sergeant who after two tours in 

Iraq, suffered a mild traumatic brain injury and post-traumatic 

stress. He has considered suicide. It wasn’t until my family and I 

intervened that he sought care and recovery. 

Our servicemembers, veterans and families have, and continue to 

display, strength and resilience. They have raised their hands and 

volunteered to serve their country and lay down their lives, if necessary, and we owe them the very best. 

The largest barrier we face as a military and a society is preventing suicide and the stigma that is associated with it. Stigma 

prevents our warfighters, veterans and their loved ones from reaching out in the most troubling of times. 

In May of 2009, DCoE launched the Real Warriors Campaign, a 

public education initiative specifically designed to combat stigma 

associated with seeking help. Realwarriors.net is accessible globally 

and has reached 72,000 unique warriors and visitors, with more 

than 110 visits and 781,000 pages viewed. The campaign partners 

with more than 100 organizations throughout the country to increase visibility and outreach. 

Additionally, DCoE has partnered with the Department of Veterans Affairs to coordinate information and resources specifically 

designed for the military community when calling the National Suicide Prevention Hotline, 1–800–273–TALK. This number continues 

to be displayed on all Web sites and resources, such as Military 

OneSource, the go-to resource for servicemembers and their families. The Department of Defense and the Department of Veterans 

Affairs continually collaborate on suicide awareness, creating resources, coordinating with the services and other relevant organizations to send messages to the widest possible audiences. 

Another important aspect of our suicide prevention efforts is to 

increase awareness and knowledge. The DCoE Outreach Center is 

staffed by health resource consultants who are available 24/7 by 

phone, by e-mail, by chat, and they are there to answer questions 

and refer callers to a wide range of resources on psychological 

health and traumatic brain injury. 


ebenthall on DSK9Q6SHH1PROD with HEARING
32 

The Reengineering System of Primary Care Treatment in the 

Military, RESPECT–MIL, is a collaborative effort and a care model 

that enables health care providers to screen patients for post traumatic stress disorder, depression in the primary care clinics. Since 

its inception in 2007, RESPECT–MIL has screened approximately 

350,000 Army personnel at medical treatment facilities. They identified 2,528 soldiers with suicidal ideation and provided the appropriate intervention and care. The program will be implemented 

across the Services very shortly. 

Another facet of DCoE’s outreach is our partnership with the 

Congressionally mandated Yellow Ribbon Reintegration Program. 

This program proactively reaches out to our National Guard and 

Reserve members and their families, and since its inception in 

2008, more than 2,000 events have been held for nearly 300,000 

servicemembers, enabling them to successfully reintegrate back 

into their families and their communities of choice. 

DCoE’s collaboration with the Sesame Street Workshop launched 

the Sesame Street Family Connections Program. The Emmy-nominated program releases 700,000 bilingual dual DVD kits that provide videos featuring Elmo and his family working through the difficult issues, and includes materials for adults on how to discuss 

the sensitive issue with children of a lost parent from combat, illness, or suicide. 

I want to thank you for the opportunity to highlight some of 

DCoE’s and DoD’s suicide prevention outreach efforts, and I look 

forward to your questions. 

[The prepared statement of Colonel Saum appears on p. 64.] 

Mr. MITCHELL. Thank you. 

The Subcommittee has been trying to determine the VA’s vision 

and its strategic plan on moving forward with their suicide prevention outreach program. So at this time we are going to show a 

short video display of some of that vision. 

[Video shown.] 

Mr. MITCHELL. Thank you. 

Dr. Jesse. 

STATEMENT OF ROBERT JESSE, M.D., PH.D. 

Dr. JESSE. Chairman Mitchell, Ranking Member Roe, and Members of the Subcommittee, thank you for the opportunity to appear 

before you today to discuss the Department of Veterans Affairs efforts to reduce suicide amongst American veterans. 

I am accompanied today by Dr. Janet Kemp, VA’s National Suicide Prevention Coordinator. Before I begin, I would like to thank 

the Committee, and you, Chairman Mitchell, for your continued advocacy on this issue and your leadership in this area. 

I would also like to thank the VSOs for their insight. But mostly 

I would like to thank Ms. Bean for being here today. I can’t begin 

to comprehend her personal pain, but I would like to acknowledge 

that sharing that and opening that public dialogue I think really 

is, as Congressman Adler said, it is the PSA that is important, that 

we continue to discuss this in a public fashion. 

I would also like to thank Dr. Kemp for being here. She truly is 

the brilliance and the spark behind the VA’s suicide prevention initiatives and clearly leads the country in this area. 


ebenthall on DSK9Q6SHH1PROD with HEARING
33 

I don’t think anybody in this room would deny how important 

this issue is to the VA. We have initiated several programs that 

have put the VA in the forefront of suicide prevention in the Nation, including the establishment of the National Suicide Hotline. 

The addition of a chat service I think has been an extremely important addition to that, the national advertising campaigns to promote that hotline and phone number to all veterans and their families. The placement of suicide prevention coordinators in all VA facilities, and expanding their role and interaction into the communities, expansion of mental health services, and to my mind most 

important, the integration of mental health services into primary 

care as a major effort to reduce the stigma of those seeking mental 

health care. 

In response to the urgent need to reduce the incidence of veterans and servicemember suicides, the VA has been significantly 

expanding its suicide prevention program since 2005. We work in 

close collaboration with other Federal partners, including our colleagues at the Department of Defense, to discuss and facilitate 

ways that we can reduce the prevalence of suicide amongst veterans and servicemembers. Part of that collaboration includes the 

Defense Centers of Excellence and Veterans Integrated Services 

Network as a formal partner in the Real Warriors anti-stigma campaign. We also serve as a member of the DoD Suicide Prevention 

and Risk Reduction Committee to ensure that suicide prevention 

efforts are coordinated between the two Departments. 

The VA Call Center for Suicide Prevention Hotline, since its creation in 2007, has now received just shy of 300,000 calls. And we 

just recently have led to more than 10,000 rescues, more than 

35,000 referrals to the suicide prevention coordinators. 

Since its inception, the VA call line has also helped more than 

3,700 active-duty servicemembers. And during 2009, the hotline 

services were supplemented with the veterans Chat, which has 

been receiving more than 20 contacts a day, again, to engage the 

younger servicemembers and veterans who would prefer that rather than a phone call. 

VA suicide prevention coordinators work hard to raise the awareness about warning signs associated with suicide and the availability of both treatment and support. In addition to these measures, VA has been aggressively advertising this information, improving outreach to veterans and family members. 

In 2009, VA began an advertising campaign in Dallas, Los Angeles, Las Vegas, Miami, Phoenix, San Francisco, and Spokane. The 

metropolitan areas second campaign is displaying suicide prevention advertisements in the interior of transit public buses. This effort has reached more than 4.3 million daily riders in 124 markets 

and covering 42 States and 21,000 buses. 

VA is reviewing the association between exposure to public 

health media messaging, knowledge of the hotline use, and self-reported likelihood of hotline use if needed. Preliminary data indicate 

an increase in the number of calls originating in the areas where 

these advertisements were deployed, and based on these promising 

efforts, VA is pursuing two contracts to further promote our suicide 

prevention efforts. 


ebenthall on DSK9Q6SHH1PROD with HEARING
34 

First, we are soliciting bids to contract to support an expanded 

presence on public buses and mass transit bid options. And secondly, we are pursuing a second generation of suicide prevention 

outreach that is based on a comprehensive strategy developed with 

social marketing experts, implemented through a newly created national outreach contract. 

We are working towards suicide prevention coordinators to secure air time locally for new public service announcements, and our 

goal is to have these PSAs at more than 70 percent of the 153 local 

markets, particularly during the National Suicide Awareness Week 

in September. 

Mr. Chairman, the VA has taken a number of steps to provide 

comprehensive suicide prevention services, and the data indicate 

our efforts are succeeding, though not complete. Our mission will 

not be fully achieved until every veteran contemplating suicide is 

able to secure services he or she needs. 

I thank you for your support of our work in this area, and we 

are prepared to answer your questions. 

[The prepared statement of Dr. Jesse appears on p. 67.] 

Mr. MITCHELL. Thank you. 

Dr. Jesse, who is in charge now of making sure the progress of 

moving forward on the momentum that was built in the pilot program that ended in the fall of 2009? 

Dr. JESSE. Mr. Chairman, we see this as a team effort, that there 

are—— 

Mr. MITCHELL. Who is the captain of the team? 

Dr. JESSE. Well, Dr. Kemp, I believe, is truly the captain of this 

team. 

Mr. MITCHELL. So she is in charge of making sure that we move 

on from the momentum that was stopped after the pilot program 

ended in 2009? 

Dr. JESSE. Well, yes, sir. But I am not sure if we would say that 

that pilot was stopped. That pilot is phasing into—— 

Mr. MITCHELL. Well, let me move on. Why did the responsibility 

for the pilot program move from Tammy Duckworth’s office to the 

VHA? 

Dr. JESSE. I don’t mean to sound like I am dodging your question, but I just simply can’t answer that. I can certainly get back 

to you on the record for it. 

[The VA subsequently provided the following information.] 

The responsibility for the pilot program never changed. Public Affairs are overseen by Assistant Secretary Duckworth’s office but the program elements are the 

responsibility of the program office, specifically the Office of Mental Health Services. VHA programs that spend more than $10,000 on marketing and advertising 

have their plans approved by Assistant Secretary Duckworth and this campaign 

falls into that category. We have included that policy in a directive that has just 

been released so everyone has a better understanding of responsibilities and oversight. 

Mr. MITCHELL. Sure. I want to know why the VA stopped airing 

public service announcements late last year? Now, I understand 

the need for a thorough evaluation to determine the effectiveness 

of this outreach, and I applaud the VA’s accountability. But your 

own testimony, in the written testimony, indicates that preliminary 

data indicates that the advertising had been successful and has resulted in an increase in calls to the suicide hotline. As of April, 


ebenthall on DSK9Q6SHH1PROD with HEARING
35 

2010, the VA reported nearly 7,000 rescues of actively suicidal veterans which are attributed to seeing the ads, PSAs, or promotional 

products, and referrals to VA’s mental health services have increased. 

Instead of suspending relatively low-cost outreach efforts like the 

public service announcement, which cost only $200,000 to produce, 

why not keep it on air while you complete your more comprehensive evaluation of its overall effectiveness? 

Dr. JESSE. I am going to ask Dr. Kemp to address that fundamentally, and I will come back on the back side if that is okay. 

Mr. MITCHELL. All right. 

Ms. KEMP. Thank you, sir. 

First I want to stress that we did not stop airing the PSAs. The 

contract that we had was for distribution. They were distributed. 

Radio stations and TV stations across the country have them, and 

we continually make stations aware of the fact that they have 

them. 

We track the number of airings that we see. They are still available to be aired, and we still are encouraging local stations to use 

them whenever they can. 

One of the ways that we have found we were most effective in 

getting stations across the country to air the announcements was 

to have local people at their sites call them and encourage them to 

use them. So we have moved into a mode where the suicide prevention coordinators will continue to have the PSAs available, continue 

to make sure that they are there at their local stations, and will 

continue to—— 

Mr. MITCHELL. Let me just interrupt real quickly. On March 

17th of this year, the VA was in this room testifying, and the question is, are the PSAs still airing? Their answer was, no, the PSAs 

are not airing. However, they are available, but they are not airing. 

And this was what the VA said on the 17th of March. 

Ms. KEMP. Right. And we, at that point, asked our suicide prevention coordinators to contact their local stations, continue to ask 

them to show them, and they have been airing since that time. 

Mr. MITCHELL. Can you give us a number later of how many 

airings they have had since April of last year? 

Ms. KEMP. No, but I certainly can get that to you. 

[The VA subsequently provided the following information.] 

We asked the Nielsen Corporation to track the airings of the PSA over the past 

year. Since January of 2010 (through August, 2010) there have been 4,279 airings 

across the country and they are continuing to air. We have placed the PSA’s on 

Facebook and during fiscal year 2010, the Gary Sinise video received approximately 4,800 hits and the Deborah Norville video over 1400 hits. 

Mr. MITCHELL. And the next question I have for Dr. Jesse, we 

have approximately 23 million veterans in this country and only 8 

million are enrolled in VA care. What about the remaining 15 million? Do you really think that stopping the airing of a PSA is the 

best way to serve them right now amidst the epidemic of veteran 

suicides? 

Dr. JESSE. Well, I think Dr. Kemp addressed the issue of stopping the airing. I think part of that answer is, what is the most 

effective way to reach out to those veterans? So, for instance, two 

of the highest days’ volumes to the call centers were, one, I think 


ebenthall on DSK9Q6SHH1PROD with HEARING
36 

when Ms. Duckworth was on CNN, and two, when Dr. Phil had a 

thing on suicide and we ran the number as a trailer underneath 

the dialogue. That taught us an important lesson, that, particularly 

the local suicide coordinators, because they know what is going on 

in the local markets, if those kind of discussions are going on or 

being aired on TV, that they can encourage the stations to run that 

number. That turns out to be hugely effective strategy. We are 

doing a lot of strategies like that. 

Now, in terms of reaching out and bringing in the remainder of 

the veterans, as I am sure you are all aware, there has been a lot 

of discussion between the Secretary of the Veterans Administration 

and Congress about how we get the rest of those veterans to come 

into the system, including opening up—as you know, President 

Obama and Secretary Shinseki have committed to opening up to 

the remainder of the Category 8 veterans. 

Mr. MITCHELL. Right. I just note that, as I said earlier, during 

the period of this testimony today, one or two veterans will have 

committed suicide. And even from your own VA, it was reported 

that there were 7,000 rescues of actively suicidal veterans that 

were attributed to the PSAs. So I think these were pretty good, and 

I would have kept them on. In any case, I have used up my time. 

Dr. Roe. 

Mr. ROE. Thank you, Mr. Chairman. Good points made. 

Colonel, a couple of questions I have is, why are active-duty suicides increasing? Is it the multiple deployments? Is it military occupations speciality (MOS)? Is it a difference between Iraq and Afghanistan? Is it the length of service? Are there more Reservists 

than active duty? I mean, I don’t have any of that information to 

know who to target. And let me just give you an example. 

The question I have is, is training going on for the young officer 

corps and the NCOs to identify—because I read an article in the 

paper a week or 2 ago where apparently this is going, this training 

is going on, a young soldier’s buddy recognized that he might be 

having problems, took the firing pin out of his weapon. And when 

he attempted to commit suicide, the weapon didn’t fire. 

And he later got help and is now doing fine. 

And is that training going on now for the online on-duty soldiers? 

And the other information, is it available and why is it increasing? 

Why do you we think it is? 

Colonel SAUM. Yes, sir, excellent question and a complicated answer. The training is ongoing, and General Casey has introduced 

a program called Comprehensive Soldier Fitness. And it addresses 

not only the physical fitness but the mental health fitness and resource availability to the NCOs and the officer corps so that training, you are correct, is going on and the buddy-buddy system of 

taking care of each other is one of the primary things that that program addresses. 

The statistics you are looking for about what are the primary 

causes for increased suicide among soldiers, I would have to take 

that to record and get back to you. I believe there are data points 

that have been collected, but I have been sitting in this chair 14 

days and I have not been exposed to it. 

[The DoD subsequently provided the following information:] 


ebenthall on DSK9Q6SHH1PROD with HEARING
37 

While the data show an increase in suicide rates among active-duty 

servicemembers, the primary causes of these increases are not definitively known. 

The causes for suicide are multifactorial, interlinked, cumulative, often repetitive, 

and progressive over a period of time. Demographic risk factors include male, 

Caucasian, E–1 to E–4, younger than 25-years old, GED or less than high school 

education, divorced, and in the Regular Component (active-duty, including National Guard and Reserve). Other potential contributing factors can include real 

or perceived relationship, financial, and/or legal difficulties. Loss of protective factors may stem from having lowered social and family support during deployment. 

The Department of Defense Suicide Event Report (DoDSER) is a monitoring 

tool designed to facilitate standardized data collection and reporting across DoD. 

Over 250 data points per suicide are captured including personal characteristics, 

historical factors, suicide event details, and clinical history. Over time, the 

DoDSER can help the DoD better identify potential risk factors for suicide events 

and help inform areas to focus prevention efforts. 

Mr. ROE. I think the importance of it is that if your training 

doesn’t do anything good, if there is not training to pick up the indicators of who might commit suicide; in other words, if somebody 

has been to Iraq four times are they much more likely, or whatever, if my MOS is combat or medic or whatever, it may be there 

are identifiers out there that you could look for. 

Colonel SAUM. Absolutely, sir. And one of the things we are finding, and I will get that report to you, is that it is the first deployment we see the most suicides. It appears that repeat deployments, 

there is a decrease of suicide among redeployed individuals. 

[The DoD subsequently provided the following information:] 

A report, pending publication by the American Association of Suicidology*, analyzed suicide risk associated with deployments. Analysis of suicide risk associated 

with deployments was demonstrated by comparing Service suicide rates in 2005 

when all Service’s rates were within historic norms, with suicide rates in 2007, 

which were higher across the Services. The analysis indicates that among the 

Regular Component of the Army, risk of suicides, measured by an odds ratio, 

dropped from 1.60 for one deployment to 1.10 for two or more deployments in 

2005 and the ratio dropped from 2.03 to 1.25 in 2007. The difference was not as 

dramatic for the other Services. However, it is important to keep in mind that 

the Army deployed the most and had more suicides compared to the other Services. The results of this analysis may illustrate the ‘‘healthy warrior effect,’’ which 

refers to servicemembers who are more at risk of suicide being removed from the 

pool of servicemembers, because unfit servicemembers are not deployed. In 2007, 

for both the Air Force and Army, there was a much greater increase in deployment/no deployment suicide risk odds ratios compared to the Navy and Marines. 

A possible explanation may be the increasing lengths of deployment over that period of time for both the Air Force (4 to 6 months) and Army (12 to 15 months), 

while length of deployments for the Marine Corps and Navy did not change. 

* July 2010—Manuscript submitted for publication, The Journal of Suicide and 

Life-Threatening Behavior. ‘‘A study of suicide incidence and risk in an Active 

Duty United States Department of Defense population.’’ Hyman, J., Frost, L.Z., 

Ireland, R., Cottrell, L. 

Mr. ROE. I think that is a very important right there; that is an 

incredibly important piece of information, I think. 

And this is for Dr. Kemp and Dr. Jesse, and has the VA—and 

obviously most veterans don’t commit suicide. Most veterans if you 

look at the vast majority of us, we don’t. You have 23 million of 

us running around, we don’t. 

Have we done those same identifiers in the veteran population 

and are we screening for that so you can pick those folks out and 

not have to wait until you get to a hotline to make a call in the 

middle of the night? 


ebenthall on DSK9Q6SHH1PROD with HEARING
38 

Ms. KEMP. We are, sir. We know a lot about the veterans who 

do die by suicide in the VA. We know about their characteristics 

and have implemented several screening programs to help us identify those ahead of time. We do have what we call a high risk list 

that we place veterans on if they meet our high risk criteria, which 

ensures that they get what we call an enhanced level of care with 

safety plans that you heard about earlier and other sorts of treatment modalities. 

The other news is that we do know that veteran suicide rates 

have decreased in the time period from 2001 to 2007 among those 

veterans who get care within the VA. 

Mr. ROE. Is the suicide rate different in the 15 million of us that 

are not in the VA system versus 8 million who are? 

Ms. KEMP. Yes. The suicide rate actually among veterans who 

get care within the VA is slightly higher, but we believe that is because of case mix and the high risk nature of veterans who do get 

care within the VA, especially in our older population groups. But 

we have been able to decrease that rate over the past 6 years. 

Mr. ROE. I agree with you on that. It depends on who you are 

seeing. So the group at the VA, the rate is higher but you are right, 

it may be more indigent. 

Ms. KEMP. People at risk in general. 

Dr. JESSE. I would like to just tack on to that just as an example 

of the very high touch and close hold on this. In these patients that 

are on that high risk designation the suicide coordinators will literally put the hotline phone number into their cell phones so that 

they have it readily handy as part of their risk plan. 

Mr. ROE. I think one of the most important people—and Tim hit 

on this just a minute ago when he was speaking—is the person 

most likely to observe your behavior is the person closest to you, 

the guy next to you, he is going to watch out for you the most and 

that is your buddy, your family, in this case for a veteran it may 

be the wife, the child, the worker at your job. So those are the folks 

that need to keep an eye on us. And I also think—and I am closing. 

My time is up, too—that the VSOs have a tremendous opportunity 

to help here. I think that the American Legion, Vietnam-era veterans, and Iraq, all of those organizations I think are doing a wonderful job at making veterans more aware that there is help out 

there and thank them for that. 

Dr. JESSE. Absolutely. If I might I think also it is important to 

mention the chaplain services, I think both in the Department of 

Defense and VA, in their outreach programs into the community 

chaplaincies to teach them particularly for the Guard who are 

going home not with the benefit of going home as a unit what to 

look for, so that the chaplains know that there are particular issues 

with the veterans that they need to watch out for and they can 

counsel the families and intervene early on. I think this very comprehensive approach is extremely important. 

Mr. MITCHELL. Thank you. Just excuse me just a minute, Mr. 

Walz. I have heard also that there has been an increase in the suicide rate among chaplains. And I don’t know if you have looked at 

that at all but I have heard because they are seeing the same thing 

veterans are seeing and talking to them and there is real work that 

needs to be done with chaplains that should be done. 


ebenthall on DSK9Q6SHH1PROD with HEARING
39 

Dr. JESSE. Gosh, I am not aware of that, but I certainly will look 

into that and get back to you. 

[The DoD subsequently provided the following information.] 

There were four active-duty and one reserve chaplain suicides in the FY 2007– 

2010 time period. Data by year and by Service are below. 

Chaplain population numbers are: 

2,800 active-duty chaplains in FY 2007; 

2,900 active-duty chaplains in FY 2008; 

211 Naval Reserve chaplains in FY 2009; 

2,973 active-duty chaplains in FY 2009; and 

3,023 active-duty chaplains in FY 2010. 

The chaplain suicide numbers are too small to perform a statistical test for 

trends. 

FY 2003: Army 0; Navy 0; AF 0 

FY 2004: Army 0; Navy 0: AF 0 

FY 2005: Army 0; Navy 0; AF 0 

FY 2006: Army 0; Navy 0; AF 0 

FY 2007: Army 1; Navy 0, AF 0 

FY 2008: Army 2; Navy 0; AF 0 

FY 2009: Army 0; Navy 1 (Reserve, not on duty); AF 0 

FY 2010–Present: Army 0; Navy 0; AF 1. 

Mr. MITCHELL. Thank you. 

Mr. Walz. 

Mr. WALZ. Thank you, Mr. Chairman, and thank you all for 

being here. You certainly could have chosen to do something else, 

go into the private sector. You did not, you chose to serve our Nation and our veterans, and for that I am incredibly grateful. 

I think you hear from us, and I said it before, I am the staunchest advocate of our VA and the care of our veterans and because 

of that I also can be some of the harshest critics. I think that is 

how I am as a parent I guess, too, because we care so deeply to 

get this right. But I don’t think we say it enough. Thank you for 

all you are doing. 

I think it is a great step to have DoD and VA sitting at the same 

table. It is something around here we don’t see that much and I 

will be honest with you I will get criticism for saying this but I am 

going to say it, but we have no one here from Armed Services Committee sitting with us. And I don’t know why we can’t do joint 

hearings. I don’t know why we can’t get together on this because 

we will ping pong it back and forth. And it is a very frustrating 

thing. 

I don’t want to send Tom off back there, but Tom, until you and 

I think of a better name the seamless transition will come back and 

I will ask on this. 

Dr. Roe was hitting on a very important point here on data driven and I applaud him for that and I know that that is where all 

of you operate from, too. And we need to do better with that. We 

need to have that data. 

I would just ask a question because I am curious about this, we 

were discussing the VA, active and all that, society as a whole because sometimes I think we need to be very careful with the VA. 

We had a hearing this week, very critical, and an error that 

shouldn’t have happened down in St. Louis. It happens once in a 

while. But the one thing is I think we need to be clear is the VA 

reports medical errors, the private sector does not at the same level 

of scrutiny and things like that. So I am just wondering, obviously 


ebenthall on DSK9Q6SHH1PROD with HEARING
40 

with this risk factor, but I would think there are some comparative 

peer groups out there, police officers, firefighters in tough areas or 

anything if we are seeing that. Are we bringing in those lessons 

learned? Are we bringing in those best practices from those? And 

maybe Dr. Kemp, it may be, or Dr. Jesse start out coming on your 

side of things. 

Dr. JESSE. That is actually very true and a very important statement and why I think that the dialogue about suicide needs to address vulnerable populations like those people who have post-traumatic stress disorder, if you will, which is not limited to veterans. 

It includes clergy and firefighters and the like, but very important 

that this become a national dialogue. It is not a dialogue about veterans, it is a dialogue about suicide and identifying people at risk, 

identifying the warning signs and, as was pointed out, it is knowing that the families, the people who are closest to those folks, the 

clergy are the first to see those signs and need to be both empowered and have access to the kind of help that they need to help prevent suicides. 

Mr. WALZ. I think it is true. I think it is a true statement, and 

we will hear from Dr. Kemp, because I think the systemic issue 

here is mental health parity and society in general reaction to it. 

So I think that is a very important point that we need to broaden 

this because I think to a certain degree you may be swimming upstream as the VA, and we have that responsibility, and all those 

who have said it, until we get everyone right we won’t rest, but we 

may get some help from the outside on that. 

Ms. KEMP. One of the things we made a conscious decision about 

in the beginning of the inception of our suicide prevention program 

and hotline was that we did want to partner with the Nation in 

addressing this issue. So our hotline actually was founded through 

interagency agreement with the Substance Abuse and Mental 

Health Services Administration (SAMSHA) and we have decided 

that we all need to have the same number available to call for help, 

whether you are a veteran or a community member or a service 

person, I mean that there are some options on that one national 

number if you are an active-duty servicemember or a veteran. 

But as a result of that, what we have been able to do is garner 

in all of the national resources, through SAMSHA, using national 

data, being able to look at best practices, be a part of the SAMSHA 

best practice registry and both the DoD and VA have partnered 

with them. 

Mr. WALZ. That is smart and I know that no one is as frustrated 

as you if we are failing on certain areas. But I think it is a broader 

dialogue. 

I want to end with just a quick question to Colonel Saum. First 

of all, your personal story is very powerful. And when you tell that 

story about your son that makes a huge difference and they have 

the right guy in the right job now and I feel good about that. The 

Yellow Ribbon Campaign is something that originated as a longtime member of the National Guard in Minnesota. I watched this 

from its inception, infancy to being implemented. How are we dropping the ball on IRR soldiers? How are we dropping the ball on our 

first panelists where they get the ball dropped on that? How does 

that happen, Colonel? 


ebenthall on DSK9Q6SHH1PROD with HEARING
41 

Colonel SAUM. Sir, I think that was very well addressed. It is a 

communication education, but most importantly, we are not giving 

them the skills when we demob. They do get the pamphlets. They 

do get the information about what the resources are. There is not 

a skill level of how to call, who to call or reaching the families of 

the IRR member. I think that is one of the key elements we need 

to focus on, who is getting that information. As Dr. Roe said, the 

buddy, and the buddy for the IRR is the family and the people in 

the community. And I think that is one of the things we have to 

focus on as we reorganize that ourselves and put that information 

out. 

Mr. WALZ. Are you confident we can capture those, that we can 

get that safety net under those IRR soldiers, too? 

Colonel SAUM. I believe we can do much better, sir. 

Mr. WALZ. Thank you and I yield back. 

Mr. MITCHELL. I would just like to ask Dr. Jesse another question. Dr. Berger on the last panel mentioned the Blue Ribbon Committee, titled the Blue Ribbon Work Group on Suicide Prevention 

in the Veteran Population. And then he goes on to say, however, 

it has been almost 2 years since the Blue Ribbon Work Group finished its work and we have yet to see any formal action plan that 

addresses each of the Group’s findings and recommendations in a 

comprehensive prioritized fashion. 

Are you aware of this Blue Ribbon Committee and its findings? 

Dr. JESSE. I am aware of the Committee. It has been my understanding that those issues have been addressed, but I would like 

to refer the specifics of that to Dr. Kemp. 

Ms. KEMP. We certainly formed a suicide prevention steering 

committee after the Blue Ribbon panel gave us their findings back. 

We do have a plan and have addressed each one of those recommendations. We have completed the major recommendations 

and most of the additional key findings. We continue to meet on 

a regular basis, and I will be glad to supply that plan and where 

we are on those recommendations to you. 

Mr. MITCHELL. Not only myself but I think the VSOs ought to 

know this. People ought to know if we spend money on a Blue Ribbon Committee and no one believes that anything is done, this just 

reflects bad. 

Ms. KEMP. Right. The past 2 years of my life have been spent 

completing those, so we would be glad to share that. 

Mr. MITCHELL. I think you ought to share those with Dr. Berger. 

Ms. KEMP. We will be happy to. 

[The VA subsequently provided the following information.] 

The Blue Ribbon Panel recommendations and outcomes are attached. These 

items are in the Suicide Prevention Strategic Plan which continues to guide the 

current the current Outreach program. 


ebenthall on DSK9Q6SHH1PROD with HEARING
42 

Attachment A—Blue Ribbon Work Group on Suicide Prevention—Recommendations 

Key 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 12/00/09 

1 VHA should establish an 

analysis and research plan 

in collaboration with other 

Federal agencies to resolve 

conflicting study results 

. . . to ensure . . . a 

consistent approach to 

describing the rates of 

suicide and suicide attempts 

in veterans. 

An initial review of methods 

used in published and 

unpublished veteran suicide 

reports has been conducted. 

This document will be 

circulated shortly to the 

Federal Work Group. 

Planning is underway for a 

face-to-face meeting of the 

Work Group for late 

January/early February to 

review differences in 

calculating veteran suicide 

rates and definitions of 

suicide attempts. 

Methodology for a potential 

study of veteran suicide will 

also be developed and 

discussed at the in-person 

meeting. 

Workgroup has been 

established and is making 

recommendations for joint 

use of both national and 

agency data. A common 

nomenclature system has 

been adopted by both the 

VA and the DoD and is in 

varying stages of 

implementation. See # 4 on 

Attachment B. 

2 VA should revise and 

reevaluate the current 

policies regarding 

mandatory suicide screening 

assessments. 

A VA work group completed 

a review of VA current 

practices as well as the 

evidence-base on screening 

and the evaluation of 

suicidality. It recommended 

continuation of VA’s current 

policy requiring a clinical 

evaluation of suicidality for 

evaluation of patients who 

screen positive for 

conditions such as 

depression and PTSD. It 

further recommended use of 

a clinical reminder, 

currently available, with 

four standardized questions 

from VA’s Suicide 

Prevention Pocket Care, to 

guide the clinical 

evaluations. 

Recommendation is 

completed. Current policy 

continues, clinical reminder 

is built, implemented and 

being used on a daily basis. 

3 Proceed with the planned 

implementation of the 

Category II flag with 

consideration given to pilot 

testing the flag in one or 

more regions before full 

national implementation. 

Based on experience with 6 

months of pilot use, the 

Category II flag has been 

implemented nationally, 

with use monitored by the 

National Suicide Prevention 

Coordinator. There have 

been no reports of 

unintended consequences 

related to privacy issues. 

There are still 9 sites that 

do not have any patients 

‘‘flagged’’ as of December 

1st. All of these sites 

indicate that they do have 

processes in place to being 

flagging as of some time in 

December. This program 

will require continued 

monitoring. 

Category II flag is still in 

place and fully 

implemented. Flagging 

program is placed and 

tracked in 100 percent of 

facilities. 

4 Ensure that suicides and 

suicide attempts that are 

reported from root cause 

analyses use definitions 

consistent with broader 

VHA surveillance efforts. 

VA’s National Center for 

Patient Safety and the 

National Suicide Prevention 

Coordinator have reached 

consensus on terminology 

and definitions, and are 

using them as a basis for 

coordination of their suicide 

prevention activities. 

Common nomenclature 

terms have been 

implemented and all 

aggregate RCAs are now 

sent to the Office of Suicide 

Prevention, Single RCA’s go 

to the NCPS and are 

tracked as part of the 

patient safety program, The 

Office of Mental Health and 

NCPS share information 

regularly. 


ebenthall on DSK9Q6SHH1PROD with HEARING
43 

Attachment A—Blue Ribbon Work Group on Suicide Prevention—Recommendations—Continued 

Key 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 12/00/09 

5 VHA should ensure that 

specific pharmacotherapy 

recommendations related to 

suicide or suicide behaviors 

are evidence-based. 

Plans regarding a national 

‘‘academic detailing’’ 

program are being reviewed 

as a component of the draft 

VHA Comprehensive 

Strategy for Suicide 

Prevention. 

Program fully implemented 

and funded for FY 2011. 

6 VA should continue to 

pursue opportunities for 

outreach to enrolled and 

eligible veterans and to 

disseminate messages to 

reduce risk behavior 

associated with suicidality. 

Based on evidence for a 

positive impact of the 

Washington, DC pilot 

program, VA is expanding 

its public awareness 

advertising campaign to 

additional markets. In 

addition, VA has developed 

a released public service 

announcements that have 

been broadly used. 

National public awareness 

plan put into place for FY09 

and FY10 including 

multimedia and public 

transit systems. FY11 plan 

in development with the use 

of an outside public 

relations firm. 

7 The issue of confidentiality 

of health records of 

Operation Enduring 

Freedom (OEF)/OIF 

servicemembers who receive 

care through the VHA 

should be clarified both for 

patient consent to care and 

for general dissemination to 

Reserve and Guard 

servicemembers 

contemplating utilizing 

VHA medical system 

services to which they are 

entitled. 

VA policy on sharing of 

clinical information with 

DoD needs to be specified by 

senior leadership. 

Discussions continue. This 

is an ongoing issue and we 

continue to work on policy 

to guide us. 

8 In order to maximize the 

effectiveness of the Suicide 

Prevention Coordinators 

program, it is recommended 

that there be ongoing 

evaluation of the roles and 

workloads of the SPC 

positions. 

The National Suicide 

Prevention Coordinator 

continues to monitor the 

work load and activities of 

the facility-based suicide 

prevention teams. 

Ongoing and monthly 

reports and scorecards 

demonstrate ongoing work 

of the SPCs. 

Attachment B—Blue Ribbon Work Group on Suicide Prevention—Strategic Plan 

Other 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 10/00/2010 

1 Adopt a standard 

nomenclature/definition for 

suicide and suicide attempt 

that is consistent with other 

Federal organizations such 

as the CDC and the 

scientific community. 

VA awaits action from CDC, 

the Federal lead on 

nomenclature, definitions, 

and standards for self-harm 

and suicide related events. 

New nomenclature system 

adopted and implemented in 

VA with expectation of 

continued training and 

implementation. 

2 Prepare a single document 

that details the 

comprehensive suicide 

prevention strategic plan 

outlined to the Work Group 

in different briefs and 

documents in order to 

facilitate more efficient 

review of suicide prevention 

progress. 

The draft VHA 

Comprehensive Plan for 

Suicide Prevention, modified 

during the concurrence 

process, awaits review by 

senior leadership. 

Suicide Strategic Plan in 

place. 

3 The VHA framework for 

suicide prevention should 

consider a public health 

approach that goes beyond 

secondary and tertiary 

prevention. 

See response to item 2. See above. 


ebenthall on DSK9Q6SHH1PROD with HEARING
44 

Attachment B—Blue Ribbon Work Group on Suicide Prevention—Strategic Plan—Continued 

Other 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 10/00/2010 

4 Portfolio for suicide research 

across VHA should be 

expanded with suicide 

prevention prioritized as a 

research area. 

1. Specifically related to 

suicide prevention, HSR&D 

DHI 08–096: Outcomes and 

Correlates of Suicidal 

Ideation in OEF/OIF 

Veterans; Steven K. 

Dobscha MD; VA Medical 

Center, Portland; Portland 

OR; Funding Period: 

October 2008—September 

2011. 

2. From the August 2008 

HSR&D review, one 

additional study that 

specifically addresses 

suicide prevention is likely 

to be funded when the IRB 

approval is received. 

3. Of the 23 mental health 

related (substance abuse, 

depression, TBI, PTSD) 

HSR&D proposals in review 

this cycle (March 2009), one 

is specifically related to 

suicide prevention. 

Portfolio is growing and 

being monitored. 

5 Consider establishing an 

Advisory Board of key VHA 

stakeholders involved in 

suicide prevention education 

treatment and research to 

monitor and evaluate 

suicide programs and 

policies on an ongoing basis, 

establish research priorities 

and provide advice to senior 

VHA leadership on existing 

and new initiatives. 

The Advisory Board has 

been convened. It meets 

monthly by conference call. 

Agendas and minutes are 

posted on its SharePoint 

site at http://vaww. national.cmop.va.gov/ 

MentalHealth/VHA%20 

Suicide%20Prevention%20 

Steering%20Committee / Forms/AllItems.aspx. 

Advisory Board established 

and meets monthly. 

6 The VA’s efforts to reach 

out to community 

emergency departments to 

improve care for active 

service and veterans at risk 

for suicidal behavior are 

encouraged. 

Funding for the SAFE VET 

demonstration project for 

FY 09 has been sent to the 

COE at Canandaigua. 

Completion of the project 

will require approximately 

$2 million in FY 2010 and 

in FY 2011. 

The protocol as submitted 

from the COE is attached 

below. In response to VACO 

input, the evaluation 

component has been revised 

to include information about 

the timeliness and processes 

for the transfer of care from 

community setting to VA. 

The SAFE VET team is 

working on developing the 

infrastructure for this 

project, which includes 

confirming the project sites 

and the recruitment of the 

Acute Service Coordinators 

at the VA hubs sites. The 

team is also planning for 

the training of the Acute 

Service Coordinators during 

early-mid February 09, and 

developing a common 

database for data collection 

to be housed on a secure 

server at the Canandaigua 

VA medical center. 

SAFE VET project on-going. 


ebenthall on DSK9Q6SHH1PROD with HEARING
45 

Attachment B—Blue Ribbon Work Group on Suicide Prevention—Strategic Plan—Continued 

Other 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 10/00/2010 

7 The VA should continue its 

efforts to promote training 

in implementing suicide 

prevention programs. 

Ongoing training for the 

Suicide Prevention 

Coordinators and their 

teams is continuing on an 

ongoing basis. The next 

formal, large scale training 

will be coordinated with the 

VA–DoD National Suicide 

Prevention Conference to be 

held in San Antonio during 

the week of 1–12–09. 

More detailed plans for 

continuation of training are 

included in the draft VHA 

Comprehensive Strategic 

Plan for Suicide Prevention 

that is currently being 

reviewed by Senior 

Leadership. 

Annual DoD/VA conferences 

established. January 2010 

was held in Washington DC. 

March 2011 is arranged in 

Boston. 

8 Promising followup 

interventions designed to 

prevent veterans identified 

as being at risk from 

‘‘falling through the cracks’’ 

should be evaluated and, if 

deemed effective, 

implemented further. 

A report on the Caring 

Letters program is included 

in the Facility Report Care 

attached to the update for 

Key Recommendation 8. 

Caring letters continued. 

Safety planning as an 

intervention implemented 

and continues. 

9 The VA should work 

collaboratively with other 

Federal agencies to 

understand and evaluate 

the implications of new 

technologies for suicide 

prevention (e.g., social 

networking, text messaging, 

etc). 

The general issue remains 

on the agenda for the 

Federal Partners Work 

Group on Suicide 

Prevention. 

The National Suicide 

Prevention Coordinator and 

the COE in Canandaigua 

have developed a Web 

Based Chat Room program 

that would connect veterans 

accessing a highly 

publicized, non-VA Suicide 

Prevention Web Site with 

professional responders at 

Canandaigua. The Chat 

Room would be anonymous 

and private. The primary 

goal would be to facilitate 

calls to the Hotline or helpseeking at VA facilities. 

Implementation of the Chat 

Room project is on-hold, 

awaiting permission to 

either load the needed 

software on VA computers, 

or for providing VA 

responders with 

authorization to use non-VA 

computers for this program. 

On-going. VA Chat Service 

implemented in July 2009 

and continues to receive 

chats. 


ebenthall on DSK9Q6SHH1PROD with HEARING
46 

Attachment B—Blue Ribbon Work Group on Suicide Prevention—Strategic Plan—Continued 

Other 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 10/00/2010 

10 The VA should design and 

disseminate psychoeducation material for 

families of veterans who are 

at risk for suicide, 

particularly, those 

hospitalized for suicide 

attempts. 

Dissemination of the 

Resource Guide for Family 

members is underway. Dr. 

Kemp has forwarded it to 

Suicide Prevention 

Coordinators and Dr. Karlin 

to Home Based Primary 

Care Mental Health 

Providers. The guide is also 

posted on the Veterans 

Integrated Services Network 

(VISN) 19 MIRECC Web 

site—http// 

www.mirecc.va.gov /visn19/ 

docs/ ResourcelGuidel FamilylMembers.pdf 

A product under 

development is a brief guide 

for parents to assist them in 

discussing family member 

suicide attempts with their 

children in a 

developmentally appropriate 

manner. 

Completed. 

12 VA should review 

approaches for better 

integrating VA chaplaincy 

and pastoral care services 

and traditional mental 

health services. . . The Work 

Group further recommends 

that the VA collaborate with 

other public and private 

partners to reach out to 

faith-based communities 

that can assist veterans at 

risk. 

This is included in the VHA 

Comprehensive Plan for 

Suicide Prevention that is 

currently under review by 

senior leadership. 

See strategic plan—this is 

an on-going item. 


ebenthall on DSK9Q6SHH1PROD with HEARING
47 

Attachment B—Blue Ribbon Work Group on Suicide Prevention—Strategic Plan—Continued 

Other 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 10/00/2010 

13 Work Group recommends 

that the VA implement a 

gun safety program directed 

at veterans with children in 

the home, both as a child 

safety measure and as a 

suicide prevention efforts. 

Funding has been sent to 

the COE in Canandaigua 

New York to implement this 

program for FY 09. 

The draft of the Statement 

of Work document with the 

National Shooting Sports 

Foundation (NSSF) is 

awaiting final cost figures 

for the education materials 

and gun locks from the 

Foundation. The draft of the 

Sole Source Justification 

document utilizing the 

unique program operated by 

NSSF has been completed. 

It is anticipated that the 

contract will be awarded by 

the end of January 2009. 

Five hundred thousand gun 

locks will be delivered to the 

153 VA Medical Centers 

within the first year of the 3 

year program. Under the 

current timetable, gun locks 

should start to arrive at VA 

locations on May 1st, 2009. 

It is anticipated that gun 

locks will be available to 

veterans, their families and 

VA employees through 

collaboration with the 

VAMC Police Departments 

and other points of contact. 

Each VA facility will be 

responsible for development 

of a locally specific policy for 

distribution of the gun locks 

and educational materials. 

The Center of Excellence is 

currently developing the 

process for tracking 

distribution and collecting 

data. 

Currently in year 2 of a 3 

year project. Several 

hundred thousand gun locks 

have been distributed. 

11 For veterans who exhibit 

chronic suicidal behavior, 

and who do not respond to 

short term therapies, more 

intensive modalities should 

be considered. Additionally, 

the evaluation of intensive 

outpatient alternatives to 

hospitalization should be 

promoted. 

Following his initial 

evidence summary 

suggesting that Dialectical 

Behavioral Therapy (DBT) 

may be effective in 

preventing suicidal behavior 

specifically in patients with 

Borderline Personality 

Disorder (BPD), Dr. Karlin 

evaluated rates of BPD 

diagnoses at all medical 

centers, and found several 

facilities with exceptionally 

high rates. One, Portland, 

was in a geographical area 

with high suicide rates. In 

evaluating services at this 

facility, he found a wellestablished DBT program. 

The next step in evaluating 

need and feasibility for 

enhancing DBT programs in 

VA will be a survey of other 

facilities to account for, 

quantify, and document 

where and to what extent 

DBT is currently available 

throughout the system, and 

to relate its available to 

diagnoses of BPD. 

DBT training programs 

being implemented and 

DBT treatment is being 

used throughout VA. 

Additional EBT programs 

established. 


ebenthall on DSK9Q6SHH1PROD with HEARING
48 

Attachment B—Blue Ribbon Work Group on Suicide Prevention—Strategic Plan—Continued 

Other 

Recommendations Summary 

Recommendation 

Progress as 12/31/08 Status as of 10/00/2010 

14 The Work Group 

recommends that VA 

analyze entitlement changes 

required to allow treatment 

of combat related conditions 

to reduce suicides in unentitled veteran 

populations. Currently, VA 

treatment of mental health 

and substance use disorders 

in some combat veterans is 

not allowed because of the 

category of their discharge, 

such as dishonorable 

discharge. Congressional 

authorization to treat some 

combat conditions in this 

population may enhance 

their outcomes and reduce 

suicide. 

As previously noted, 

implementation of this 

recommendation could only 

be accomplished through 

Congressional action. 

Closed. New PTSD 

legislation has been helpful. 

Program Office: Office of Mental Health 

Mr. MITCHELL. I would like also to thank Colonel Saum for your 

service, your son’s and your family’s because your wife is as much 

of what we are doing here as you and your son. So I want to thank 

you for your service. 

And I want to ask kind of a followup on Mr. Walz very quickly, 

when a person is in the Ready Reserve and not on active duty, are 

they under the, I guess they are under VA and not DoD, when they 

are called active duty they go under DoD. Is there a disconnect 

sometimes between when a person is in between deployments? 

Colonel SAUM. I am sorry, sir, deployments or active duty to Reserve you mean? I believe that is what you mean. 

Mr. MITCHELL. Right, I am sorry. 

Colonel SAUM. No. It is a seamless transition as far as the benefits when you come from the Reserve Component National Guard 

to active duty because the pre-mob that they do at the Reserve 

Guard units gets the families enrolled and gets the individual enrolled. Where we are looking at—and we have a program called 

Transition for when they demob and they are leaving, say, Fort 

Sill, Oklahoma, and going to California, that transition program is 

in place and giving them the information during transition home 

for resources that they would have for resources within the DoD. 

Mr. MITCHELL. So when that soldier goes back to California he 

is now under the VA system, not DoD? 

Colonel SAUM. No. There is a transition system where he is still 

covered by us. 

Mr. MITCHELL. Thank you. And again Dr. Roe. 

Mr. ROE. Just very briefly, I am sitting here, I sat here today 

and heard a lot of compelling testimony and I am trying to get a 

take-away from this, and part of it is, I believe, and one of the 

things I am going to do is make sure that it is on my official House 

Web page, that that hotline number is on there; number two on my 

campaign Web page that I put it on there and veterans have access 

to it. So I would encourage all of our House Members to do those 

two things. You can cover a lot of people. We get a lot of hits on 

the Web site. 


ebenthall on DSK9Q6SHH1PROD with HEARING
49 

The other that I hadn’t appreciated as much is how the Committees, our own Committees, haven’t interacted, and it has been 

brought, Sergeant Major Walz brought it up, the Chairman brought 

it up, and Mr. Hall brought it up, about how the Armed Services 

Committee and this Committee haven’t coordinated this at all, and 

so I don’t really see as much coordination between DoD and VA as 

I think we need and I need a little better clarification on what the 

DoD is doing in training the buddies. I think that may be going on 

right now. I believe that General Casey said he is in the process 

of doing that. I think this Committee needs to know how that is 

going on and then how that information can be shared with the 

VA, so that we know that soldiers who have maybe been trained 

to look for things in their buddies that that is actually being done, 

because I believe that has as much to do with it on the active-duty 

side than the VA, the veterans side where I am, and where the sergeant major is, is a totally different issue and are we doing enough 

there. And I am not there yet that we are. 

I really appreciate you being here, all the witnesses being here, 

and Colonel, so much, I look at your chest and you are a patriot 

and I appreciate you coming back on the service to help veterans 

and help active-duty soldiers. 

Colonel SAUM. Thank you, sir. 

Mr. MITCHELL. Again on behalf of this Committee and the Congress, we want to thank all of you for your service. I do want to 

let you know that there will be followup with these questions from 

our Committee staff. And with that this hearing is adjourned. 

[Whereupon, at 12:25 p.m., the Subcommittee was adjourned.] 


ebenthall on DSK9Q6SHH1PROD with HEARING
(50) 

A P P E N D I X 

Prepared Statement of Hon. Harry E. Mitchell, Chairman, 

Subcommittee on Oversight and Investigations 

Good morning and welcome. I appreciate everyone being here today, and for your 

interests and concerns on the progress of suicide prevention outreach efforts. Before 

we begin, I want to acknowledge a positive step that the VA has taken recently to 

help veterans suffering from Post-Traumatic Stress Disorder, or ‘‘PTSD’’. The VA recently announced that it is easing the evidentiary hurdle that veterans must clear 

to receive treatment for PTSD. This is a step in the right direction, and I am glad 

they’re doing it. 

However, to be truly effective in reaching all the veterans who need help—not just 

those who are already showing up the VA and asking for it—the VA also needs an 

effective outreach strategy. We have 23 million veterans in this country—only 8 million of which are enrolled to receive care with the VA. The VA has an obligation 

to the 15 million who are not enrolled for care—not just the 8 million who are already enrolled. If these other veterans have PTSD—or are at risk for suicide—the 

VA has an obligation to reach out to them, as well—and let them know where they 

can turn for help. Last year, upwards of 30,000 people took their lives by suicide 

in the United States. Twenty percent of these deaths were veterans. Each day, an 

estimated 18 veterans commit suicide. By the time this hearing concludes—between 

one and two veterans will have killed themselves by suicide. These statistics are 

startling. 

As you know, many of our newest generation of veterans, as well as those who 

served previously, bear wounds that cannot be seen and are hard to diagnose. 

Proactively bringing the VA to them, as opposed to waiting for veterans to find the 

VA, is a critical part of delivering the care they have earned in exchange for their 

brave service. No veteran should feel they are alone. 

As Chairman of this Subcommittee, I have repeatedly called upon the VA to increase outreach to veterans who need mental health services and are at risk of suicide—and members on both sides of the aisle have urged the same. In 2008, the 

VA finally reversed its long-standing self-imposed ban on television advertising and 

launched a nationwide public awareness campaign to inform veterans and their 

families about where they can turn for help. As part of the campaign, the VA produced a public service announcement featuring Gary Sinise, and distributed it to 

222 stations around the country that aired it more than 17,000 times. The VA also 

placed print ads on buses and subway trains. According to the VA’s own statistics, 

the effort proved successful. As of April 2010, the VA has reported nearly 7,000 rescues of actively suicidal veterans, which were attributed to seeing the ads, PSAs, 

or promotional products. Additionally, referrals to VA mental health services increased. 

However, despite this success, late last year the public service announcement 

stopped airing. I don’t understand this. If anything, it seems to me we need to be 

increasing outreach to veterans at risk for suicide, not stopping it. It is my understanding the VA is planning to produce a new public service announcement, which 

will be ready by the end of this year. 

However, the question remains—why did the VA stop running the first public 

service announcement while they work on the second one? How does it help veterans to go dark for more than a year? 

While I commend the additional expansion in outreach that has grown in the way 

of brochures and other useful steps, I do not think the VA should suspend—even 

temporarily—outreach efforts like the public service announcement that have proven successful. It is also imperative for the VA to utilize and adapt to technology, 

including the use of Facebook and Twitter to reach the latest generation of veterans. 

Doing so, I believe will help transform VA into a 21st century organization and most 

importantly save lives. 


ebenthall on DSK9Q6SHH1PROD with HEARING
51 

Today, the Subcommittee is assessing the suicide prevention outreach program on 

national implementation and achievements. We have a wide range of testimony that 

will be presented today and I look forward to hearing all that will be said on this 

vitally important issue. We appreciate our panelists’ dedication in the formulation 

of a more comprehensive and targeted suicide prevention outreach program. These 

struggling veteran’s deserve our help, and we must work in a bipartisan way to ensure that the VA delivers it to them. 

f 

Prepared Statement of Hon. David P. Roe, Ranking Republican Member, 

Subcommittee on Oversight and Investigations 

Thank you Mr. Chairman. 

I appreciate you calling this hearing today to review what the VA has done in 

the area of outreach to the veterans in our communities who are feeling vulnerable 

and uncertain of their future. I cannot imagine what goes through the mind of 

someone seeking to end their life, but we must do anything we can to ease their 

pain and help them through the crisis that they find themselves in, so that they 

can move forward and heal from the wounds from which they are suffering. 

Public Law 110–110 was signed on November 5, 2007, by President Bush. This 

law, as part of the comprehensive program for suicide prevention among veterans 

provided that the Secretary may develop a program for a toll-free hotline for veterans available and staffed by appropriately trained mental health personnel at all 

times, and also designated that the Secretary would provide outreach programs for 

veterans and their families. 

As part of this outreach, the VA contracted with the PlowShare Group, Inc. to distribute, promote and monitor a Public Service Announcement (PSA) featuring actor 

Gary Sinise, who played Lt. Dan in the movie ‘‘Forrest Gump,’’ and also performs 

in the Lt. Dan Band. This moving PSA, which can still be found on YouTube (http:// 

www.youtube.com/watch?v=x1QXoVJQdDm), encourages veterans to contact the tollfree national Suicide hotline number in an emotional crisis. According to PlowShare, 

their work on this campaign was successful, as they were able to generate nearly 

$4 million in donated media, and the suicide hotline saw an increase in activity during the campaign. 

The VA also piloted outreach advertising right here in the metro area of Washington, DC. Driving around the city and on the metro system buses and signs could 

be seen in various locations promoting the hotline to veterans. 

What I look forward hearing today is the following: Have we seen a reduction in 

the number of veteran suicides since the inception of the PSAs; what plans are 

there to continue the PSAs now that the contract for the previous PSAs has expired; 

How has the National Suicide Hotline helped in the reduction of veteran suicides, 

and where do we go from here? 

I am pleased that we have witnesses from our veteran community here today, as 

well as the VA, so that we can hear from everyone how useful the previous PSAs 

were, and what other kinds of outreach efforts need to be made to reach not just 

our older veteran population but our new veterans coming out of Iraq and Afghanistan. How is VA using new media to get information out to our new set of veterans 

who may not be aware of all the services the department provides? 

We need to review and evaluate the success of these outreach efforts on an ongoing basis, and see where they can be improved, and enhanced, as well as how frequently they are being broadcast to the general public. 

Again, thank you Mr. Chairman, and I yield back my time. 

f 

Prepared Statement of Warrant Officer Melvin Cintron, USA (Ret.), 

Manassas, VA (Gulf War Veteran and OIF Veteran) 

Distinguished Members of the Committee on Veteran Affairs, my name is Melvin 

Cintron. I am a veteran of both Desert Storm and the current war in Iraq. In Desert 

Storm I worked as a flight medic conducting forward area medical evacuation support of both U.S. and enemy injured and wounded personnel, both civilian and military with a large portion of those being children and a portion of those that died 

in transport in our aircrafts. Additionally, although I had been inactive for approximately 6 years, I also received notification of my reactivation into active duty beginning 2004 for a period of 18 months for the war in Iraq. While I could have chosen 

at that time to seek the avenue of many of those who were in my condition and 


ebenthall on DSK9Q6SHH1PROD with HEARING
52 

were activated I chose not to seek deferment or to make any attempt to shy away 

from my responsibility in responding to my country’s call. I did this, as our oath 

requires, without purpose of evasion or mental reservation because I knew that if 

I did not go then some other father, mother, son or daughter would have to have 

the same painful conversation with their family that I had with my family when 

I received my letter, because someone else would have to go in my place because 

I didn’t and that was not an acceptable option for me so I chose to answer this Nation’s call and serve it proudly and honorably. In the first Gulf War I was submitted 

for a combat air medal for part of my efforts and the conduct of my duties in support of our units mission. In my second activation I was submitted and received the 

army’s Bronze Star medal for my contributions and performance as the unit’s aviation maintenance officer in the 1159th medical evacuation company. My and my 

team’s combined efforts led to our unit having the following approximate statistics 

in our Medical Evacuation mission; over 2400 U.S. Military, over 700 U.S. civilian 

and Coalition and more then 150 EPW (Enemy Prisoners of War). Within these 

there where over 2100 Litter patients and over 1700 ambulatory 

While I feel that I served honorably and at great cost to myself financially, physically and mentally and to my quality of life, and at a much higher cost to my family 

and my children and yet I have no regrets of having answered a call and would 

proudly do so again. And yet my sacrifice to me seems so small and I consider myself often ashamed to enter the VA to seek help when I have seen so many of my 

colleagues who have faced so much of a higher price than I and some who I’ve seen 

pay the ultimate price. I have never been nor will I ever be ashamed of the service 

that I have performed for my country nor will I ever cease to be proud of what I 

have seen my fellow soldiers do in answering their call to duty. This goes to a sharp 

and contrary contrast to the service provided by the VA to those men and women 

whom like me have served proudly and selflessly. When I walk into the VA medical 

center I see in the walls posters that say ‘‘it takes the courage of a warrior to ask 

for help’’, but I am here to tell you that it really should read not that ‘‘it takes the 

courage of a warrior to ask for help’’, but ‘‘it takes the courage of a warrior to ask 

for help from the VA’’. I can give countless examples of many of the failures encountered by our veterans daily in seeking help from the VA, but that is a different 

chapter. This Committee as I understand it is seeking input on the suicide prevention hotline and efforts of the VA. Make no mistake, I consider myself extremely 

blessed with all the blessings that God has and continues to bestow on me regardless of my deserving or not. But there are many who are not as blessed and their 

need for good timely help from the VA should never be compromised as I believe 

it is now. But I digress so I will state that I believe that the VA suicide prevention 

hotline and suicide prevention efforts in my singular opinion are not working. I 

often call the VA for medical appointments and there is a message that comes on 

and it says that if I or a loved one is at risk for committing suicide to call the suicide hotline. I’m here to tell you that while I have never considered suicide nor see 

that as an option in my life I have often desired someone to talk to or share with 

when I’ve had a bad day who would understand, however never would I consider 

calling a suicide hotline if it is not something that I see as an option in my life. 

I believe that there are many veterans whose faith might be different and for whom 

suicide is not as foreign a thing as I consider it to be in my life. However these veterans too seek no more than someone to talk to or help them get through a certain 

hour in their life. However the VA in my experience does not provide for that, what 

it provides for is suicide so a veteran would have to have reached the point of actually considering suicide to actually call the suicide hotline and I would submit that 

by then for some it could have prevented or that might have been prevented it 

would already have been too late. I am not an expert in these matters but I would 

think that providing for the mental well being of our returning soldiers in a manner 

that allows them to seek and get help without tying to them the stigma of ‘‘you are 

considering suicide so you need to call this number’’. In my 19 plus years since coming back from desert storm as well as in the last 5 years in coming back from Iraq 

this time I have met many veterans who have seen fit to talk to me about their 

experiences and who have broken down in the middle of telling these experiences 

to me. These have been things they’ve held in for a long time. I’ve asked them why 

they don’t go to the VA for help already knowing the answer. I’ve also advised them 

of calling the VA and they too have shared with me that they are not suicidal nor 

would they want to risk such a label for fear within their job, their family or their 

social circles. 

Much to my discomfort I interact with the VA on a regular basis and in all of 

the time that I interact with the VA I have been keenly aware of the suicide prevention and the posters suggesting that you call for help. What I have not readily and 

easily encountered is a system that puts strong emphasis, however if in all these 


ebenthall on DSK9Q6SHH1PROD with HEARING
53 

years of dealing with the VA I am ignorant of the easily accessible and readily available intermediate or non-suicidal hotline efforts going on then I apologize, however 

the fact that I don’t know it means that that system needs help in its promotion, 

marketing and easy accessibility for our veterans to seek and receive help long before the point of resorting to a suicide hotline by which time I would consider we’ve 

missed the help opportunity. 

As stated earlier, I am one who is blessed beyond anything I could ever earn. I 

have 2 arms to hug my children with, I have full sight to see my family and my 

blessings and 2 legs which easily led me here today to testify not for my need but 

in hopes that others who are not as blessed and who have need of better support 

from their government would hopefully receive it and if I can be a part of making 

their support easier then I am proud to have come and testified before this Committee. And I hope that instead of just suicide prevention that we also attack the 

problem at a point long before our system would lead another veteran to just a dire 

end. I am not aware of ongoing efforts but if not considered I would strongly recommend that those more learned than I would seek to establish a system of continuity support or life intervention type program that would address a basic need 

to our soldiers to talk without acquiring the stigma of, or being considered, a suicidal risk or at least without having the perception whether real or not that you need 

to talk a suicide hotline because you are now suicidal just because you wanted 

someone to talk to on any given day and in any given hour. 

In addition to such a continuity support/life intervention program I also feel that 

a peer mentor program would be an effective approach to helping veterans before 

they reach the point of considering suicide. On a personal note, I just as many of 

my peers, was hesitant to make any formal approach to the VA or another medical 

facility to talk about any problems because of the stigmas I noted previously. However, if there are mentors or peers who had lived through the same experiences and 

with whom soldiers could express themselves as counterparts and receive guidance 

on how to deal with their emotions and move forward with their lives, this would 

have provided a much more approachable solution for their problems rather than 

a sterile doctor’s office or an open forum. Only those who have lived through these 

experiences can truly listen and understand those who have. 

However for such a program to be successful it must start not only at the VA but 

in our services. As an example, when returning from Iraq, as we out processed in 

Fort Dix, New Jersey, in an auditorium, a sergeant asked ‘‘Is there anybody here 

who feels they need to talk to someone about anything they saw or did?’’ Nobody 

raised their hand. He then stated, if you want to do it confidentially please sign the 

roster that will be in the adjoining room. On the day prior to our leaving the out 

processing center the sergeant again addressed the crowd of soldiers and with the 

pad in his hand he read out the names of those soldiers that had signed up confidentially for the offer made the previous day and asked do you still need to see 

somebody. Needless to say, nobody responded with a yes. I was one of those soldiers. 

I further recommend that we have a program within each unit to help identify 

both formal and informal leaders within the groups that can be trained on a voluntary basis to be outreach mentors or peer confidants who could informally reach 

out as colleagues or fellow soldiers to talk to them as friends or as fellow soldiers 

who have been through similar situations and can equally share discussions outside 

of to structured a program although it could lean towards a more structured group 

help type program should it be needed down the road as they currently exist today 

(group therapy programs). 

In a magazine I read many years ago there was a picture of a wall that was depicted as a wall where people where executed by firing squads it read ‘‘you have 

never lived till you’ve almost died, for those who fight for it, life has a flavor that 

the protected will never know’’ I would at that such a taste also has a price that 

no soldier should be left to pay alone. 

I thank you for this opportunity and pray that my contribution may in some way 

help my fellow men and women of our armed forces and others who support our 

countries efforts in combat zones or in harm’s way. 

f 

Prepared Statement of Linda Bean, Milltown, NJ 

(Mother of OIF Veteran) 

Mr. Chairman and Members of the Subcommittee. 

Thank you for allowing me to appear before you. And thank you, Rep. Holt, for 

standing with me and my family. 


ebenthall on DSK9Q6SHH1PROD with HEARING
54 

I testify today because my son, U.S. Army Sgt. Coleman Bean, 25 and a veteran 

of two tours of duty in Iraq, shot and killed himself on Sept. 6, 2008. I am grateful 

for this opportunity; I have a duty to Coleman and I owe a debt to those with whom 

he served. 

It is my hope that these observations, which are drawn from a shared experience 

of loss, will be useful to you as you oversee the continued development and implementation of suicide-prevention programs. 

First, we need to accept these facts: Many veterans come home to families and 

towns that are a far remove from VA hospitals or Vet centers. Some veterans at 

risk for suicide would not describe themselves as suicidal and some veterans will 

not or cannot use VA mental-heath services. 

I believe it is crucial that the VA: 

• Identify and publicize civilian counseling alternatives, including The Soldier’s 

Project, GiveAnHour and The National Veterans Foundation. • Partner with civilian organizations to assure that all vets have immediate access to a wide range of mental-health care, and • Encourage media outlets to publish local information on mental-health resources for veterans. 

Second, I believe it is critical to implement a simple, straightforward public 

information campaign geared specifically to veterans’ family members and friends. 

It may fall to a grandmother, a best friend or a favorite neighbor to seek out help 

for a veteran who is suffering. Make information on available services easy to find 

and understand and publish it broadly. The suicide hotline number is not enough. 

Help veterans help each other. The VA is confronting PTSD and suicide with 

new programs and new research, good and important work. But that hasn’t always 

been the case and there are vets who will tell you that they have had to scrap and 

fight for every VA service they’ve received. In addition to the official patient-advocacy complaint resolution program, please establish a peer body—made up of the 

most feisty, tenacious veterans. They will help assure that no vet gives up because 

it just got too hard or took too long to navigate the VA system. 

My son joined the Army when he was 18, enlisting on Sept. 5, 2001. The terrifying tragedy of Sept. 11 reaffirmed for Coleman the rightness of his commitment. 

Home on leave, he took a pair of socks that had been lovingly laundered by his 

mother and refolded them to comport with Army specifications. It was his intention, 

Coleman said, to be a perfect soldier. 

In the days following Coleman’s death, our family had the humbling opportunity 

to meet men with whom he had served; they traveled from around the country to 

be with us, and with each other. It was clear to us then that many of these men 

carried their own devastating burdens. 

I spent hours on the telephone, trying to identify services for these young men, 

reaching out first to the VA facilities in the States where they lived. My inquiries 

netted mixed results. 

A VA representative in Texas, horrified when I describe our fears for a young veteran there, said ‘‘just tell me where he is and I will go there. I’ll get in my car right 

now.’’ 

By contrast, a man in Maryland was firm: ‘‘If they won’t come here, we can’t help 

them,’’ he said. 

That simply is not right. Of course we can help them and we can help their families. And it is our duty—not theirs—to figure out how. 

f 

Prepared Statement of Timothy S. Embree, Legislative Associate, 

Iraq and Afghanistan Veterans of America 

Mr. Chairman, Ranking Member, and Members of the Committee, on behalf of 

Iraq and Afghanistan Veterans of America’s one hundred and eighty thousand members and supporters, thank you for the opportunity to testify before you today. My 

name is Tim Embree. I am from St. Louis, MO and I served two tours in Iraq with 

the United States Marine Corps Reserves. Veteran suicide is an issue that resonates 

with all of our members and we are grateful that you are holding this hearing. As 

an IAVA member recently told us: 

‘‘For most of the past year I thought about suicide almost every hour of every 

day, and I felt so ashamed for this. I wondered what was wrong with me, why 

I couldn’t get rid of it.’’—IAVA Member 

And this issue is of particular importance to me because I lost one of my Marines 

to suicide in 2005. 


ebenthall on DSK9Q6SHH1PROD with HEARING
55 

1 In 2009, a record 334 servicemembers committed suicide. 

2http://www.armytimes.com/news/2010/04/militarylveteranslsuicidel042210w/ 3http://www.armytimes.com/news/2010/04/.militarylveteranslsuicidel042210w/. 

The Most Dangerous Part Of Going To War These Days Is Coming Home. 

‘‘Since my return, I have lost 2 close friends to suicide, 2. . . I said 2, from my 

platoon. That is the sick reality.’’—IAVA Member 

Last year, more U.S. servicemembers died by their own hands than in combat in 

Afghanistan.1 Most Iraq and Afghanistan veterans know a fellow war fighter who 

has taken their own life since coming home. The numbers do not even include the 

veterans who commit suicide after their service is complete. They are out of the system and their deaths are often unknown and uncounted. Recently the Army Times 

reported ‘‘18 veterans commit suicide each day . . . an average of 950 suicide attempts each month [are] by veterans who are receiving some type of treatment from 

the Veterans Affairs Department’’. 2 Worse yet, the Department of Defense (DoD) recently released numbers showing that we are on track to surpass last year’s 30- 

year-high suicide rate. 

As the suicide rate of our servicemembers and veterans continues to increase, 

without any signs of abating, we must acknowledge that suicide is only one piece 

of the mental health epidemic plaguing our returning war fighters. Left untreated, 

mental health problems can and do lead to substance abuse, homelessness and suicide. A 2008 RAND study reported that almost 20 percent of Iraq and Afghanistan 

veterans screened positive for Post Traumatic Stress Disorder (PTSD) or major depression. A recent Stanford University study found that this number might actually 

be closer to 35 percent. Compounding the problem is the fact that fewer than half 

of those suffering from mental health injuries are receiving sufficient treatment. 

Suicide Hotline is a Real Lifesaver. 

The VA National Suicide Prevention Lifeline (800–273–TALK) is a 24-hour hotline 

for veterans in crisis, which fields nearly 10,000 calls a month. These calls have rescued more than 7,000 veterans wrestling with suicide.3 IAVA proudly supported the 

Joshua Omvig Veteran Suicide Prevention Act which established this important hotline. Our members continually inform us that they have used this valuable service 

for themselves and have referred it to their friends. 

We know this because IAVA hosts an online community for Iraq and Afghanistan 

veterans to connect. Across the country, through CommunityofVeterans.org, they 

share their challenges and support one another as only they can. 

CommunityofVeterans.org also connects veterans with private and VA mental health 

support information—including the VA National Suicide Prevention Lifeline. Recently a veteran asked, 

‘‘How often do YOU think of suicide? It kinda creeps up on me every couple 

of days, I toss the idea in my head around a little bit, then tuck it away again 

till the next time. It mildly disturbs me because I don’t WANT (consciously) to 

kill myself, but sometimes it just seems easier.’’—IAVA Member 

One of the many veterans who reached out to this vet responded, 

‘‘Maybe you should call that National hotline, just to ask a couple more questions. I am pretty sure it’s a free service, and they’re there to listen a bit, and 

could tell you if it’s more serious or not.’’—IAVA Member 

For a veteran considering suicide, the act of reaching out to those close to them 

can often seem overwhelming. The act of a simple anonymous call to the VA’s National Suicide Prevention Lifeline might be enough to save the life of a veteran who 

is sitting alone, with a gun and a bottle of booze. Veterans in these desperate situations can’t wait for regular business hours to seek help. Thankfully, the National 

Suicide Prevention Lifeline is available 24 hours a day, 7 days a week. 

The National Suicide Prevention Lifeline recently added a live chat feature which 

allows veterans to express their fears, anger, and sadness in a confidential manner, 

24 hours a day, with a trained professional on-line. This on-line chat is a good way 

to reach suffering veterans not reachable through the hotline. 

‘‘When the online counselor said, ‘I hear you’ I knew I was going to be ok,’’— 

IAVA Member 

Outreach, Outreach, Outreach. 

The Department of Veterans Affairs must develop a relationship with 

servicemembers while they are still in the service. Like many successful college 

alumni associations that greet students at orientation and put on student programs 

throughout their time in college, the VA must shed its passive persona and start 


ebenthall on DSK9Q6SHH1PROD with HEARING
56 

4http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1707. 

recruiting veterans and their families more aggressively into VA programs. Once a 

veteran leaves the military, the VA should create a regular means of communicating 

with veterans about events, benefits, programs and opportunities. If a veteran received half as many letters and emails from the VA, as college grads do from their 

alumni association, we would be getting somewhere. 

Moreover, the VA must aggressively promote all VA programs and reach out to 

veterans who have yet to access their VA benefits. 

‘‘The VA could be more aggressive in contacting OIF/OEF veterans and at 

least talking to them before the veteran has a mental health crisis. They need 

to be proactive instead of reactive.’’—IAVA Member 

To begin the shift from a passive to an active agency, IAVA believes the VA must 

prioritize outreach efforts and include a distinct line item for outreach within each 

VA appropriation account. This line item should fund successful outreach programs 

such as the OEF/OIF Outreach Coordinators, Mobile Vet Centers, and the VA’s new 

social media presence on Facebook and Twitter. In their current forms, these outreach programs are much too small to make a transformative difference. IAVA was 

disappointed that there were only a few brief mentions of outreach activities in the 

President’s VA budget submission. Regrettably, none of them were to a dedicated 

outreach campaign. 

The VA’s current outreach campaign is disappointing. When the VA announced 

that it had placed ads on more than 21,000 buses nationally,4 to spread the word 

about the suicide prevention lifeline, we were initially enthusiastic; an image of the 

ad is below. When we saw the ad, it was clearly a failure. The ad has over 30 small 

print words; the average bus ad is limited to 5–10 words. In the short time in which 

a bus passes, a veteran would have to go by the bus repeatedly to even read the 

hotline number. 

IAVA has run one of the largest non-governmental outreach campaigns in history, 

through a partnership with the Ad Council and some of the world’s best advertizing 

firms. We have learned a lot about the best ways to communicate complex and serious issues through television and print. We are ready to work with the VA and 

share our expertise. 

The World’s Best Mental Health Program Will Still Fail If No One Uses It. 

The heavy stigma associated with mental health care stops many servicemembers 

and veterans from seeking treatment. More than half of soldiers and Marines in 

Iraq who tested positive for a psychological injury reported concerns that they will 

be seen as weak by their fellow servicemembers. One in three of these troops worried about the effect of a mental health diagnosis on their career. Even in an anonymous survey we conducted in December of last year, more than 10 percent of our 

members selected ‘‘prefer not to answer’’ in response to the question of whether they 

had sought care for a mental health injury. It is easy to conclude that those most 

in need of treatment may never seek it out. 

‘‘paradigm shift must occur. . . . ‘you’re a wimp if you see the wizard’ needs 

to go away and be replaced with ‘everyone needs someone’.’’—IAVA Member 

To end the suicide epidemic and forever eliminate the stigma associated with combat stress, the VA and DoD must declare war on this problem. They must launch 


ebenthall on DSK9Q6SHH1PROD with HEARING58058A.000
57 

5 ‘‘Back from Iraq war, and alone.’’, Mike Scotti, March 10, 2010; http://www.cnn.com/2010/ 

OPINION/03/10/scotti.war.veterans/index.html?iref=allsearch. 

a nationwide campaign to combat stigma and to promote the use of DoD and VA 

services such as Vet Centers and the National Suicide Prevention Lifeline. 

This campaign must be well-funded, research-tested and able to integrate key 

stake-holders such as veteran service organizations and community-based non-profits. Furthermore, the VA must develop and aggressively deploy combat-stress injury 

training programs for civilian behavioral health professionals who treat veterans 

outside of the VA (e.g., college counselors, rural providers, behavioral health grad 

students, and professional associations). 

The VA must allocate specific resources toward battling this dangerous stigma, 

or we will never see a critical mass of veterans coming in to seek help. 

Department of Veterans Affairs, IAVA Has Your Back. 

Through our own historic Public Service Announcement (PSA) campaign with the 

Ad Council, IAVA has learned a lot about stigma busting and veteran outreach campaigns. Millions of Americans continue to see our iconic PSAs, like the one featuring 

two young veterans shaking hands on an empty New York street. 

‘‘The Iraq and Afghanistan Veterans of America brilliantly portrayed this feeling 

of isolation in a 2008 ad where a soldier returning from the war walks through 

an empty airport. He continues through downtown Manhattan, which is also 

completely empty. No cars. No people. It isn’t until a young veteran approaches 

the soldier with a handshake, a smile and pat on the back saying, ‘Welcome 

home, man,’ that the street becomes populated. 

I was a bit shaken the first time I saw it, as it immediately resonated with 

me. It hit an exposed nerve, and I knew that those guys at the IAVA ‘got it.’ 

They knew exactly where we were coming from. 

The problem, of course, is that we, as veterans, live the rest of our young lives 

in the ‘civilian’ world and not on the battlefield. It took me several months to 

fully comprehend this. After realizing that my sense of isolation was alienating 

me from those I loved, I made the conscious decision to use my experiences in 

combat as a source of great strength, versus letting them become a weakness.’’ 5

The TV ads are just one component of this groundbreaking campaign. They are 

complemented by billboards, radio commercials, and web ads which have blanketed 

the country and touched countless Americans. In just the first year of the campaign, 

IAVA secured $50 million in donated media while reaching millions of veterans and 

their families. 

This campaign is an example of the innovation coming out of the VSO and nonprofit communities, which the VA should treat as an asset. This cutting-edge campaign directs veterans to an exclusive online community, mentioned above, that 

strongly shows our Nation’s new veterans that ‘‘We’ve Got Your Back’’. It also directs them to a wide range of mental health, employment and educational resources—operated by both private non-profits and the Department of Veteran Affairs. Innovative, aggressive outreach programs like this should become part of the 

new VA culture and they can fuel-inject outreach efforts. IAVA is learning what 

works, and we want to share our knowledge. 

‘‘Eight Weeks To See A Counselor?’’ 

‘‘It took me over 6 months for a mental health appt through VA and this was 

after I told them I was having suicidal and homicidal ideations. I’m still waiting 

now for some appointments.’’—IAVA Member 

Convincing a veteran to overcome his fear of ostracism and choose to seek help 

is an uphill battle. We must ensure that when they do seek treatment, there is 

ready access to the necessary care. Regrettably, many of our veterans have complained about long wait times and inconvenient hours. 

The VA must focus on dramatically increasing the number of mental health providers within the Department of Veteran Affairs. This increase will reduce wait 

times and improve overall quality of care. 

‘‘I went 80 miles to the local VA outpatient treatment facility, they did not 

have anyone on staff to talk to. They have group meetings, but again, its 80 

miles roundtrip and I would have to be there by 4. I work till 5. That means 

that I would have to leave almost 2 hours early to drive 80 miles roundtrip just 

to talk to someone who had a similar experience. I can’t do that.’’—IAVA member 


ebenthall on DSK9Q6SHH1PROD with HEARING
58 

‘‘We need a ‘surge’ of mental health professionals! It is time the rest of the 

country steps up and begins to sacrifice as well.’’—IAVA Member 

Additionally, IAVA supports creative solutions for rural veterans. Many veterans 

live too far from local VA facilities to receive treatments at traditional brick and 

mortar VA facilities. We support contracting with local community mental health 

clinics and extending grants to groups that provide programs such as peer-to-peer 

counseling. Veterans must be able to receive mental health care near their personal 

support system, whether that system is in New York City or Peerless, Montana. 

Our veterans are facing a mental health epidemic. Unless we address the overall 

issue of mental health stigma, we will never be able to stem the growing tide of 

suicides. The VA and DoD have created many programs that are extremely effective 

in helping servicemembers and veterans who are hurting. But great programs are 

worthless if servicemembers and veterans don’t know they exist, can’t access them, 

or are ashamed to use them. 

IAVA is proud to speak on behalf of the thousands of veterans coming home every 

day. We work tirelessly so veterans know we have their back. Together, with this 

Congress and the Department of Veteran Affairs, every veteran must be confident 

that America has their back. 

Thank you. 

f 

Prepared Statement of Jacob B. Gadd, Deputy Director, 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

Thank you for this opportunity to submit The American Legion’s views on 

progress of the Suicide Prevention efforts at the Department of Veterans Affairs 

(VA) to the Subcommittee today. The American Legion commends the Subcommittee 

for holding a hearing today to discuss this timely and important issue. 

Suicide among servicemembers and veterans has always been a concern; it is the 

position of The American Legion that one suicide is one too many. However, since 

the war in Iraq and Afghanistan began, the numbers of servicemembers and veterans who have committed suicide have steadily increased. As our servicemembers 

are deployed across the world to protect and defend our freedoms, we as a Nation 

cannot allow them to not receive the care and treatment they need when they return home. The tragic and ultimate result of failing to take care of our Nation’s heroes’ mental health illnesses is suicide. 

Turning first to VA’s efforts in recent years with Mental Health Care, The American Legion has consistently lobbied for budgetary increases and program improvements to VA’s Mental Health Programs. Despite recent unprecedented increases in 

the VA budget, demand for VA Mental Health services is still outpacing the resources and staff available as the number of servicemembers and veterans afflicted 

with Post Traumatic Stress (PTS) and Traumatic Brain Injury (TBI) continues to 

grow. This naturally leads to VA’s increase in mental health patients. 

In 2008, RAND’s Center for Military Health Policy Research, an independent, 

nonprofit group, released a report on the psychological and cognitive needs of all 

servicemembers deployed in the past 6 years, titled, ‘‘Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery,’’ which estimated that more than 300,000 (20 percent of the 1.6 million) Iraq 

and Afghanistan veterans are suffering from PTS or major depression and about 

320,000 may have experienced TBI during deployment. 

The Centers for Disease Control and Prevention estimates 30,000–32,000 U.S. 

deaths from suicide per year among the population. VA’s Office of Patient Care and 

Mental Health Services reported in April 2010 that approximately 20 percent of national suicides are veterans. The National Violent Death Reporting System reports 

18 deaths per day by veterans and VA’s Serious Mental Illness Treatment, Research 

and Evaluation Center reported about five deaths occur each day among VA patients. In a recent AP article, it was cited that there have been more suicides than 

servicemembers killed in Afghanistan. 

The Veterans Health Administration (VHA) has made improvements in recent 

years for Mental Health and transition between DoD and VA such as the Federal 

Recovery Coordinators, Polytrauma Rehabilitation System of Care, Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) case management teams, 

integrating mental health care providers into primary care within VA Medical Center Facilities and Community Based Outpatient Clinics (CBOCs), VA Readjustment 

(Vet) Centers hiring of Global War on Terrorism (GWOT) Counselors, establishing 


ebenthall on DSK9Q6SHH1PROD with HEARING
59 

directives for TBI screening, clinical reminders and a new symptom and diagnostic 

code for TBI. 

Regarding suicide prevention outreach efforts, VA founded the National Suicide 

Prevention Hotline, 1–800–273–TALK (8255) by collaborating with the National Suicide Prevention Lifeline where veterans are assisted by a dedicated call center at 

Canandaigua VA Medical Center in New York. The call center is staffed with 

trained VA crisis health care professionals to respond to calls on a 24/7 basis and 

facilitate appropriate treatment. VA reported in 2010 a total of 245,665 calls, 

128,302 of which were identified as veterans. Of these veterans, 7,720 were rescues. 

VA hired Local Suicide Prevention Coordinators at all of the 153 VA Medical Centers nationwide in an effort to provide local and immediate assistance during a crisis, compile local data for the national database and train hospital and local community on how to provide assistance. One of primary responsibilities of the Local Suicide Prevention Coordinators is to track and monitor veterans who are placed on 

high risk of suicide (H.R.S). A safety plan for that individual veteran is created to 

ensure they are not allowed to fall through the cracks. 

In 2009, VA instituted an online chat center for veterans to further reach those 

veterans who utilize online communications. The total number of VeteransChat contacts reported since September 2009 was 3,859 with 1471 mentioning suicide. VA 

has also had targeted outreach campaigns which included billboards, signage on 

buses and PSA’s with actor Gary Sinise to encourage veterans to contact VA for assistance. 

The American Legion Suicide Prevention and Referral Programs 

The American Legion has been at the forefront of helping to prevent military and 

veteran suicides in the community. The American Legion approved Resolution 51, 

The American Legion Develop a Suicide Prevention and Outreach Referral Program, 

at the 2009 National Convention. In addition, VA’s National Suicide Prevention Coordinator Dr. Janet Kemp facilitated an Operation S.A.V.E. Training for our Veterans Affairs and Rehabilitation Commission members. VA&R Commission members and volunteers subsequently developed American Legion State, district and 

post training programs to provide referrals for veterans in distress with VA’s National Suicide Prevention Hotline. The American Legion currently has over 60 posts 

with active Suicide Prevention and Referral Programs. 

In December 2009, The American Legion took the lead in creating a Suicide Prevention Assistant Volunteer Coordinator position, under the auspices of VA’s Voluntary Service Office. Each local suicide prevention office is encouraged to work 

with veteran service organizations and community organizations to connect veterans 

with VA’s programs in their time of transition and need. The Suicide Prevention offices can increase their training of volunteers to distribute literature and facilitate 

training in order to further reach veterans in the community. 

This year, The American Legion entered into a partnership with the Defense Centers of Excellence’s Real Warrior Campaign to educate and encourage our members 

to help transitioning servicemembers and veterans receive the mental health treatment they need. Additionally, during our 2010 National Convention we will have 

a panel to discuss prevention, screening, diagnosis and treatment of TBI with representatives from DoD, VA and the private sector. 

Challenges 

Despite recent suicide prevention efforts, yet more needs to be done as the number of suicides continues to grow. The American Legion’s System Worth Saving 

(SWS) program, which conducts site visits to VA Medical Center facilities annually, 

has found several challenges with the delivery of mental health care. VA has the 

goal to recruit psychologists from their current nationwide level of 3,000 to 10,000 

to meet the demand for mental health services. However, VA Medical Center Facilities have expressed concerns with hiring and retaining quality mental health specialists and have had to rely on fee basis programs to manage their workload. 

The American Legion applauds last year’s action by Congress in passing Advance 

Appropriations for mandatory spending. However, problems exist in VA itself in allocating the funds from VA Central Office to the Veteran Integrated Service Networks (VISNs) and to the local facilities. This delay in funding creates challenges 

for the VA Medical Center Facility in receiving its budget to increase patient care 

services, hiring or to begin facility construction projects to expand mental health 

services. VA’s 2011 budget provides approximately $5.2 billion for mental health 

programs which is an 8.5 percent, or $410 million, increase over FY 2010 budget 

authorization. The American Legion continues to be concerned about mental health 

funds being specifically used for their intent and that Congress continue to provide 

the additional funding needed to meet the growing demand for treatment. 


ebenthall on DSK9Q6SHH1PROD with HEARING
60 

Challenges in preventing suicide include maintaining confidentiality and overcoming the stigma attached to a servicemember or veteran receiving care. Additionally, the issue of a lack of interoperable medical records between DoD and VA, while 

being addressed by Virtual Lifetime Electronic Records (VLER), still exists. The 

American Legion has supported the VLER initiative and the timely and unfettered 

exchange of health records between DoD and VA. Unfortunately, DoD and VA still 

have not finalized both agencies AHLTA and VistA architecture systems since the 

project began in 2007, which limits DoD and VA’s ability to track and monitor high 

risk suicide patients during their transition from military to civilian life. The American Legion recommends VA take the lead in developing a joint database with the 

DoD, the National Center for Health Statistics and the Centers for Disease Control 

and Prevention to track suicide national trends and statistics of military and veteran suicides. 

The American Legion continues to be concerned about the delivery of health care 

to rural veterans. As mentioned, a nationwide shortage of behavioral health specialists, especially in remote areas where veterans have settled, reduces the effectiveness of VA’s outreach. No matter where a veteran chooses to live, VA must continue 

to expand and bring needed medical services to the highly rural veteran population 

through telehealth and Virtual Reality Exposure Therapy (VRET). DoD and VA 

have piloted VRET at bases at Camp Pendleton, Camp Lejuene and the Iowa City 

VA Medical Center. VRET is an emerging treatment that exposes a patient to different computer simulations to help them overcome their phobias or stress. The 

younger generation of veterans identifies with computer technology and may be 

more apt to self-identify online rather than at a VA Medical Center or CBOC. 

Both DoD and VA have acknowledged the lack of research on brain injuries and 

the difficulties diagnosing PTS and TBI because of the comorbidity of symptoms between the two. The Defense and Veterans Brain Injury Center (DVBIC) developed 

and continues to use a 4-question screening test for TBI today. At the same time, 

Mount Sinai School of Medicine in New York developed the Brain Injury Screening 

Questionnaire (BISQ), the only validated instrument by the Centers for Disease 

Control to assess the history of TBI, which has over 100 questions with 25 strong 

indicators for detecting TBI. Mount Sinai has published data that suggest some of 

the symptoms, particularly those categorized as ‘‘cognitive,’’ when found in large 

numbers (i.e. 9 or greater), indicate the person is experiencing complaints similar 

to those of individuals with brain injuries. The American Legion wants to ensure 

that DoD and VA are working with the private sector to share best practices and 

improve on evidence-based research, screening, diagnosis and treatment protocols of 

the ‘‘signature wounds’’ of Iraq and Afghanistan. 

Recommendations 

The American Legion has seven recommendations to improve Mental Health and 

Suicide Prevention efforts for VA and DoD: 

1. Congress should exercise oversight on VA and DoD programs to insure maximum efficiency and compliance with Congressional concerns for this important 

issue. 

2. Congress should appropriate additional funding for mental health research and 

to standardize DoD and VA screening, diagnosis and treatment programs. 

3. DoD and VA should expedite development of a Virtual Lifetime Medical Record 

for a single interoperable medical record to better track and flag veterans with 

mental health illnesses. 

4. Congress should allocate separate Mental Health funding for VA’s Recruitment 

and Retention incentives for behavioral health specialists. 

5. Establish a Suicide Prevention Coordinator at each military installation and 

encourage DoD and VA to share best practices in research, screening and treatment protocols between agencies. 

6. Congress should provide additional funding for telehealth and virtual behavior 

health programs and providers and ensure access to these services are available on VA’s web pages for MyHealthyVet, Mental Health and Suicide Prevention as well as new technologies such as Skype, Apple i-Phone Applications, 

Facebook and Twitter. 

7. DoD and VA should develop joint online suicide prevention servicemember and 

veteran training courses/modules on family, budget, pre, during and post deployment, financial, TBI, PTSD, Depression information. 

In conclusion, Mr. Chairman, although VA has increased its efforts and support 

for suicide prevention programs, it must continue to reach into the community by 

working with Veteran Service Organizations such as The American Legion to improve outreach and increase awareness of these suicide prevention programs and 


ebenthall on DSK9Q6SHH1PROD with HEARING
61 

services for our Nation’s veterans. The American Legion is committed to working 

with DoD and VA in providing assistance to those struggling with the wounds of 

war so that no more veterans need lose the fight and succumb to so tragic a selfinflicted end. 

Mr. Chairman and Members of the Subcommittee, this concludes my testimony. 

f 

Prepared Statement of Thomas J. Berger, Ph.D., Executive Director, 

Veterans Health Council, Vietnam Veterans of America 

Chairman Mitchell, Ranking Member Roe, and Distinguished Members of the 

HVAC Subcommittee on Oversight and Investigations, Vietnam Veterans of America 

(VVA) thanks you for the opportunity to present our views on ‘‘Examining the 

Progress of Suicide Prevention Outreach Efforts at the VA’’. We should also like to 

thank you for your overall concern about the mental health care of our troops and 

veterans. 

The subject of suicide is extremely difficult to talk about and is a topic that most 

of us would prefer to avoid. Although statistics on suicide deaths are not as accurate 

as we would like because so many are not reported, as veterans of the Vietnam War 

and those who care for them, many of us have known someone who has committed 

suicide and others who have attempted it. But as uncomfortable as this subject may 

be to discuss, VVA believes it to be a very real public health concern that needs 

solutions now. 

Suicide is most often the result of unrecognized and untreated mental health injuries. Depression, Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) are three of the most common mental health injuries and conditions that 

can lead to suicide. The three conditions in particular are medical conditions that 

can be life-threatening. 

In more than 120 studies of a series of completed suicides, according to the American Foundation for Suicide Prevention, at least 90 percent of the individuals involved were suffering from a mental illness at the time of their death. The most 

important interventions are recognizing and treating these underlying illnesses, 

such as depression, alcohol and substance abuse, post-traumatic stress and traumatic brain injury. Many veterans (and active duty military) resist seeking help because of the stigma associated with mental illness, or they are unaware of the warning signs and treatment options. These barriers must be identified and overcome. 

Consider the facts: earlier this spring, troubling data showed an average of 950 

suicide attempts by veterans who are receiving some type of treatment from the VA. 

Seven percent of the attempts are successful, and 11 percent of those who don’t succeed on the first attempt try again within 9 months. These numbers show about 18 

veteran suicides a day and about five by vets receiving VA care. These numbers are 

simply unacceptable to both the veterans’ community and the American public. 

To be fair, since media reports of suicide deaths and suicide attempts began to 

surface back in 2003, the VA has claimed to have developed prevention strategies 

to reduce suicides and suicide behaviors that includes: the establishment of the Suicide Prevention Hotline in partnership with the Substance Abuse and Mental 

Health Administration; the institution of suicide prevention coordinator (SPCs) positions at all VA medical facilities whose duties include education, training, and clinical quality improvement for VHA staff members; increased screening and monitoring of individuals who have been identified as being at high risk for suicide; and 

research efforts utilizing cognitive-behavioral interventions that target suicidal ideation and behaviors. While these efforts are laudable, VVA continues to believe they 

have not gone far enough. 

In May 2008, then-VA Secretary Peake chartered ‘‘The Blue Ribbon Work Group 

on Suicide Prevention in the Veteran Population’’. Its function was to provide advice 

and consultation to him on various matters relating to research, education, and program improvements relevant to the prevention of suicide in the veteran population. 

Although their report was not made public, the Work Group panel presented a series of findings and recommendations to improve relevant VA programs, with the 

primary objective of reducing the risk of suicide among veterans. 

The panel’s work was not made public because some in the VA claimed that even 

talking about suicide made it much more likely to occur among veterans and soldiers. VVA takes the view that transparency in government in general, and at the 

VA in particular, leads to better and more consistent application of the very evidence based medicine that is founded on peer reviewed science. It also would be in 

keeping with the proclaimed principles of the Administration of President Obama. 


ebenthall on DSK9Q6SHH1PROD with HEARING
62 

Perhaps most importantly, it will lead to much more accountability in government. 

It is past time for the VA to make the full report public. 

The Work Group report discussed eight key findings and recommendations: 

Panel Finding 1. Conflicting and inconsistent reporting of veteran suicide 

rates were observed across various studies. 

Blue Ribbon Recommendation 1: VHA should establish an analysis and research plan in collaboration with other Federal agencies to resolve conflicting 

study results in order to ensure that there is a consistent approach to describing the rates of suicide and suicide attempts among veterans. 

Panel Finding 2. Suicide screening processes being implemented in VHA 

primary care clinics go beyond the current evidence and may have unintended effects. 

Blue Ribbon Recommendation 2: The VA should revise and reevaluate the 

current policies regarding mandatory suicide screening assessments. 

Panel Finding 3. The VA is attempting to systematically provide coordinated, intensive, enhanced care to veterans identified as being at high risk 

for suicide. However, the criteria for being flagged as high risk are not 

clearly delineated; nor are criteria for being removed from the high risk list. 

Blue Ribbon Recommendation 3: Proceed with the planned implementation 

of the Category H flag, with consideration given to pilot testing the flag in one 

or more regions before full national implementation. 

Panel Finding 4. The root cause analyses presented to the Work Group did 

not distinguish between suicide deaths, suicide attempts, and self-harming 

behavior without intent to die. 

Blue Ribbon Recommendation 4: Ensure that suicides and suicide attempts that are reported from root cause analyses use definitions consistent 

with broader VHA surveillance efforts. 

Panel Finding 5. The emphasis by VHA leadership on the use of clozapine 

and lithium does not appear to be sufficiently evidence-based. 

Blue Ribbon Recommendation 5: VHA should ensure that specific 

pharmacotherapy recommendations related to suicide or suicide behaviors are 

evidence-based. 

Panel Finding 6. Efforts to improve accurate media coverage and disseminate universal messages to shift normative behaviors to reduce population 

suicide risk behavior are not being fully pursued. 

Blue Ribbon Recommendation 6: The VA should continue to pursue opportunities for outreach to enrolled and eligible veterans, and to disseminate messages to reduce risk behavior associated with suicidality. 

Panel Finding 7. Concerns about confidentiality for OIF/OEF 

servicemembers treated at VHA facilities may represent a barrier to mental 

health care. 

Blue Ribbon Recommendation 7. The issue of confidentiality of health 

records of OIF/OEF servicemembers who receive care through the VHA should 

be clarified both for patient consent-to-care and for general dissemination to Reserve and Guard servicemembers contemplating utilizing VHA medical system 

services to which they are entitled. 

Panel Finding 8. The introduction of Suicide Prevention Coordinators 

(SPCs) at each VA medical center is a major innovation that holds great 

promise for preventing suicide among veterans; however, there is insufficient information on optimal staffing levels of SPCs. 

Blue Ribbon Recommendation 8. In order to maximize the effectiveness of 

the Suicide Prevention Coordinators program, it is recommended that there be 

ongoing evaluation of the roles and workloads of the SPC positions. 

In addition to the above central findings and recommendations, the Work Group 

panel identified fourteen other areas for possible action, including: 

• adopting a standard definition for suicide and suicide attempts; 

• preparing a single document that details the comprehensive suicide prevention 

strategy; 

• considering a public health approach as part of the VA framework for suicide 

prevention that goes beyond secondary and tertiary prevention; 

• expanding the portfolio for suicide research across the VA, with suicide prevention prioritized as a research area; 


ebenthall on DSK9Q6SHH1PROD with HEARING
63 

• considering the establishment of an Advisory Board of key VA stakeholders involved in suicide prevention, education, treatment, and research; 

• increasing VA efforts to reach out to community emergency departments to improve care for active duty servicemembers and veterans at risk for suicide; 

• continuing efforts to promote training in implementing suicide prevention programs; 

• developing and implementing followup interventions for veterans identified as 

being at risk; 

• working collaboratively with other Federal agencies to understand the implications of new technologies for suicide prevention; 

• designing and disseminating psycho-education materials for families of veterans 

at risk for suicide, particularly those hospitalized for suicide attempts; 

• considering more intensive therapies for veterans who exhibit chronic suicidal 

behavior; 

• more effectively integrating pastoral care services and traditional mental health 

services; 

• implementing a gun safety program directed at veterans with children in the 

home; and 

• analyzing entitlement changes required to allow treatment of combat-related 

conditions to reduce suicides in un-entitled veteran populations. 

Suicide prevention, of course, starts with leadership. However it has been almost 

2 years since the Blue Ribbon Work Group finished its work and we have yet to 

see any formal action plan that addresses each of the Group’s findings and recommendations in a comprehensive, prioritized fashion. In fact, no one outside a select circle of bureaucrats at the Veterans Health Administration (VHA) has ever 

seen the complete report of this panel, which was of course, funded with taxpayer 

dollars. 

Why not? 

There are no valid reasons for keeping this report a secret. The Russians do not 

have spy networks out looking for copies of this report, so there is no valid national 

security reason not to make this report available to the Congress, to veterans advocates, to VA’s own clinicians at the service delivery level, and to the public. The reason for the delay initially was to give the VHA time to design a good implementation plan to carry out all of the panel’s recommendations, and to take steps to address concerns raised by the report, it seems to us at Vietnam Veterans of America 

(VVA) that 21 months is enough time to do that, even with the change in formal 

leadership as to the Undersecretary of Health. Dr. Petzel has now been on the job 

long enough to review any such plans, and be ready to implement the recommendations in a timely way. 

This Subcommittee must ensure that our veterans and their families are given 

access to the resources and programs necessary to stem the tide of suicide. The first 

step in that process is knowing what has been recommended by the best medical 

scientists the VA could assemble to study the problem (the above referenced report), 

and what is being done to implement the recommendations and address the findings 

of those experts. 

While we do not mean to distract from the basic thrust of this hearing, VVA 

points out that PTSD is a common condition among veterans that often leads to suicide attempts. We continue to be troubled that VHA has also not implemented, nor 

seemingly even tried to implement, the recommendations of the report commissioned by the VA and delivered by the Institute of Medicine (IOM) of the National 

Academies of Sciences (NAS) on June 16 of 2006 entitled ‘‘Posttraumatic Stress Disorder: Diagnosis and Assessment.’’ (http://iom.edu/Reports/2006/PosttraumaticStress-Disorder-Diagnosis-and-Assessment.aspx) Even more troubling is that the Department of Defense has not tried to systematically implement these very important 

findings as to the best medical science can recommend as to proven techniques and 

procedures for accurately diagnosing and properly assessing Post traumatic Stress 

Disorder (PTSD). If you do not accurately diagnose and accurately assess a veterans’ 

(or a returning war fighters’) condition as PTSD which may be so acute that he or 

she is at risk of attempting to take their own life, then there is no way that you 

can effectively intervene or treat that American who has put their life on the line 

for our country. This is bad medicine, and it leaves our veterans at risk. VVA hopes 

that this distinguished Subcommittee will take a look at this issue, perhaps as a 

followup to this hearing. 

Once again, on behalf of VVA National President John Rowan and our National 

Officers and Board, I thank you for your leadership in holding this important hearing on this topic that is literally of vital interest to so many veterans, and should 


ebenthall on DSK9Q6SHH1PROD with HEARING
64 

be of keen interest to all who care about our Nation’s veterans. I also thank you 

for the opportunity to speak to this issue on behalf of America’s veterans. 

I shall be glad to answer any questions you might have. 

f 

Prepared Statement of Colonel Robert W. Saum, USA, Director, 

Defense Centers of Excellence for Psychological Health and 

Traumatic Brain Injury, U.S. Department of Defense 

Introduction 

Chairman Mitchell, Congressman Roe, distinguished Members of the Committee; 

thank you for the opportunity to appear here today to talk to you about the Department of Defense’s (DoD) suicide prevention programs and related outreach efforts. 

On behalf of DoD, I want to take this opportunity to thank you for your continued 

support and demonstrated commitment to our servicemembers, veterans, and their 

families. 

Over the last 9 years, a new era of combat emerged where our servicemembers 

are constantly challenged by the demands of a high operational tempo. Despite 

these challenges, they continue to meet the increasing demands placed upon them 

with resilience, dedication and remarkable ability. 

However, the constant stress placed upon our servicemembers is taking its toll. 

The loss of even one life to suicide is unacceptable and of deep concern at all levels 

of DoD leadership. DoD has developed many resources and tools for 

servicemembers, veterans and families; however we realize utilization of these resources is dependent upon prevention education and communication about their existence. Therefore, continued outreach to servicemembers, veterans and families is 

an essential part of the Department’s overall suicide prevention strategy. Today, I 

will share with the Committee our current suicide prevention outreach efforts. 

Suicide has a multitude of causes, and no simple solution. Recognizing this, DoD 

is using a multi-pronged strategy involving comprehensive prevention education, research, and outreach. We believe in fostering a holistic approach to treatment, engaging the community, leveraging primary care for early recognition and intervention, and, when needed, providing innovative specialty care. This includes a 

proactive preventive approach addressing multiple stressors. Some of these stressors 

include relationship failures, legal/work/financial problems and substance misuse. 

Outreach is only one part of DoD’s overall strategy, but is an essential part. As 

we shift to a culture focused on building resilience and improving the well-being of 

the force, we need to educate our servicemembers, veterans and families on the 

available resources to achieve and sustain a healthy lifestyle. DoD conducts outreach through a variety of mechanisms to disseminate available resources, promote 

awareness and encourage servicemembers, veterans and families to seek help when 

they need it. 

Collaborative Outreach Efforts 

Continued collaboration and coordination with the Department of Veterans Affairs 

(VA) and other Federal, private, and academic organizations is the key to ensuring 

we reach our military community in the most meaningful way. We collaborate with 

the VA on many outreach initiatives to ensure that servicemembers, veterans and 

their families receive resources and access to services on a continued and consistent 

basis. 

In November 2007, the DoD established the Defense Centers of Excellence for 

Psychological Health and Traumatic Brain Injury (DCoE) to offer a central coordinating point for activities related to psychological health concerns and traumatic 

brain injuries. DCoE focuses on the full continuum of care and prevention to enhance coordination among the Services, Federal agencies, and civilian organizations. 

DCoE works to identify best practices and disseminate practical resources to military communities. 

DCoE works closely with the VA to coordinate information and resources with the 

National Suicide Prevention Lifeline (1–800–273–TALK). This partnership facilitated a modification to the introductory message on the Lifeline, by pressing the 

number 1, that enables veterans, servicemembers, or callers concerned about a veteran or servicemember to access a crisis counselor who is knowledgeable about the 

military and has access to resources designed specifically for this community. 

The DCoE Outreach Center is staffed by health resource consultants (licensed 

mental health and traumatic brain injury clinicians) who are available to listen, answer questions, and refer callers, to a wide range of resources. These consultants 

include licensed nurses, social workers, and doctoral-level clinical psychologists. In 


ebenthall on DSK9Q6SHH1PROD with HEARING
65 

March 2010, the Outreach Center health resource consultants attended and completed the American Association of Suicidology (AAS) ‘‘Recognizing and Responding 

to Suicide Risk’’ 2-day training program. Since then, the Outreach Center utilized 

AAS’ best practice methodologies and constructed a lethality assessment document 

as well as a safety plan document to further assess suicide risk and need for intervention. Since its launch in January 2009, the Outreach Center has been utilized 

by approximately 5,000 people. 

DoD and VA collaborate to educate and train regional suicide prevention coordinators each year on innovative programs, best practices and new platforms for outreach. 

DoD and VA are collaborating annually to promote suicide awareness week, creating common theme materials such as factsheets and coordinating with the Services and other relevant organizations to disseminate messages to the widest audience possible. 

The Suicide Prevention and Risk Reduction Committee (SPARRC) has served and 

will continue to serve as the venue for inter-Service and interagency collaboration 

on suicide prevention activities. Members include Suicide Prevention Program Managers from the Services and representatives from the National Guard Bureau, Office 

of the Assistant Secretary of Defense for Reserve Affairs, VA, Office of Armed Forces 

Medical Examiner, National Center for Telehealth and Technology (T2), Substance 

Abuse Mental Health Services Administration (SAMHSA), and others. This Committee is the main forum for ensuring coordination and consistency in system-wide 

communication related to suicide, risk reduction policy initiatives, and suicide surveillance metrics across the military. 

DoD Outreach Initiatives 

Each of the Services has a variety of suicide prevention programs and outreach 

efforts tailored to their specific population. They utilize multiple communication 

avenues to increase awareness of available resources. In addition, DoD has many 

efforts currently in place to raise awareness and increase leadership involvement in 

promoting healthy choices. The initiatives listed below are not dedicated solely to 

suicide prevention, but they feature a variety of resources for psychological health, 

including suicide prevention, and offer the opportunity to increase outreach to 

servicemembers, veterans and families. 

Real Warriors Campaign 

Stigma is a toxic threat to our servicemembers, veterans and families receiving 

the care they need. We recognize that outreach is essential for combating stigma, 

encouraging help-seeking behaviors and promoting awareness of resources. 

In May 2009, DCoE launched the Real Warriors Campaign, a multimedia public 

education initiative designed to combat the stigma associated with seeking psychological health care and encourage servicemembers to reach out for the care they 

may need. Under the theme ‘‘Real Warriors, Real Battles, Real Strengths,’’ this effort provides concrete examples of servicemembers who sought care for psychological 

health concerns and are maintaining a successful military career. 

While primarily focused on combating stigma, the Real Warriors Campaign addresses the issue of suicide in a number of ways: 

• The Web site, www.realwarriors.net, prominently displays the National Suicide 

Prevention Lifeline on every page. 

• Two video profiles of servicemembers involved in the campaign openly discuss 

their struggles with thoughts of suicide by demonstrating that they reached out 

for care, received it and that action has enabled them to continue to lead a fulfilling personal and professional life. 

• The site allows servicemembers, veterans, families and health professionals to 

confidentially reach out to health consultants for assistance around the clock 

through the Real Warriors Live Chat feature or by calling the DCoE Outreach 

Center. 

The Campaign’s message boards include numerous posts from servicemembers 

who share their coping strategies for dealing with suicidal ideation. The site includes content that focuses on suicide prevention and substance abuse, which is a 

potential contributing factor to suicide. Short, documentary-style videos illustrate 

the resilience exhibited by servicemembers, their families and caregivers. 

The Real Warriors campaign has reached thousands since the Campaign launched 

in May 2009. The Web site, www.realwarriors.net, which servicemembers can access 

globally, has reached 72,239 unique visitors, with more than 110,000 visits and 

781,600 page views. The campaign is featured in the Army G–1 Suicide Prevention 

Program and the Air Force Surgeon General’s Office used the campaign in a Suicide 


ebenthall on DSK9Q6SHH1PROD with HEARING
66 

Prevention Stand Down in May 2010. In addition, the campaign has partnered with 

more than 100 organizations to increase their visibility and reach among 

servicemembers, veterans and military families. 

Military OneSource 

Military OneSource, the ‘‘go-to’’ resource for servicemembers and families, prominently features the National Suicide Prevention Lifeline on its home page and provides suicide prevention information. 

Yellow Ribbon Program 

DCoE is an active contributor to the legislatively mandated Yellow Ribbon program and working group, which provides suicide prevention information, services, 

referrals and proactive outreach programs to servicemembers of the National Guard 

and Reserves and their families through all phases of the deployment cycle. The intent of the program is to proactively prevent suicide by reaching out to National 

Guard and Reserve members and their families to prepare them for deployment; 

sustaining their families during the deployment; and reintegrating the 

servicemembers with their families, communities and employers upon re-deployment 

or release from active duty. The Yellow Ribbon program also conducts outreach to 

help servicemembers and their families navigate through the numerous DoD, VA, 

and State systems to ensure they receive information and assistance regarding all 

the benefits and entitlements they have earned as a result of deployment. The working group is conducting a gap analysis of existing suicide prevention programs specific to the National Guard and Reserve populations. 

Afterdeployment.org 

DoD is leveraging technology to conduct outreach in real time and connect 

servicemembers, veterans and families to resources. Web-based resources such as 

afterdeployment.org provide a safe platform to better understand and increase 

awareness of substance misuse, depression and other mental health related issues. 

In August 2008, the National Center for Telehealth and Technology (T2) launched 

the Web site afterdeployment.org to support servicemembers, veterans and families 

with adjustment concerns that often occur after a deployment. The Web site provides interactive, self-paced solutions addressing post-traumatic stress, depression, 

relationship problems, substance abuse, and several other health issues including 

mild traumatic brain injury and spirituality concerns. Site features include quick 

health tips, self-assessments, e-libraries, self-paced workshops, warrior and family 

stories, community forum, RSS feeds, and daily topical quotes. Additionally, a 

Google map locator helps users find providers close to home. Visitors to the site can 

benefit from a sense of community by joining the Facebook group, receive Twitter 

messages, and download podcasts from iTunes or Zune depicting warrior stories. 

Afterdeployment.org surpassed the 100,000 visitor milestone in April 2010. 

Telebehavioral Health 

T2 is developing and testing multiple technologies that will provide ways to supply timely telebehavioral health services to enable a broad telehealth network for 

servicemembers and their families across the deployment cycle of support. Populations with access to care barriers such as geography, mobility, and stigma can 

benefit greatly from telebehavioral health services, which refer to the use of telecommunications and information technology for clinical and non-clinical behavioral 

health care. Leveraging these technologies enables DoD to reach out to a broad 

array of populations and provide servicemembers, veterans and their families access 

to patient-centric behavioral health care even in the most extreme and/or remote 

circumstances. 

Caring Letters 

An outreach effort that has shown significant promise to reduce suicides in the 

civilian sector is the Caring Letters Program. In a randomized clinical trial, sending 

brief letters of concern and reminders of treatment to patients hospitalized for suicide attempts, ideation or for a psychiatric condition was shown to dramatically reduce the risk of death by suicide following their hospitalization. In an effort to determine the applicability to military populations, T2 is piloting a program at Ft 

Lewis, Washington. Efforts are currently underway to plan a multi-site randomized 

control trial. 

Way Forward 

DoD has made much progress in suicide prevention outreach, but we recognize 

that there is still much to be done. 


ebenthall on DSK9Q6SHH1PROD with HEARING
67 

DoD and VA are currently developing a strategic action plan for the next 3 years. 

This plan will: create consistent communication of suicide data between DoD and 

VA; improve communication to servicemembers, veterans and families on available 

suicide prevention practices, programs and tools; continue resource and information 

sharing between VA and DoD; and coordinate training efforts to educate community 

members, suicide prevention coordinators and medical staff throughout both agencies. 

Families play a vital role in preventing suicides among servicemembers and veterans. A current Suicide Prevention and Risk Reduction Committee (SPARRC) initiative is focused on identifying available resources for families and dissemination 

platforms used throughout DoD in order to increase outreach efforts targeted to 

families. 

In addition to numerous existing DoD web-based resources, the SPARRC is developing a Web site to serve as the clearinghouse for suicide prevention information, 

contacts, innovative approaches, and tools. This Web site will be open to anyone 

looking for suicide prevention information specific to the military and will leverage 

existing resources. The Web site will provide a platform to increase awareness and 

streamline access to current suicide prevention initiatives and resources. 

Conclusion 

The Department of Defense is aggressively pursuing new ways to address suicide 

prevention in collaboration with our partners at the VA. Outreach is a crucial part 

of DoD’s multi pronged suicide prevention strategy which emphasizes education, 

early recognition and intervention, and providing the best treatment possible. 

On behalf of the DoD, thank you for the opportunity to address this vital issue. 

I look forward to your questions. 

f 

Prepared Statement of Robert Jesse, M.D., Ph.D., Principal 

Deputy Under Secretary for Health, Veterans Health Administration, 

U.S. Department of Veterans Affairs 

Chairman Mitchell, Ranking Member Roe, and Members of the Subcommittee: 

Thank you for the opportunity to appear before you today to discuss the Department 

of Veterans Affairs’ (VA) efforts to reduce suicide among America’s Veterans. I am 

accompanied today by Dr. Janet Kemp, VA National Suicide Prevention Coordinator. My testimony today will cover four areas: first, data on suicidality in Veterans and VA’s Suicide Prevention Program; second, VA’s National Suicide Prevention Hotline and Veterans Chat (an online resource); third, VA’s outreach and informational awareness efforts to reduce suicide among Veterans; and finally, VA’s impact on reducing the risk of suicide among Veterans. 

Let me begin by saying how very important this issue is to VA and all of us in 

the VA health community. We have initiated several programs that put VA in the 

forefront of suicide prevention for the Nation. Chief among these are: 

• Establishment of a National Suicide Prevention Hotline, including a major advertising campaign to provide the hotline phone number to all Veterans and 

their families; 

• Placement of Suicide Prevention Coordinators at all VA medical centers; 

• Significant expansion of mental health services; and 

• Integration of primary care and mental health services to help alleviate the 

stigma of seeking mental health assistance. 

I will discuss these initiatives in detail later in my testimony. 

VA’s Suicide Prevention Program 

A suicide by a Servicemember or Veteran is a tragedy for the individual, his or 

her friends and family, and the Nation. Data indicate that while civilian suicide 

rates have remained fairly static over the past 30 years, there has been a deeply 

concerning increase in the suicide rate among members of the Armed Forces over 

the last 5 years. Eighteen deaths per day among the Veteran population are attributable to suicide. Approximately 50 percent of suicides among VA health care users 

are among patients with a known mental health diagnosis. 

These are staggering numbers, and the data fail to reveal the true cost of suicide 

among Veterans. In response to this urgent need, VA has been significantly expanding its suicide prevention program since 2005, when it initiated the Mental Health 

Strategic Plan and the Mental Health Initiative Funding. In 2006, VA supported 

two conferences on evidence-based interventions for suicide and provided funding to 


ebenthall on DSK9Q6SHH1PROD with HEARING
68 

begin integrating mental health care into primary care settings and expanding services at community-based outpatient clinics (CBOC) for treatment of mental health 

conditions such as post-traumatic stress disorder (PTSD), and substance use disorders (SUD). In 2007, VA began providing specific funding and training for each 

facility to have a designated Suicide Prevention Coordinator; it also held the first 

Annual Suicide Awareness and Prevention Day and opened the National Suicide 

Prevention Hotline in partnership with the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA). 

VA also established new access standards that require prompt evaluation of new 

patients (those who have not been seen in a mental health clinic in the last 24 

months) with mental health concerns. New patients are contacted, within 24 hours 

of the referral being made, by a clinician competent to evaluate the urgency of the 

Veteran’s mental health needs. If it is determined that the Veteran has an urgent 

care need, appropriate arrangements (e.g., an immediate admission), are to be 

made. If the need is not urgent, the patient must be seen for a full mental health 

diagnostic evaluation and development and initiation of an appropriate treatment 

plan within 14 days. Across the system, VA is meeting this standard 95 percent of 

the time. The same year, VA initiated system-wide suicide assessments for those 

Veterans screening positive for PTSD and depression in primary care, instituted 

training for Operation S.A.V.E. (which trains non-clinicians to recognize the SIGNS 

of suicidal thinking, to ASK Veterans questions about suicidal thoughts, to VALIDATE the Veteran’s experience, and to ENCOURAGE the Veteran to seek treatment), and required Suicide Prevention Coordinators to begin tracking and reporting suicidal behavior. In addition, VA added more suicide prevention coordinators 

and suicide prevention case managers in its larger medical centers and communitybased outpatient clinics, doubling the number of dedicated suicide prevention staff 

in the field. 

By 2008, VA had re-established a monitor for mental health followup after patients were discharged from inpatient mental health units, developed an online clinical training program, and held a fourth regional conference on evidence-based 

interventions for suicide. In 2009, VA launched the Veterans Chat Program to create an online presence for the Suicide Prevention Hotline. VA also added a clinical 

reminder flag to patient records to notify physicians of patients at risk for suicide. 

This year, VA has already held a Suicide Prevention Coordinator conference and cohosted a conference with the Department of Defense (DoD) to discuss ways VA and 

DoD can reduce the prevalence of suicide among Veterans and Servicemembers. 

VA has adopted a broad strategy to reduce the incidence of suicide among Veterans. This strategy is focused on providing ready access to high quality mental 

health and other health care services to Veterans in need. This effort is complemented by helping individuals and families engage in care and addressing suicide 

prevention in high risk patients. VA cannot accomplish this mission alone; instead, 

it works in close collaboration with other local and Federal partners and brings together the diverse resources within VA, including individual facilities, a Center of 

Excellence in Canandaigua, New York; a Mental Illness Research and Education 

Clinical Center in Veterans Integrated Service Network (VISN) 19; VA’s Office of 

Research and Development; and clinicians. 

During fiscal year (FY) 2009, VA’s Suicide Prevention Coordinators reported 

10,923 suicide attempts among patients and non-patients, 673 of which were fatal 

(6.2 percent). There were 9,297 unique Veterans who attempted suicide and survived in FY 2009; 811 of these Veterans made repeated attempts, and 42 died from 

suicide after they survived an initial attempt during the year. Approximately 47 

percent of those who attempted suicide in FY 2009 attempted it for the first time, 

and more than 31 percent of reported deaths from suicide involved cases where the 

individual had previously attempted suicide in 2009 or before. 

It is not possible to determine if the reported cases are representative of 

suicidality in VA’s patient population, but we do know that suicidality can be both 

an acute and a chronic condition. Those who survive attempts are at high risk for 

reattempting and dying from suicide within a year, so it is essential that we engage 

survivors in intensified treatment to prevent further suicides. It is precisely because 

of this concern that VA has initiated the post-discharge followup for patients leaving 

its inpatient mental health units. The data reported above include self-reporting of 

previous suicide attempts that have not been validated by VA, and all estimates are 

based on events reported in the Suicide Prevention Coordinator database and may 

not represent the complete number of suicide attempts among Veterans. Also, the 

records of suicide attempts for 136 Veterans were incomplete and omitted from this 

analysis. 

This evidence clearly demonstrates that once a person has manifested suicidal behavior, he or she is more likely to try it again. As a result, VA has adopted a comVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00072 Fmt 6604 Sfmt 6621 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
69 

prehensive treatment approach for high risk patients. This includes a flag in a patient’s chart, necessary modifications to the patient’s treatment plan, involvement 

of family and friends, close followup for missed appointments, and a written safety 

plan included in the Veteran’s medical record. This plan is shared with the Veteran 

and includes six steps: (1) a description of warning signs; (2) an explanation of internal coping strategies; (3) a list of social contacts who may distract the Veteran from 

the crisis; (4) a list of family members or friends; (5) a list of professionals and agencies to contact for help; and (6) a plan for making the physical environment safe 

for the Veteran. 

VA’s Vet Centers also fulfill a critical role in reducing the risk of Veteran suicide. 

The Vet Centers screen all Veterans who visit them for potential harm to themselves or others; in FY 2009, this resulted in 174,700 assessments. Vet Centers intervened in 132 cases of potential suicide or homicide in the Center or in the community. There were no negative outcomes and their engagement potentially saved 

at least as many lives. All Vet Center staff members have been trained in the Gatekeeper suicide prevention model, based on the U.S. Air Force’s similar approach. Vet 

Centers also participate in outreach and community education projects with local 

county, State, Federal and DoD components and can identify Veterans at risk during these events. 

Suicide Prevention Hotline and Veterans Chat 

Between its creation in 2007 and March 2010, the VA Call Center for the Suicide 

Prevention Hotline (1–800–273–TALK) has received more than 256,000 calls. Approximately a third of these calls are from non-Veterans. These calls have led to 

8,183 rescues of those determined to be at imminent risk for suicide and 30,176 referrals to VA Suicide Prevention Coordinators at local facilities. The VA Call Center 

has received calls from 3,270 active duty Servicemembers, a little more than 1 percent of all calls. To address the needs of the active duty population, VA worked with 

SAMHSA to modify the introductory message for Lifeline (their well-established hotline that feeds calls to the VA Suicide Hotline) developed memoranda of understanding with DoD, and established processes for facilitating rescues, including collaborations with the U.S. Armed Services in Iraq. During 2009, the Hotline services 

were supplemented with Veterans Chat, which has been receiving more than 20 

contacts a day. 

The Hotline has 15 active phone lines, 1 warm transfer line, and 151 employees, 

consisting of 123 Hotline responders, 17 health technicians, 6 shift supervisors, 3 

administrative staff, 1 clinical care coordinator and psychologist, and 1 supervising 

program specialist. There is also a director, a deputy director, and their program 

support assistant. After receiving a call from a Veteran, Servicemember or family 

member, the responder conducts a phone interview to assess the emotional, functional and psychological condition. The responder then determines the level of the 

call, namely whether it is emergent, urgent, routine or informational. 

Emergent calls require emergency services to keep the caller (or the person about 

whom the caller is concerned) safe; urgent care requires same day services at a local 

VA facility; and routine calls require a consultation by the local Suicide Prevention 

Coordinator. Consults occur if a Veteran consents to a consultation or if emergency 

services are required. They are simply alerts to the Suicide Prevention Coordinator 

and do not mean the Veteran is suicidal. Even if the Veteran is already engaged 

in treatment, a consultation can be done to alert the Suicide Prevention Coordinator 

to changes in the Veteran’s circumstances or to other needs he or she may have. 

VA analyzed data from the Hotline and identified the top 10 reasons for calls: 

1. Mental Health Needs 59 percent 

2. Substance Abuse 28 percent 

3. Other 21 percent 

4. Loss of Home/Job/Finances 15 percent 

5. Physical Health Problems 15 percent 

6. Relationship Issues 10 percent 

7. Loneliness 7 percent 

8. Sleep Problems 6 percent 

9. Death of Friend/Family Member/Pet 5 percent 

10. Questions about VA 4 percent 

The warm transfer line referenced above is a special phone line that is staffed 

24 hours a day, 7 days a week and accepts calls from sites or other call centers who 

want to transfer a caller to VA directly, without having to call the main 1–800 numVerDate Nov 24 2008 16:33 Jan 04, 2011 Jkt 058058 PO 00000 Frm 00073 Fmt 6604 Sfmt 6621 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
70 

ber. VA has pre-arranged agreements to do this with over 20 entities, as well as 

all other community crisis centers. 

The online version of the Hotline, Veterans Chat, enables Veterans, family members and friends to chat anonymously with a trained VA counselor. If the counselor 

determines there is an emergent need, the counselor can take immediate steps to 

transfer the visitor to the Hotline, where further counseling and referral services 

can be provided and crisis intervention steps can be taken. Veterans Chat and the 

Hotline are intended to reach out to all Veterans, whether they are enrolled in VA 

health care or not. Since July 2009, when Veterans Chat was established, VA has 

learned many valuable lessons. First, it is clear that conversations are powerful and 

capable of saving lives. As a result, opening more avenues for communications by 

offering both an online and phone service is essential to further success. Second, 

training and constant monitoring is very important, and VA will continue pursuing 

both of these efforts aggressively. 

The Lifeline and VA Call Center may be the most visible components of VA’s suicide prevention programs, but the Suicide Prevention Coordinators are equally important. Both the VA Call Center and providers at their own facilities notify the 

Suicide Prevention Coordinators about Veterans at risk for suicide. The Coordinators then work to ensure the identified Veterans receive appropriate care, coordinate 

services designed specifically to respond to the needs of Veterans at high risk, provide education and training about suicide prevention to staff at their facilities, and 

conduct outreach and training in their communities. Other components of VA’s programs include a panel to coordinate messaging to the public, as well as two Centers 

of Excellence charged with conducting research on suicide prevention: one, in 

Canandaigua, NY, focused on public health strategies, and one in Denver, CO, focused on clinical approaches. VA also has a Mental Health Center of Excellence in 

Little Rock, Arkansas, focused on health care services and systems research. 

Outreach and Awareness of VA’s Suicide Prevention Efforts 

As discussed previously, VA’s Suicide Prevention Coordinators do a tremendous 

amount of work to raise awareness about warning signs associated with suicide and 

the availability of treatment and support. For example, in February 2010, VA’s Suicide Prevention Coordinators provided 614 informational and outreach programs in 

their local communities. As a result, VA added 1,511 Veterans to its High Risk List 

and 1,353 (90 percent) have completed safety plans. In addition to these measures, 

VA has been aggressively advertising this information and improving outreach to 

Veterans and family members alike. Perhaps the most notable examples of this outreach are the public service announcements (PSA) featuring actor Gary Sinise and 

broadcaster and journalist Deborah Norville. All told, these PSAs have been shown 

more than 17,000 times and represent a significant cost savings. The two PSAs cost 

approximately $200,000 to produce, while the estimated value of the air time in 

which they were broadcast is $3.8 million. 

Another major effort in this regard is the advertising VA developed and placed 

on buses and Metro trains in the Washington, D.C. area, resulting in a significant 

increase in calls to the Hotline from the area. In 2009, VA began an advertising 

campaign in Dallas, Los Angeles, Las Vegas, Miami, Phoenix, San Francisco and 

Spokane metropolitan areas (all locations where the suicide rate among Veterans is 

greater than the national average). The table below contains specific information on 

the forms and extent of outreach VA pursued in these areas. These advertisements 

ran for 12-week, non-concurrent periods starting in late spring and ending in early 

fall 2009. ‘‘Units’’ refer to each specific location, so a bus displaying side, taillight 

and interior advertisements would count as three units. A second advertising campaign is being pursued through a contract with BluLine Media, Inc. and is producing and displaying suicide prevention advertisements in the interior of public 

transit buses. This effort has reached 4.3 million daily riders in 124 markets covering 42 States and 21,000 buses. The total cost for these two campaigns was approximately $1.4 million. 

City Media Form Number of 

Units 

Dallas Bus: Side, Taillight, and Interior Ads 275 

Los Angeles Bus: Taillight and Interior Ads 1,700 

Bus Shelter Ads 40 


ebenthall on DSK9Q6SHH1PROD with HEARING
71 

City Media Form Number of 

Units 

Rail Car Ads 105 

Las Vegas Bus: Side, Taillight and Interior Ads 1,112 

Bus Shelter Ads 150 

Miami Bus: Side, Taillight, and Interior Ads 310 

Rail Station Ads 22 

Rail Car: Interior Ads 136 

Phoenix Bus: Side, Taillight and Interior Ads 950 

Bus Shelter Ads 25 

San Francisco Bus: Taillight and Interior Ads 1,265 

Rail Car Ads 336 

Rail Station Ads 140 

Spokane Bus: Side, Taillight, and Interior Ads 348 

VA is continuing to conduct assessments of these programs. The Center of Excellence at Canandaigua is reviewing the associations between exposure to public 

health media messaging, knowledge of Hotline use among those known to the participant, and self-reported likelihood of Hotline use if in need. The current evaluation strategy aims to collect data from three random samples of approximately 500 

community members from each of the 2009 media campaign implementation sites. 

To identify any long-term associations between exposure to media messaging and 

likelihood of Hotline use, data are collected at baseline (the time the campaign was 

initiated), and 6 and 12 months following the start of the campaign. This study is 

not complete, but preliminary data indicate an increase in the number of calls originating in the areas where these advertisements were deployed. Phoenix, for example, saw a 234 percent increase in calls from the 602 area code within 30 days of 

the start of the media campaign. This change is all the more notable due to the contrast between it and the more modest change or even decrease among calls originating from other Arizona area codes during those same time periods. Based on 

these promising efforts, in FY 2011 VA will pursue a ‘‘next generation’’ of suicide 

prevention outreach based on a comprehensive strategy developed with ‘‘social marketing’’ experts and implemented through a newly created national outreach contract. 

VA’s Impact on Reducing Suicide 

On the macro level, one way to evaluate the impact of VA mental health care and 

its suicide prevention program is to evaluate suicide rates. However, before addressing this issue, it is important to consider who accesses VA health care. For this, it 

is useful to refer to findings on those Veterans returning from Afghanistan and Iraq 

who participated in the Post-Deployment Health Re-Assessment (PDHRA) program 

administered by DoD. Between February 2008 and September 2009, approximately 

119,000 returning Veterans completed PDHRA assessments using the most recent 

version of DoD’s form. Of the more than 101,000 who screened negative for PTSD, 

43,681 came to VA for health care services (43 percent). Among 17,853 who screened 

positive for PTSD, 12,674 came to VA for health care services (71 percent). These 

findings demonstrate that Veterans screening positive for PTSD were substantially 

more likely to come to VA for care. Findings about depression were similar. Both 

sets of findings support earlier evidence that those Veterans who come to VA are 

those who are more likely to need care and to be at higher risk for suicide. The increased risk factors for suicide among those who came to VA is often referred to as 

a case mix difference. 

Working with the Centers for Disease Control and Prevention’s National Violent 

Death Reporting System, VA recently calculated rates of suicide for all Veterans, 

including those using VA health care services and those who do not. This analysis 

included data from 16 States for individuals aged 18–29, 30–64, and 65 and older 

for the years 2005, 2006, and 2007 (during the period of VA’s mental health enVerDate Nov 24 2008 12:30 Jan 11, 2011 Jkt 058058 PO 00000 Frm 00075 Fmt 6604 Sfmt 6621 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
72 

hancement process). The year 2005 marked the beginning of enhancement, while 

the year 2007 is the most recent one for which data are available. 

Suicide rates for Veterans using VA health care services aged 30–64, and those 

65 and above were higher than rates for non-users, and they remained higher from 

2005 to 2007, probably a reflection of the case mix discussed above. However, findings for those aged 18–29 were quite different. In 2005, younger Veterans who came 

to VA for health care services were 16 percent more likely to die from suicide than 

those who did not. However, by 2006, those younger Veterans who came to VA were 

27 percent less likely to die from suicide, and by 2007, they were 30 percent less 

likely. This difference appears to reflect a benefit of VA’s enhancement of its mental 

health programs, specifically for those young Veterans who are most likely to have 

returned from deployment and to be new to the system. 

Because the number of Veterans from the 16 States in this group is relatively low, 

the rates are, for statistical reasons, variable. Nevertheless, they demonstrate important effects. In 2005, 2006, and 2007, respectively, those who came to VA were 

56, 73, and 67 percent less likely to die from suicide. Those who utilized VA services, to some extent, showed a lower rate of suicide with an effect that appeared 

to increase during the time of VA’s mental health enhancements. More broadly, the 

rate of suicide among Veterans receiving health care from VA has declined steadily 

since FY 2001; specifically, the rate declined more than 12 percent during this time. 

From a public health perspective, the decline in rates is significant, corresponding 

to about 250 fewer lives lost as a result of suicide. A chart detailing the VHA suicide 

rate from FY 2001 through FY 2007 is attached. 

Conclusion 

Mr. Chairman, as my testimony demonstrates, VA has taken a number of steps 

to provide comprehensive suicide prevention services, and the data indicate our efforts are succeeding. But our mission will not be fully achieved until every Veteran 

contemplating suicide is able to secure the services he or she needs. I thank you 

again for your support of our work in this area, and for the opportunity to appear 

before you today. I will be happy to respond to any questions from you or other 

Members of the Subcommittee. 

f 

Statement of Paula Clayton, M.D., Medical Director, 

American Foundation for Suicide Prevention 

Chairman Mitchell, and Ranking Member Stearns, and Members of the Committee. Thank you for inviting the American Foundation for Suicide Prevention 

(AFSP) to provide a written statement on the issue of suicide and suicide prevention 

among our Nation’s veterans. My name is Paula Clayton. I am a physician. I currently serve as AFSP’s medical director. My responsibilities include overseeing and 

working closely with the AFSP’s scientific council to develop and implement directions, policies and programs in suicide prevention, education and research. I also supervise staff assigned to the research and education departments within AFSP. 

Prior to joining AFSP, I served as professor of psychiatry at the University of New 

Mexico School of Medicine in Albuquerque. I also currently serve as professor of psychiatry, Emeritus, for the University of Minnesota, where I was a professor and 

head of the psychiatry department for nearly 20 years. My research on bipolar disorder, major depression and bereavement allow me to understand some of the antecedents of suicide and to appreciate medical research and public/professional education programs aimed at preventing it. 

AFSP is the leading national not-for-profit organization exclusively dedicated to 

understanding and preventing suicide through research, education and advocacy, 

and to reaching out to people with mental disorders and those impacted by suicide. 

You can see us at www.asfp.org. 

To fully achieve our mission, AFSP engages in the following Five Core Strategies, 

(1) Funds scientific research, (2) Offers educational programs for professionals, (3) 

Educates the public about mood disorders and suicide prevention, (4) Promotes policies and legislation that impact suicide and prevention, (5) Provides programs and 

resources for survivors of suicide loss and people at risk, and involves them in the 

work of the Foundation. 

I have provided the Committee staff with a Power Point presentation I delivered 

here in Washington, DC on March 8, 2010, entitled, ‘‘Suicide Prevention—Saving 

Lives One Community at a Time.’’ I also included a copy of AFSP’s 2010 Facts and 

Figures on Suicide. Both documents will provide Committee members and their staff 


ebenthall on DSK9Q6SHH1PROD with HEARING
73 

an overview on the issues associated with suicide in America today, along with some 

examples of programs and services to prevent this major public health problem. 

Chairman Mitchell, Ranking Member Stearns, suicide in America today is a public health crisis. Consider the facts: 

• More than 34,500 people die by suicide each year in the United States. Approximately 20 percent of those individuals—or one in five—are veterans. • Suicide is the 4th leading cause of death in the United States for adults 18— 

65 years old and the third leading cause of death in teens and young adults 

from ages 15—24. Currently 67 percent of all Marines are between the ages of 

17 and 25. • Male veterans are twice as likely to die by suicide as male non-veterans. On 

average 18 veterans commit suicide each day. • Men account for 80 percent of all completed suicides in America. • A suicide occurs approximately every 15 minutes, totaling over 90 suicides a 

day. • Suicide in the military is not just a mental health problem; it is a public health 

problem. The number of suicide attempts by Army personnel has increased sixfold since the wars in Afghanistan and Iraq began. • Depression, Post Traumatic Stress Disorder and traumatic brain injury are real 

medical conditions. 

We need to let our veterans know that seeking help for mental health and substance abuse problems is a sign of strength. The keys to improving these statistics 

are reducing the stigma associated with mental illness, encouraging help-seeking 

behavior, and being aware of warning signs and treatment options. 

Suicide is the result of unrecognized and untreated mental disorders. In more 

than 120 studies of a series of completed suicides, at least 90 percent of the individuals involved were suffering from a mental illness at the time of their deaths. The 

most common is major depression, followed by alcohol abuse and drug abuse, but 

almost all of the psychiatric disorders have high suicide rates. 

So the major risk factors for suicide are the presence of an untreated psychiatric 

disorder (depression, bipolar disorder, generalized anxiety and substance and alcohol abuse), the history of a past suicide attempt and a family history of suicide or 

suicide attempts. The most important interventions are recognizing and treating 

these disorders. Veterans have strong biases against doing that. These must be 

identified and overcome. 

Whether a civilian or a veteran, there are signs that health care professionals look 

for, what we call risk factors. In addition to those above, they include: 

• Difficulties in a personal relationship; 

• A history of physical, sexual or emotional abuse as a child; 

• Family discord; 

• Recent loss of a loved one; 

• A recent arrest; 

• Sexual identity issues; 

• Availability of firearms. 

Protective factors or interventions that work, again in the general population and 

for veterans include: 

• Regular consultation with a primary care physician; 

• Effective clinical care for mental and physical health, substance abuse; 

• Strong connections to family and community support; 

• Restricted access to guns and other lethal means of suicide. 

It is vitally important that we communicate effectively with our veterans that consulting a health care professional does not in and of itself preclude an individual 

from obtaining a security clearance. On May 7, 2010, Admiral Mike Mullen, stated 

concerning behavioral health issues, ‘‘If you feel as though you or a close family 

member needs help, please don’t wait. Tell someone. Asking for help may well be 

the bravest thing you can do.’’ Mr. Chairman, and Members of the Committee, we 

must make sure that Admiral Mullen continues to be heard loud and clear inside 

and outside the military and veteran community. 

AFSP is pleased to report that help is available. The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) founded a national suicide prevention hotline to ensure veterans in emotional crisis have free, 24/7 access to 

trained counselors. To operate the Veterans Hotline, the VA partnered with the 

Substance Abuse and Mental Health Services Administration (SAMSHA) and the 

National Suicide Prevention Lifeline. Veterans can call the Lifeline number, 1–800– 

273–TALK (8255), and be routed to the Veterans Suicide Prevention Hotline. This 


ebenthall on DSK9Q6SHH1PROD with HEARING
74 

Hotline is available 24 hours a day, 7 days a week. It is important to note that 

friends and family members of veterans in crisis are welcome to call the Veterans 

Hotline. 

The VA has expanded an advertising campaign that debuted in Washington DC, 

and is now active in 124 cities with advertisements on local buses. The ads are designed to make veterans and their family members aware of the VA Suicide Prevention Lifeline. The VA has also been distributing brochures, wallet cards, bumper 

magnets and other educational items to veterans, their families and VA employees 

to promote awareness of the Lifeline number. These items serve to educate the public, veterans and family members about suicide risk factors and how to get help for 

those veterans that need it. They are all important building blocks in our efforts, 

both public and private, to get the word out regarding the services and programs 

available. 

Another valuable service that veterans, their family members, and even friends 

can access, is a program called Veterans Chat through the National Suicide Prevention Lifeline Web site. Veterans Chat enables veterans, their families and friends 

to go online where they can anonymously chat with a trained VA counselor. If the 

chats are determined to be a crisis, the counselor can take immediate steps to transfer the individual to the VA Suicide Prevention Hotline, where further counseling 

and referral services are provided and crisis intervention steps can be taken. 

Additionally, AFSP supports President Obama and the new VA policies that will 

make it easier for war zone veterans with PTSD to receive disability benefits by 

stripping the requirement to produce evidence that a specific incident triggered 

their stress disorder. This policy has kept those who served in non-combat roles in 

war zones from getting the care they need and the new policy changes will expand 

access to care for those veterans. 

AFSP would like to commend the U.S. Department of Veteran Affairs, Dr. 

Antonette Zeiss and Dr. Jan Kemp for their leadership and vision in constructing 

and implementing this program designed to help our veterans contemplating suicide. We urge this Subcommittee, the full Committee and the entire Congress to 

fully support Dr. Zeiss and Dr. Kemp in their important efforts. 

Chairman Mitchell, Ranking Member Stearns, suicide in Veterans is an absolute 

crisis. Depression can be fatal. Excessive drinking or drug use can be fatal. The fatality is mainly by suicide. Culturally sensitive but sustained efforts with multiple 

approaches offer our best hope to get veterans into treatments. We must reduce this 

fatal outcome. The American Foundation for Suicide Prevention is ready and willing 

to offer our expertise and advice to this Committee and to all Members of Congress 

as you make the important decisions on how to reduce suicide among our veterans. 

f 

Statement of Penny Coleman, Rosendale, NY, Author, 

Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War 

Mr. Chairman, Ranking Member, and Members of the Subcommittee, I thank you 

for the opportunity to share my views and concerns on the very important issue of 

the VA’s national suicide prevention outreach efforts, which are based on the reported success of a pilot program that encouraged veterans at-risk for suicide to call 

the VA suicide hotline. 

I have several concerns about the current suicide prevention outreach efforts: 

a. that it is being called a success when there is little evidence of that, 

b. that it is a non-evidenced-based strategy, and 

c. that it intervenes with the problem of suicide at the moment of crisis rather 

than providing a more proactive and systematic approach. 

I will first address each of these in turn. Following that, I will present a number 

of suggestions for alternative strategies: 

1. Make VA enrollment automatic and universal 

2. Integrate and coordinate DoD and VA their health care transition 

3. Hire more mental health care providers 

4. Give the VA a budget that will not require outsourcing of services 

5. Reinstitute VA counseling for incarcerated veterans 

6. Establish Veterans Programs in the Nation’s prisons 

7. Support Community Living projects like Valley Forge Village and most importantly, 

8. Establish more Vet Centers 


ebenthall on DSK9Q6SHH1PROD with HEARING
75 

1 House Committee on Veterans’ Affairs, Subcommittee on Oversight and Investigations, 

Lisette M. Mondello, Assistant Secretary for Public and Intergovernmental Affairs, U.S. Department of Veterans Affairs, September 23, 2008. http://veterans.house.gov/Media/File/110/7–15–08/ 

Demvaqfrs.htm 2 ‘‘Calls To Veterans’ Suicide Hot Line Double,’’ Jul 28, 2008. http://cbs3.com/national/vet- erans.affairs.suicide.2.781329.html 3 ‘‘Strategies for Suicide Prevention in Veterans.’’ www.hsrd.research.va.gov/publications/. . ./ 

Suicide-Prevention-2009.pdf 4 ‘‘Strategies for Suicide Prevention in Veterans,’’ Appendix D: The VA National Center for Suicide Prevention and the MIRECC in Denver may have at least some published data describing 

the impact of the recent VA national suicide prevention hotline. This would obviously be the 

most relevant information, yet there was no mention of this in the project synthesis. It would 

be helpful if the document states explicitly one way or another if there is any recent data to 

be factored from either of these VA suicide prevention centers, either in the literature, in press 

or otherwise. www.hsrd.research.va.gov/publications/. . ./Suicide-Prevention-2009.pdf 5Donna Miles. ‘‘VA officials strive to prevent veteran suicides’ ’’ American Forces Press Service, 4/23/2010. http://www.af.mil/news/story.asp?id=123201368 

a. My first concern is that the stated purpose of these hearings is based on the 

assumption that the pilot suicide hotline program was a success. 

In 2008, Lisette Mondello, Assistant Secretary for Public and Intergovernmental 

Affairs for the VA, reported to this Committee that the pilot program, a televised 

public service announcement and posters placed on area trains and buses encouraging veterans considering suicide to call the VA’s suicide hotline, had produced a 

50 to 100 percent increase in calls from the area where the advertising ran.1

The 50 to 100 percent increase may sound substantial, but it actually refers to 

only eight more calls a week in the D.C. area, nine more in Northern Virginia, and 

17 more in Maryland. And there is no indication that even those small numbers are 

indicative of success. For one thing, Assistant Secretary Mondello’s statement fails 

to acknowledge that calls to the VA’s hotline more than doubled in the first 6 

months of 2008 nationwide, independent of the Washington metro ad campaign.2

Second, rather than a measure of the pilot’s success, that increase in calls can also 

be interpreted as a warning that failures of our military and veterans’ mental 

health care systems were leaving increasing numbers of the men and women who 

so desperately need them on the brink of crisis. Thus, my first concern is whether 

this program should in fact be considered successful. In other words, is it working? 

b. That there is no viable data to suggest that it is brings me to my second concern: that this is not an evidence-based strategy. 

In the fall of 2008, the VA’s blue ribbon panel of experts recommended that the 

VA ‘‘apply evidence-based research’’ in their intervention efforts. In January 2009, 

VA’s Health Services Research and Development Service (HSR&D) published a 

pamphlet called ‘‘Strategies for Suicide Prevention in Veterans’’ in which the authors state categorically that they ‘‘found no studies that assessed the specific effectiveness of any hotlines.’’ 3 The peer review comments (Appendix D) 4 specifically 

chide the VA for withholding data describing the impact of their national suicide 

prevention hotline. 

In April 2010, Dr. Janet Kemp, the national suicide-prevention coordinator for the 

VA, proudly told the American Forces Press Service that the advertising campaign, 

now in 124 cities nationwide, had increased the hotline call volume to about 10,000 

calls a month, or about 25 percent in 2 years. 

But she offered no information about who is calling, what era and branch of service they represent, how many of those callers have attempted suicide in the past, 

what kind of followup procedures are in place, how many of the callers are already 

enrolled in the VA system, how many are re-routed to back-up call centers, and 

nothing to back up her claim that the calls to the hotline were responsible for stopping 7000 in-process suicides. 

Instead of data, Dr. Kemp offered an anecdote about a veteran who was in the 

process of writing a suicide note when he happened to notice a poster with the hotline number on it and placed the call. ‘‘He’s now alive and well and telling his story 

of success.’’ 5

This is not evidence-based intervention. 

In June of 2010, doctors from the Los Angeles VA and the RAND Corp. did a systematic review of suicide prevention programs developed for military and veterans 

world wide. This program is not listed among them. The review found that all of 

the programs developed for the military reported declines in suicides and suicide attempts, but all were so badly designed, so inadequately documented and the data 

so poorly analyzed that ‘‘it was not possible to infer causality from the reported asVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00079 Fmt 6604 Sfmt 6621 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
76 

6Steven C. Bagley, MD, MS, Brett Munjas, BA, and Paul Shekelle, MD, PhD. ‘‘A Systematic 

Review of Suicide Prevention Programs for Military or Veterans Suicide and Life-Threatening 

Behavior,’’ 40(3), June 2010, p. 263–4. www.hsrd.research.va.gov / publications /.../SuicidePrevention-2009.pdf 7Gregg Zoroya, ‘‘No Letup in Marine attempted Suicides,’’ U.S.A Today, June 8, 2010. http:// 

www.usatoday.com/news/military/2010-06-07-marine-suicideslN.htm 8Suicide Facts. http://www.athealth.com/Consumer/issues/factsuicide.html 9 Armen Keteyian. ‘‘VA Hid Suicide Risk, Internal E-Mails Show: Follow-Up Reporting On Exclusive Investigation Reveals Officials Hid Numbers, April 21, 2008. http://www.cbsnews.com/ 

stories/2008/04/21/cbsnewslinvestigates/main4032921.shtml 10http://www.chron.com/disp/story.mpl/nation/6428651.html 11Pia Malbran, ‘‘VA To Test Suicide Public Service Ads,’’ July 14, 2008. http:// 

www.cbsnews.com/stories/2008/07/14/cbsnewslinvestigates/main4260904.shtml 12Tanielian, T., and Jaycox, L.H. (2008). Invisible Wounds of War Psychological and Cognitive 

Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: Rand Corporation. Accessed July 1, 2008. http://www.rand.org/pubs/monographs/MG720/ 13 VCS Fact Sheet: Consequences of Iraq and Afghanistan Wars. Updated March 13, 2010 

using documents obtained from the Department of Veterans Affairs (VA) under the Freedom of 

Information Act (FOIA). 14 ‘‘Calls To Veterans’ Suicide Hot Line Double.’’ http://cbs3.com/national/veterans.affairs. 

suicide.2.781329.html 

sociations.’’ And they found no studies focusing on veterans. Their conclusion that 

‘‘(t)here is an urgent need for continued research in this area’’ seems restrained.6

These hearings are evidence that the VA is still asking Congress to take this program seriously, yet in 2 years they have produced nothing to back up their claim 

that what they are doing is working. In fact, there is no way to distinguish between 

those callers who have been driven to their limits by service-related injuries and 

those who have been driven to their limits by the failure of the VA to deliver the 

care and support that are so desperately needed. 

While there is a lack of convincing evidence that the hotline has been successful 

as an suicide intervention strategy, there is no lack of evidence that it has not. Military suicides have continued to rise across all branches of service: in 2009, the suicide rate in the Marine Corps was 24-per-100,000; it was 23 in the Army; 15.5 in 

the Air Force; and 13.3 in Navy, all, by the way, higher than in 20087 and all significantly higher than the civilian suicide rate which has held steady at 11.1 for 

some years.8 The VA acknowledges that 18 veterans take their lives every day, the 

same number the VA accepted in 2007 when confronted with the CBS investigation.9 That is 6570 veteran suicides a year, or almost 60,000 in the 9 years since 

these wars began.10

c. My final concern with the hotline program is its centrality to the VA’s suicide 

prevention efforts. I take no issue with a hotline, only with the suggestion that 

it is anything more than an 11th-hour prayer. Rather than waiting until veterans are at the edge of the precipice and relying on haphazard message to pull 

them back, the VA should be focusing their attention on evidence-based interventions, interventions with documented histories of success. 

In 2008, when the pilot was announced, CBS News quoted David Rudd, a former 

army psychologist, warning that after the posters and the public service ads have 

directed veterans to turn to the VA for help, the VA had best be prepared to deliver. 

Specifically, they had best reduce delays and provide the services that will keep veterans in care. ‘‘Those are the things we know reduce death rates.’’ 11

A 2008 RAND Corporation report warned that fully a third of returning veterans 

were suffering from post-traumatic stress injuries.12 In 2008, that was 300,000 

troops. In 2010, over 2 million troops have been deployed in Iraq and Afghanistan, 

and a third is just shy of 700,000, a number that continues to grow.13 The magnitude of that crisis requires a response of commensurate magnitude. A hotline 

doesn’t belong at the top of the list. 

In that vein, the following are offered as an incomplete list of suggestions for evidence-based interventions that prioritize prevention rather than crisis management, 

and avoid raising hopes and expectations that will not be met. Perhaps even more 

to the point, invest in programs that offer the hope of dignity and independence. 

1. Make VA enrollment automatic and universal. 

In 2008, Congressman Harry Mitchell, who has been instrumental in pushing the 

VA to improve its suicide outreach, told CBS News, ‘‘We can’t just wait for veterans 

to come to us, we need to bring the VA to our veterans.’’ 14 The VA should take him 

at his word. When servicemembers are being processed out of the military, when 

they are cut loose and sent home, the VA should be sitting in the room signing them 

up, simply and automatically. 


ebenthall on DSK9Q6SHH1PROD with HEARING
77 

15The Relationship Between PTSD and Suicide—National Center for PTSD http:// 

www.ptsd.va.gov/professional/pages/ptsd-suicide.asp. 16http://www.cbsnews.com/stories/2010/01/11/national/main6083072.shtml 17 Interestingly, the number of veterans under VA care who took there own lives in 2007, five, 

is the same number cited by the VA in 2005. 18 Allan Breed, ‘‘Tide of new PTSD cases raises fears of fraud: Some veterans have learned 

to game the system to get disability payments,’’ May 2, 2010. http://www.msnbc.msn.com/id/ 

36852985/ns/health-mentallhealth/page/2/Tide of new PTSD cases raises fears of fraud. 19 No Across-the-Board Review of PTSD Cases—Secretary Nicholson, Public and Intergovernmental Affairs, November 10, 2005, http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1042 20The scandal at Walter Reed (http://www.washingtonpost.com/wp-dyn/content/article/2007/03/ 

04/AR2007030401394.html), was followed by stories of VA using veterans as guinea pigs in dangerous drug trials (http://www.washingtontimes.com/news/2008/jun/17/va-testing-drugs-on-war- veterans/), and then by the revelation that VA employees had taken $24 million in bonuses 

(http://www.veteranstoday.com/2009/08/21/va-24-million-bonus-scandal/), to the multiple scandals that resulted in the ‘‘retirement’’ of the director of the Philadelphia VA (http:// 

www.vawatchdog.org/10/nf10/nffeb10/nf021710-6.htm). Just Google VA scandal. 21 Veterans For Common Sense et al. v. Peake, Case No. C 07 3758, U.S.D.C. (N.D. Cal. 2007) 

http://www.veteransptsdclassaction.org/ 22Terri Tanielian and Lisa H. Jaycox, Eds., ‘‘Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery,’’ RAND, 2008: http:// 

www.rand.org/pubs/monographs/MG720/ p.17. 

Post-traumatic stress injuries are unique among anxiety disorders in that they 

are significantly associated with suicide, suicidal ideation and attempts.15 If suicide 

prevention is the issue, it is surely counter productive to make access to support 

and services dauntingly complicated and selectively exclusive. Especially if betrayal 

of expectations and frustration with what are perceived to be gratuitously forbidding 

procedures are going to exacerbate their post-traumatic stress symptoms and make 

disaster more likely. 

It is also well understood that the stigma associated with mental health issues 

prevents those who need it most from asking for help. Especially with new veterans, 

the VA should take advantage of the anonymity of universality. If everybody does 

it, nobody is exposed. 

Contrary to popular belief, currently, only about 20 percent of all of America’s veterans are enrolled in the VA and make use of their health care services. Far too 

many are excluded, far too many are daunted and overwhelmed, and far too many 

need help with the process. The VA has recently been pointing out that if there is 

any cause for optimism in the recent suicide data it is that it appears that veterans 

using VA health care seem increasingly less likely to take their own lives than those 

who did not.16,17

So make it accessible. Make enrollment simple and automatic and universal. The 

new rules streamlining the process for filing disability claims is a long overdue improvement, but already the posturers are lining up wagging fingers and tongues 

about how veterans are gaming the system and taking advantage of easy handouts.18 There will be Fraud! There will be Malingering! There will be Chronic Dependency! And there will be Budget Deficits! 

Shame on their selective memories. It has only been 5 years since the VA was 

directed to review the claims files of the 72,000 most fragile, most vulnerable (most 

expensive to maintain) veterans, those with 100 percent disability ratings for posttraumatic stress. After a review of a sample 2100 of those files, a review that was 

so stressful that one veteran was driven to suicide, the Inspector General’s report 

found not a single case of fraud on the part of a veteran. What it did find was an 

administrative mess. Then-Secretary Nicholson called off the review and promised 

to improve VA employee claims handling and administrative oversight.19

When there is real fraud at the VA, it is almost always at the top and very expensive, not just in dollars, but in lives.20 And though the VA declined to be the object 

of a lawsuit in 2007, it was not because they were innocent of the charges leveled 

against them, but because of a legal technicality that prevented the lawsuit from 

proceeding.21

And as to budget deficits, the RAND Corporation estimates the costs of the psychological and neurological injuries suffered by Iraq and Afghanistan veterans at between $4 and $6.2 billion, just in the first 2 years after combat. Providing proper 

evidence-based care for all of these veterans would lower that cost to society by 

about 27 percent.22

2. Integrate and coordinate DoD and VA their health care transition. 

There is no logical or moral justification for the chasm that is allowed to exist 

between the two agencies—only an apparently territorial one and the ubiquitous financial one. Both agencies are confronting the same terrible problem with suicide, 


ebenthall on DSK9Q6SHH1PROD with HEARING
78 

23 I have only heard variations on what is essentially the same story from veterans: ‘‘They 

try to fill your head at the last formation before the weekend, the last day before you get out. 

Everybody’s trying to sit in the back of the room, just waiting for a smoke break, with shades 

on because we’d drunk too much the night before because we were going home and what were 

they going to do to us anyway? Give us an Article 15?’’ ‘‘VA eligibility, TRICARE, the GI Bill, 

and a million other things were covered. The suicide hotline got one sentence.’’ Did he still have 

all the handouts he got in his ACAP[23] folder? ‘‘I took what was important, the GI Bill and 

TRICARE stuff and tossed the rest without reading it.’’ 24The Relationship Between PTSD and Suicide—National Center for PTSD http:// 

www.ptsd.va.gov/professional/pages/ptsd-suicide.asp. 25Paul Rieckhoff, ‘‘A Memo to Obama from America’s Vets,’’ Military.com, November 06, 2008. 

http://www.military.com/opinion/0,15202,178674,00.html 26 Ed Green, New Veterans unit could be big business for Humana Inc.—June 1, 2007. http:// 

louisville.bizjournals.com/louisville/stories/2007/06/04/story6.html 27Dennis Douda, ‘‘Expanding Private Medical Care For Veterans,’’ (WCCO), Feb 19, 2009. 

http://wcco.com/health/project.hero.veterans.2.939294 

and their attempts at intervention have produced the same disappointing results. 

There will be fewer suicides, on whichever side of the tally sheet they are finally 

counted, if soldiers and veterans who are at-risk for suicide aren’t allowed to get 

lost in the system—or worse, to it. 

If the DoD wanted enlisted men and women to know about the programs that will 

be available to them after they leave the service, they have a captive audience. Veterans who left the service years ago and veterans who left months ago tell the same 

story: suicide awareness and intervention options are touched on in a single sentence, at the last minute, as a footnote in an overwhelmingly condensed out-processing ordeal.23

One recently returned veteran compared the suicide awareness presentations 

given at out-processing to pharmaceutical ads on TV: don’t pay any attention to this 

list of lethal side effects that we are reading through as fast as we can; just keep 

your eye on the seductive fantasy payoff: happiness, health, sanity, and especially 

home. 

If suicide awareness and intervention options are important to both agencies, perhaps some thought should be given to how and when and with what degree of seriousness and urgency they are presented by the military and then what the VA can 

do to followup and reinforce the message. 

Perhaps more to the point, after years of stalling, the VA and the DoD have yet 

to implement a fully interoperable electronic health record systems. It is those who 

are most at risk who most need continuity of care, and continuity of care is exactly 

what gets lost in the tug of war over whose software system is going to win. 

3. Hire more mental health care providers. 

The significant association of post-traumatic stress injuries with suicide24 makes 

the availability of adequate numbers of trained providers key to any suicide intervention strategy. It is not enough to say that an additional 2000 or 4000 or 6000 

have been hired, if at-risk veterans are not seen in a timely fashion and given care 

that lives up to best-practice standards. 

If experienced therapists continue to leave both the military and the VA because 

they can get higher paying, less stressful jobs in the private sector, then the budget 

for mental health services must include higher salaries and incentives to induce 

them to stay.25 If younger, less experienced providers are more easily available, 

then they must be hired immediately, as it will take time to train them in cultural 

competencies essential to establishing the trusting relationships with veterans that 

will keep them in care. 

In fact, if a hotline generates 50,000 calls a day, 100,000, and the services and 

support advertised are not actually available, it can only add to a caller’s despair, 

and may even make it more likely that he or she will give up. 

4. Give the VA a budget that will not require outsourcing of services. 

Contracting out the responsibilities of the VA may be an attractive short-term solution to a very real problem, but it is a solution that leaves the 3 million veterans 

who live in rural areas that are underserved by VA facilities particularly vulnerable. 

In three short years, Project HERO, run by Humana, has expanded from an experimental pilot program specifically charged with providing health care to rural 

veterans into an entity providing a full range of services in metropolitan areas— 

in direct competition with established VA Medical Centers. The Business Section of 

the Milwaukee Journal referred to that phenomenon as ‘‘big business for Humana, 

Inc.’’ 26 The VA is dependent on Project HERO for 30 percent of their fee-based contracts nationwide,27 and so far they have managed to keep providers ‘‘stepping up’’ 


ebenthall on DSK9Q6SHH1PROD with HEARING
79 

28 Healthcare Inspection Inadequate Coordination of Care Orlando VA Medical Center Orlando, Florida—Report Number 10–00219–180, 6/24/2010. http://www4.va.gov/oig/54/reports/ 

VAOIG-10-00219-180.pdf 29 Alice Lipowitz, ‘‘Agencies Faulty Claims make OMB site hit list,’’ June 25, 2010, http:// 

washingtontechnology.com / Articles / 2010 / 06 / 25 / OMB-sets-up-new-Web-site-to-track-improperpayments-by-agencies.aspx?Page=2 30Danny Spatchek, ‘‘Chiarelli: suicides down, but not enough,’’ Jun 25, 2010. http:// 

www.army.mil/-news/2010/06/25/41363-chiarelli-suicides-down-but-not-enough/ 31 Christopher Mumola and Margaret E. Noonan, ‘‘Justice involved Veterans,’’ Bureau of Justice Statistics, Power Point presentation: The VHA National Veterans Justice Outreach Planning Conference, Dec. 2, 2008 Baltimore. 32 In 1994, a few concerned members of Congress managed to get a provision attached to the 

Violent Offender Incarceration and Truth in Sentencing Incentive which would have rewarded 

the operators of correctional facilities for adopting policies that would identify the veterans 

among their inmates. Those incentive grants were passed, but they were rescinded by the Gingrich Congress before they were ever implemented. 33 Hal S. Wortzel, MD, Ingrid A. Binswanger, MD, MPH, C. Alan Anderson, MD and Lawrence 

E. Adler, MD. ‘‘Suicide Among Incarcerated Veterans,’’ J Am Acad Psychiatry Law 37:1:82–91 

(2009). http://www.jaapl.org/cgi/content/full/37/1/82 

and ‘‘doing the right thing,’’ but the more dependent the VA gets on Humana, the 

less leverage they will have over their service delivery and fees. 

Humana was generously excused for their slow start, for the time it took to establish a network of providers, but it is still ostensibly on trial, and already it is ‘‘not 

living up to its contractual obligations for timely referrals and communication with 

FB (fee-based) providers’’ at the Orlando VMHC.28 In June, the VA Inspector General found that veterans were waiting for referrals, for appointments, for test results, and for medical record updates for up to 3 months. 

Furthermore, the new Web site of the Office of Management and Budget, 

PaymentAccuracy.gov, which showcases Federal ‘‘high-error’’ programs, included 

Project Hero in their June audit, identifying $11.6 million in potentially erroneous 

payments.29

Outsourcing VA services delays the construction of new VA facilities and the 

training and hiring of VA staff. Vet Centers will not be established, VA mental 

health teams will stop building travel to Community Based Clinics into their schedules, the burgeoning fleet of mobile VA clinics will be side-lined rather than expanded. 

The wars in Iraq and Afghanistan have drawn heavily on recruits from rural 

areas, and the need for VA services will only continue to grow. The Reserve is also 

largely drawn from those same communities and already exceptionally at-risk for 

suicide. In 2009, Army Reserve suicides were up 26 percent.30

For all its challenges and problems, the VA still manages to deliver the best medical care to the most people at the best price in the country. Humana never promised to be cheaper, only to give the VA a chance to catch up with the overwhelming 

needs of a rapidly expanding veteran population. Rural veterans at-risk for suicide 

need reliable, accessible mental health services. The VA should be funded at the levels required to put that system in place. 

5. Reinstitute VA counseling for incarcerated veterans. 

Current regulations restrict VA from providing counseling to incarcerated veterans because it is the duty of ‘‘another government agency,’’ in this case the criminal justice system, to provide that care. They don’t. 

The most recent Bureau of Justice estimate of incarcerated veterans in 2007 was 

228,700,31 many, perhaps most, as a result of their untreated, service-related psychic injuries. That is only an estimate though. No one actually knows because the 

Federal Government doesn’t require prison authorities to ask.32

Prison is a terrible place for veterans suffering from post-traumatic injuries. Left 

untreated, PTSD predictably gets worse and becomes chronic, making one of two 

scenarios far more likely: recidivism or suicide. The suicide rate in jails is an astonishing 47 per 100,000. The Army’s is now 23 per 100,000, and everyone agrees that 

is a crisis. 

And no one knows how many of the suicides in jails and prisons are veterans, 

but an article published last year in the Journal of the American Academy of Psychiatry and Law, points to the ‘‘absolute dearth of data,’’ and suggests that ‘‘defining 

the scope of this problem should be an absolute priority.’’ 33

To whatever extent PTSD and TBI and the other emotional, cognitive, and behavioral consequences of such injuries account for criminal behaviors, throwing this vulnerable population behind bars, where they will not get treatment, is compounding 

the risk that they will not survive. The probability that the produces an excess of 


ebenthall on DSK9Q6SHH1PROD with HEARING
80 

34http://www.valleyforgecenter.org/ 35Steven C. Bagley, MD, MS, Brett Munjas, BA, and Paul Shekelle, MD, PhD. ‘‘A Systematic 

Review of Suicide Prevention Programs for Military or Veterans Suicide and Life-Threatening 

Behavior,’’ 40(3), June 2010, p. 263–4. www.hsrd.research.va.gov / publications /.../SuicidePrevention-2009.pdf 

suicides should be reason enough for the VA to re-institute counseling for incarcerated veterans. 

6. Establish Veterans Programs in the Nation’s prisons. 

The relatively new phenomenon of veterans’ courts is a laudable attempt to intervene in an historical injustice. Veterans with service-connected mental injuries 

whose symptomatic behaviors get them in trouble with the law can opt into a treatment program rather than going to jail or prison. But those courts can’t yet begin 

to deal with the numbers and only a few are willing to accept veterans whose crimes 

are considered violent. 

In the meantime, veterans with felony convictions are more likely to be unemployed or homeless, both of which contribute to hopelessness and despair. 

In 1993, New York State had Veterans’ Programs in 19 of its facilities that offered 

VA substance abuse and PTSD counseling, and education and job training opportunities. They had a documented recidivism rate of 8.9 percent after 5 years for veterans who completed the program, compared to 51.6 percent for non-veterans. 

Those programs have been eviscerated or killed, but the model exists and would 

be a valuable component of any suicide intervention strategy. 

7. Support Community Living projects like Valley Forge Village 

Valley Forge Village,34 outside of the Twin Cities, is a 240-acre community for 

that will house 200 veterans coping with mental health conditions and cognitive impairments and their families. As conceived, it will be a place for veterans to go to 

heal and learn new skills. Organic farming and sustainable practices will be taught 

in a therapeutic setting. Residents can go to school in the surrounding area and 

business start-up skills and development training are an integral part of the program. 

Valley Forge Village is one of a growing number of privately funded intentional 

communities that will serve as models for the future. The combination of therapy, 

and farming in a peaceful, therapeutic, predominately peer environment is one the 

VA might do well to watch. As a suicide intervention strategy, it holds great promise. 

8. Establish more Vet Centers 

For 25 years, Vet Centers have been the first line of defense against suicide. They 

are walk-in clinics, designed to be less intimidating than the large VA medical centers. They are largely staffed by veterans, and unlike the big medical centers, they 

offer counseling to veterans regardless of discharge status and to their family members as well. 

It is family members who are most likely to notice behaviors or attitudes suggestive of suicidal ideation, and Vet Center counselors can help them decide how best 

to help. It is the families who are best positioned to encourage traumatized veterans, especially those who are in denial about or ashamed of their mental health 

issues, to get the help they need. 

Vet Center counselors are specifically trained to deal with combat- and other service-related issues, and they are fluent in with necessary cultural competencies. They 

offer an array of social support services, employment and addiction counseling, sexual trauma and family counseling, as well as housing and legal support. 

Vet Centers are not the answer to the homelessness and unemployment problems 

that so disproportionately affect the veteran community, and it is the co-occurrence 

of multiple issues that is most likely to leave a veteran feeling the despair and hopelessness that can lead to self-destructive behaviors.35

Expanding this system of small, local, largely veteran staffed, walk-in clinics, as 

General Shinseki has proposed, is an evidence-based suicide intervention strategy 

that has an undeniable documented history of success. 

Advertising the existence of the Vet Centers and the services they provide would 

help to prevent veterans from ever reaching the crisis state in which a call to a suicide hotline appears to be the only option. 

f 


ebenthall on DSK9Q6SHH1PROD with HEARING
81 

Statement of Oregon Partnership, Portland, OR 

Chairman Mitchell, Ranking Member Roe, and Members of the Committee, an 

alarming threat to the well-being of our active military and veterans is emerging. 

In the past several years, members of the military, veterans and their families 

have placed an increasing number of calls to Oregon’s statewide crisis lines, operated by the nonprofit Oregon Partnership (OP). 

While calls to Oregon Partnership’s 24–7 Suicide Interventionline have more than 

doubled since June of 2008 because of the economic downturn, we were surprised 

to learn of a corresponding increase in calls from the military. Since March 2009, 

OP’s Crisis Lines have received over 1,600 calls from members of the military, veterans and their families. 

These calls have run the gamut—from suicide and substance abuse to concerns 

about symptoms of post traumatic stress disorder, depression, and questions about 

jobs about health benefits. 

As a result, this past spring Oregon Partnership established a Military Helpline 

to meet the tremendous and growing need for compassionate, confidential crisis 

intervention and referral. The line—one of five specifically targeted crisis lines at 

OP—is operated by highly trained and dedicated staff and volunteers who are on 

hand around the clock. Some possess a military background, bringing a strong understanding of the daunting challenges our citizen soldiers and their families face. 

There is no question that America must do right by the men and women who have 

served and continue to serve our country. 

After experiencing war, life back home can be overwhelming. Issues such as unemployment, family strife, the loss of a home, PTSD and other serious health care 

concerns descend as soldiers return from long—and often repeated—deployments. 

These challenges may stop them from seeking help at all. 

What Oregon Partnership found was a huge gap in services—a gap that is serious 

and time-sensitive. 

Soldiers, veterans and their families desperately need the immediate and confidential help that 24-hour crisis lines offer—crisis lines operated outside the military and the Veterans Administration. 

There is a clear and present stigma in the military culture about seeking help for 

mental illness, emotional distress and contemplation of suicide. Recent efforts by the 

Department of Defense to diffuse this are to be applauded, but have decades of practice to overcome. 

Many active duty soldiers or members of the reserves are hesitant to seek help 

within the military health care system because of fear that it would appear on their 

military record, jeopardize their security clearance and/or impact promotion opportunities. 

So often, men and women separating from the military are reluctant to access the 

VA because of perceived agency dysfunction, claims denial, red tape, and frustration 

about the length of the process. 

It is vital that veterans and active military can call a confidential line and speak 

anonymously if they so choose. It’s all about reacting quickly, compassionately and 

effectively in time-sensitive situations, and providing for the safety of those suffering from invisible wounds. 

Recently, a severely depressed and suicidal veteran called our helpline. Wheelchair-bound and without transportation to the VA to get his prescribed medication, 

he was ready to kill himself. We connected him with the Portland VA Medical Center’s suicide prevention team and secured a quick resolution to his life-threatening 

situation. Without our helpline, he was tragically slipping through the cracks. 

A confidential military helpline is a valuable tool for returning soldiers who struggle with PTSD. Early intervention and assessment is key. And Oregon Partnership’s 

Military Helpline provides that, guiding individuals and families on a path to safety 

and healing. 

In establishing the Military Helpline, Oregon Partnership has received unwavering support from the Oregon Military Department and the Oregon National Guard. 

They have been and will continue to be tremendous partners in this life-saving 

work. 

The brave men and women who have served us so faithfully deserve our faithfulness in return. Oregon Partnership urges Congress to help robustly support these 

non-military lifelines. 


ebenthall on DSK9Q6SHH1PROD with HEARING
82 

MATERIAL SUBMITTED FOR THE RECORD 

Committee on Veterans’ Affairs 

Subcommittee on Oversight and Investigations 

Washington, DC. 

July 28, 2010 

Honorable Robert M. Gates 

Secretary of Defense 

U.S. Department of Defense 

1000 Defense Pentagon 

Washington, DC 20301 

Dear Secretary Gates: 

Thank you for the testimony of Colonel Robert W. Saum, USA, Director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury at 

the U.S. House of Representatives Committee on Veterans’ Affairs Subcommittee on 

Oversight and Investigations hearing that took place on July 14, 2010, entitled ‘‘Examining the Progress of Suicide Prevention Outreach Efforts at the U.S. Department of Veterans Affairs.’’ 

Please provide answers to the following questions by Friday, September 10, 2010, 

to Todd Chambers, Legislative Assistant to the Subcommittee on Oversight and Investigation. 

1. Can you give examples of how DoD has used multi-media to prevent suicide 

prevention within its own ranks? I know you have only been on the job for 

about a month, but what are your impressions so far on ways VA could improve outreach to at risk veterans and servicemembers contemplating suicide? 

2. Can you explain how the DoD and VA coordinate to help activated guard and 

reserve members—and ensure that they have the resources they need to help 

prevent them from becoming suicidal? 

3. During the July 15, 2008 hearing on Media Outreach, then Ranking Member 

Ginny Brown-Waite asked if there was a prohibition on using email addresses, 

or social media sites such as Facebook or Twitter to contact veterans regarding 

services available to them. At that time, Ms. Mondello, the Assistant Secretary 

of Public and Intergovernmental Affairs for VA stated that VA is working to 

enable Federal representation of citizen information on social media Web sites, 

and is planning an initial social media presence on four of the most popular 

networking Web sites: Facebook, MySpace, YouTube, and Second Life. What is 

the current status on the use of these types of Web sites by the Department 

of Defense, and how is the Department integrating its suicide prevention outreach into these social media? 

4. According to a fact-sheet we received from the VA on suicide statistics, there 

are between 30,000 and 32,000 U.S. deaths from suicide per year among the 

population in the U.S. overall. Of these about 20 percent are veterans, about 

18 deaths from suicide per day are veterans. Does your Department also keep 

statistics on active duty personnel, as well as Guard and Reservists with relation to the rate of suicides? 

5. On June 8, 2010, there was an article in Marine Times about the rise in suicide 

attempts by Marines. In the report, it indicated that ‘‘recent improvements in 

tracking suicide attempts may have contributed to more reports.’’ What is the 

Department of Defense currently doing to track suicide attempts amongst not 

only its active duty personnel, but also among the National Guard and Reserve 

units, and the Individual Ready Reserve? 

6. What is the Department of Defense doing to combat the stigma, or the worry 

that they are possibly jeopardizing the military career if a servicemember calls 

a hotline, or sought other help when they have suicidal thoughts? What reassurances do servicemembers have that when they call for help, they will not 

be tagged as a weakling or someone not worthy of being in the military? 

7. How does the Department of Defense reach out to servicemembers who may 

be at risk for suicidal ideation? 

8. Would the Department of Defense be interested in working on a coordinated 

effort with the VA on working to prevent suicides amongst our Nation’s 

servicemembers and veterans through outreach and media advertising? 

Thank you again for taking the time to answer these questions. The Committee 

looks forward to receiving your answers. If you have any questions concerning these 

questions, please contact Martin Herbert, Majority Staff Director for the Subcommittee on Oversight and Investigations at (202) 225–3569 or Arthur Wu, MinorVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00086 Fmt 6621 Sfmt 6621 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
83 

ity Staff Director for the Subcommittee on Oversight and investigations at (202) 

225–3527. 

Sincerely, 

Harry E. Mitchell David P. Roe 

Chairman Ranking Republican Member 

MH:tc 

Hearing Date: July 14, 2010 

House Committee on Veterans’ Affairs 

Member: Congressman Mitchell 

Witness: Colonel Saum 

Question 1: Can you give examples of how DoD has used multi-media to prevent 

suicide prevention within its own ranks? I know you have only been on the job for 

about a month, but what are your impressions so far on ways VA could improve 

outreach to at risk veterans and servicemembers contemplating suicide? 

Answer: The Department of Defense and the Military Services have designed and 

implemented multimedia programs to promote the processes of building resilience, 

facilitating recovery, and supporting reintegration for returning Servicemembers 

and their families. The Defense Centers of Excellence for Psychological Health and 

Traumatic Brain Injury’s Real Warriors Campaign is a multimedia public education 

initiative that is designed to break down the barriers to care for the invisible 

wounds of war and to encourage Servicemembers to reach out for the care they may 

need. Visitors to www.realwarriors.net who are experiencing suicidal ideation—or 

who know someone who is—will find articles, video profiles, and message boards 

that focus on suicide prevention as well as combat-related stress, traumatic brain 

injury and other invisible wounds. The Web site also includes a live chat feature 

that makes it easy for visitors to confidentially connect to health consultants with 

expertise in psychological health and traumatic brain injury for information 24 

hours a day/7 days a week/365 days a year. Many of our campaign materials were 

developed in collaboration with the VA, and all materials are in the public domain. 

There are also multimedia initiatives within each of the Services to encourage 

Servicemembers to reach out for necessary care before they reach a moment of crisis. The Army Suicide Prevention Office’s ‘‘Shoulder to Shoulder’’ program includes 

the video ‘‘I Will Never Quit on Life,’’ which includes vignettes and testimonials of 

members of Army families who received help for psychological stress or who assisted 

individuals in need. The Navy Suicide Prevention Program includes posters and 

other materials, such as brochures and public service announcements to educate 

sailors about the signs and symptoms of combat-related stress and available treatment resources. The Air Force Suicide Prevention Program includes tools and resources for Airmen and their families, commanders, leaders, and health professionals, as well as videos addressing ways Airmen can help their fellow Servicemembers who are experiencing combat-related stress. 

Question 2: Can you explain how the DoD and VA coordinate to help activated 

guard and reserve members—and ensure that they have the resources they need to 

help prevent them from becoming suicidal? 

Answer: When Guard and Reserve members are activated, they are fully eligible 

for care through the Department’s Mental Health System. In addition, there are numerous suicide prevention programs within the Department of Defense (DoD) to 

which activated Guard and Reserve members are exposed and have access to. The 

DoD and Department of Veterans Affaoirs (VA) coordinate their outreach and suicide prevention resources for activated Guard and Reserve members through: (1) the 

DoD/VA Integrated Mental Health Strategy, (2) the National Suicide Prevention 

Lifeline, and (3) National Suicide Prevention Week activities. 

First, through DoD/VA Integrated Mental Health Strategy, the two Departments 

will be coordinating suicide surveillance standards, trainings and suicide prevention 

outreach efforts for Servicemembers, including activated Guard and Reserve members, and veterans. Second, the VA National Suicide Prevention Lifeline offers suicide prevention services with trained crisis counselors for Active Duty Servicemembers, including activated Guard and Reserve members, and veterans. There is 

also a process in development for warm transfers between DoD call centers and the 

VA Lifeline. The VA Lifeline serves as the primary crisis counseling resource for 


ebenthall on DSK9Q6SHH1PROD with HEARING
84 

DoD servicemembers and their families. Third, the DoD and VA are coordinating 

activities for National Suicide Prevention Week, which begins September 6, 2010. 

Both departments will be cross-promoting each other’s activities and resources such 

as webinars and suicide prevention factsheets. In addition, the DoD and VA are 

working with the American Association of Suicidology so that veterans and activated Guard and Reserve members receive all relevant and appropriate resources. 

Question 3: During the July 15, 2008 hearing on Media Outreach, then Ranking 

Member Ginny Brown-Waite asked if there was a prohibition on using email addresses, or social media sites such as Facebook or Twitter to contact veterans regarding services available to them. At that time, Ms. Mondello, the Assistant Secretary of Public and Intergovernmental Affairs for VA stated that VA is working to 

enable Federal representation of citizen information on social media Web sites, and 

is planning an initial social media presence on four of the most popular networking 

Web sites: Facebook, MySpace, YouTube, and Second Life. What is the current status on the use of these types of Web sites by the Department of Defense, and how 

is the Department integrating its suicide prevention outreach into these social 

media? 

Answer: Social media are an integral part of Department of Defense (DoD) operations. The Services have social media platforms, including, but not limited to, 

Facebook, Twitter, YouTube, and Flikr. The DoD has created a special Web site designed to help the DoD community use social media and other Internet-based capabilities responsibly and effectively, both in official and unofficial capacities. Each of 

the Services uses social media to drive traffic to their respective suicide prevention 

Web sites and programs. The Service-specific social media outlets can be found online at http://socialmedia.defense.gov/services/. 

The Defense Centers of Excellence for Psychological Health and Traumatic Brain 

Injury (DCoE) also uses social media to guide those who may need help or information on suicide prevention and available psychological health resources; to promote 

psychological resilience; and to combat stigma. The DCoE social media team provides information on suicide prevention programs and access to a 24/7 call center 

through its pages on Facebook, Twitter, and the DCoE blog. 

Question 4: According to a fact-sheet we received from the VA on suicide statistics, there are between 30,000 and 32,000 U.S. deaths from suicide per year among 

the population in the U.S. overall. Of these about 20 percent are veterans, about 

18 deaths from suicide per day are veterans. Does your Department also keep statistics on active duty personnel, as well as Guard and Reservists with relation to the 

rate of suicides? 

Answer: Yes. The DoD maintains suicide statistics on Active Duty, Guard, and 

Reserve personnel and calculates the rate on an annual basis. In calendar year (CY) 

2008, the suicide rate among Active Duty personnel, including activated Guard and 

Reserves was 16.2 per 100,000 per year. In CY 2009, the suicide rate was 18.4 per 

100,000 per year, for the same population. An annual report with suicide data, historical and civilian context, and summaries of DoD suicide prevention initiatives are 

submitted to the Secretary of Defense. The DoD also began tracking Inactive National Guard and Reserves suicide data starting in 2009. 

Question 5: On June 8, 2010, there was an article in Marine Times about the 

rise in suicide attempts by Marines. In the report, it indicated that ‘‘recent improvements in tracking suicide attempts may have contributed to more reports.’’ What is 

the Department of Defense currently doing to track suicide attempts amongst not 

only its active duty personnel, but also among the National Guard and Reserve 

units, and the Individual Ready Reserve? 

Answer: The Department of Defense (DoD) uses a standardized surveillance system called DoD Suicide Event Report (DoDSER) to track suicide attempts among 

Active Duty personnel. The DoDSER captures data points such as personal characteristics, historical factors, event details, and clinical history for each suicide or suicide attempt. Some of the Services also collect this information on suicide attempts 

among the National Guard and Reserve units. At this time, the DoD does not track 

suicide attempts among the Individual Ready Reserve members. 

Created to facilitate collaboration and synchronize suicide prevention surveillance 

across the Services, the DoDSER tool has been used to capture information on suicides since January 1, 2008. As of January 12, 2010, as directed by the Under Secretary of Defense for Personnel and Readiness, the DoDSER has been used by all 

the Services to track suicide attempts. 


ebenthall on DSK9Q6SHH1PROD with HEARING
85 

Question 6: What is the Department of Defense doing to combat the stigma, or 

the worry that they are possibly jeopardizing the military career if a servicemember 

calls a hotline, or sought other help when they have suicidal thoughts? What reassurances do servicemembers have that when they call for help, they will not be 

tagged as a weakling or someone not worthy of being in the military? 

Answer: To successfully encourage at-risk veterans and Servicemembers who are 

experiencing suicidal ideation to reach out for help, we must prove to them that 

every warrior experiences some deployment stress; treatment and resources are 

readily available and they work; and reaching out is a sign of strength and not automatically a career-ender. 

The warriors profiled on www.realwarriors.net are sharing their own stories of resilience, recovery, and reintegration because they want to encourage others to reach 

out for necessary care. They are proof that Servicemembers need to know that 

reaching out makes a difference for their mental health but not in their careers. 

Many of the Servicemembers profiled on the Web site have been promoted since 

seeking care for their invisible wounds. We hope that these real-life stories are inspiring others to reach out and access psychological health resources such as the 

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury’s Outreach Center and ‘‘GiveAnHour,’’ which can be accessed online and by 

telephone to provide confidential assistance. 

As part of encouraging Servicemembers to reach out without fear of repercussion, 

in May 2008, Defense Secretary Robert M. Gates announced the change to Question 

21 on the National Security Background Questionnaire (SF–86), which asks security 

clearance applicants to indicate whether they had ever received psychological health 

care. The question now excludes counseling related to service in combat. 

Question 7: How does the Department of Defense reach out to servicemembers 

who may be at risk for suicidal ideation? 

Answer: The Department of Defense (DoD) leverages a variety of approaches to 

reach out to Servicemembers, including education campaigns and interactive Web 

sites. There are practical challenges to identifying individuals who are at risk for 

suicidal ideation, therefore the DoD and the Services have designed and implemented broad outreach initiatives to encourage Servicemembers to seek help and to 

educate them on all the available resources. 

The Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury’s Real Warriors Campaign is a multimedia public education initiative designed to break down the barriers to care, and to encourage Servicemembers to reach out for the care they may need. The Real Warriors Campaign provides real-life examples of Servicemembers and veterans who have had the strength 

to reach out for care for psychological health concerns, including suicidal ideation. 

They illustrate the importance of support from friends, families and units, and show 

examples of individuals who are now maintaining successful careers either in the 

military or as civilians. For example, our most recently featured Real Warrior 

speaks candidly about suicidal ideation after losing his leg as a result of an improvised explosive device. He had the strength to reach out for care and continues to 

serve the military community in a civilian career. 

The Web site, www.realwarriors.net, also includes a live chat feature that enables 

visitors to confidentially connect to health consultants with expertise in psychological health and traumatic brain injury for information 24 hours a day, 7 days a 

week, 365 days a year. 

The Caring Letters Project is an outreach program that involves sending brief letters of concern and reminders of treatment availability at regular intervals to individuals at high risk for suicide following psychiatric hospitalization. The Caring Letters Project has proven to be a successful intervention practice in the civilian sector. 

The DCoE’s National Center for Telehealth and Technology is currently piloting a 

Caring Letters program at Madigan Army Medical Center. 

In addition, DCoE’s web-based platform www.afterdeployment.org, offers a safe 

and interactive platform to better understand and increase awareness of substance 

misuse, depression, and other mental health related issues. The site features include quick health tips, self-assessments, e-libraries, self-paced workshops, personal 

stories, and a community forum. There is also a Google map locator tool to help 

users find providers close to home. 

Question 8: Would the Department of Defense be interested in working on a coordinated effort with the VA on working to prevent suicides amongst our Nation’s 

servicemembers and veterans through outreach and media advertising? 


ebenthall on DSK9Q6SHH1PROD with HEARING
86 

Answer: The Department of Defense (DoD) is interested in expanding our collaboration with the Department of Veterans Affairs (VA) on outreach and media advertising efforts. Currently, the DoD is coordinating with the VA on outreach and 

media advertising for the National Suicide Prevention Lifeline, which is a crisis hotline. Promotional materials and public service announcements attempt to increase 

awareness of the crisis line as a resource for Active Duty Servicemembers as well 

as veterans and their families. 

In addition, the DoD and VA are coordinating to prevent suicides among Servicemembers and veterans through outreach during National Suicide Prevention Week, 

which begins September 6, 2010. Both departments will be cross promoting each 

other’s activities and resources such as webinars and suicide prevention factsheets. 

In addition, the DoD and VA are working with the American Association of 

Suicidology so that veterans and activated Guard and Reserve members receive all 

relevant and appropriate resources. Lastly, there are plans included in the DoD/VA 

Integrated Mental Health Strategy for increasing coordination on communication 

and outreach to families of Servicemembers and veterans in the area of suicide prevention. 

f 

Committee on Veterans’ Affairs 

Subcommittee on Oversight and Investigations 

Washington, DC. 

July 28, 2010 

Honorable Eric K. Shinseki 

Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, D.C. 20420 

Dear Secretary Shinseki: 

Thank you for the testimony of Robert L. Jesse, M.D., Ph.D., Principal Deputy 

Undersecretary for Health, Veterans Health Administration, U.S. Department of 

Veterans Affairs, accompanied by Janet Kemp, R.N., Ph.D., National Suicide Prevention Coordinator, U.S. Department of Veterans Affairs at the U.S. House of Representatives Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations hearing that took place on July 14, 2010, entitled ‘‘Examining the Progress 

of Suicide Prevention Outreach Efforts at the U.S. Department of Veterans Affairs.’’ 

Please provide answers to the following questions by Friday, September 10, 2010, 

to Todd Chambers, Legislative Assistant to the Subcommittee on Oversight and Investigations. 

1. What progress have you made in advancing the VA’s use of multi-media in outreach efforts since the pilot program ended in the fall of 2009? 

2. What lessons did the VA learn from the suicide prevention outreach pilot? 

a. How is the VA planning on utilizing the lessons learned going forward? 

3. In your testimony you state that in 2009, VA launched the Veterans Chat Program to create an online presence for the Suicide Prevention Hotline. Do you 

think this initiative is doing what it was designed to do, and how do you track 

whether this initiative is succeeding? 

4. You stated in your testimony that all Vet Center staff members have been 

trained in the Gatekeeper suicide prevention model and that the Vet Centers 

participate in outreach and community education projects. Do you think there 

is a better way for VA to do this by using the power of multi-media? If so, in 

what ways? 

5. How was the hand off of the success of the pilot program carried out in the 

transition of power from the last administration to the current one? 

6. During the July 15, 2008 hearing on Media Outreach, then Ranking Member 

Ginny Brown-Waite asked if there was a prohibition on using email addresses, 

or social media sites such as Facebook or Twitter to contact veterans regarding 

services available to them. At that time, Ms. Mondello, the Assistant Secretary 

of Public and Intergovernmental Affairs for VA stated that VA is working to 

enable Federal representation of citizen information on social media Web sites, 

and is planning an initial social media presence on four of the most popular 

networking Web sites: Facebook, MySpace, YouTube, and Second Life. What is 

the current status on the use of these Web sites by VA, and how is VA integrating its suicide prevention outreach into these social media? 


ebenthall on DSK9Q6SHH1PROD with HEARING
87 

7. Members of your staff recently briefed the Senate and House staff on the 

progress being made by the Suicide Hotline in preventing suicides amongst 

veterans. Included in the discussion was an update on the calls to the hotline 

during times when VA made a concerted effort to advertise the hotline in 

major media outlets, including the Public Service Announcement (PSA) featuring actor Gary Sinise. These statistics showed that during peak advertising 

periods, the rate of calls to the hotline increased. What is your plan for your 

outreach and advertising campaign for 2011? 

8. Is there a one-stop shop, so to speak for an individual to go to when they are 

feeling depressed, want someone to talk to, and need help regardless of whether they are a veteran, a servicemember, a guard or reservist, or even just a 

regular citizen on the street? What occurs when someone calls into your existing hotline who is not a member of the armed forces, or a veteran? 

9. The New York Police Department has a partnership with an organization 

called POPPA, Police Organization Providing Peer Assistance, to help the 

NYPD officers deal with the stress of their jobs. This mainly serves as a 24- 

hour helpline staffed by other police officers who volunteer to act as suicide 

counselors. Officers often feel most comfortable talking anonymously to fellow 

members of the force. The POPPA helpline is credited with saving the lives of 

80 NYPD officers in the last 14 years, and the rate of suicides within the department has fallen 40 percent. What efforts has the VA made to make peerto-peer counseling available to veterans? Are there any plans to expand this, 

and has the VA considered partnering with other organizations that have developed such programs? 

Thank you again for taking the time to answer these questions. The Committee 

looks forward to receiving your answers. If you have any questions concerning these 

questions, please contact Martin Herbert, Majority Staff Director for the Subcommittee on Oversight and Investigations at (202) 225–3569 or Arthur Wu, Minority Staff Director for the Subcommittee on Oversight and Investigations at (202) 

225–3527. 

Sincerely, 

Harry E. Mitchell David P. Roe 

Chairman Ranking Republican Member 

MH:tc 

Questions for the Record 

The Honorable Harry E. Mitchell, Chairman 

The Honorable David P. Roe, Ranking Republican Member 

Subcommittee on Oversight and Investigations 

House Committee on Veterans’ Affairs 

‘‘Examining the Progress of Suicide Prevention Outreach Efforts at the 

U.S. Department of Veterans Affairs’’ 

July 14, 2010 

Question 1: What progress have you made in advancing the VA’s use of multimedia in outreach efforts since the pilot program ended in the fall of 2009? 

Response: Veterans Health Administration (VHA) social media outreach continues to expand. Suicide prevention themes remain a core message. VHA Facebook 

fans currently are about 35,000. Twitter followers are over 3,500. We monitor 

Facebook for Veterans who express suicidal thoughts and reach out and contact 

them directly and have been successful in getting these Veterans help when needed. 

In addition, the Veteran’s Chat Service was implemented in 2009, since then over 

7,000 ‘‘chatters’’ have worked with VA counselors on a one-on-one basis using the 

chat. We continue to work with our Substance Abuse and Mental Health Services 

Administration (SAMHSA) and Lifeline Partners to market the service and increase 

usage. We continue to do local outreach efforts including poster placement at various VA and Community sites, Suicide Prevention Coordinator training in the community, and regular ‘‘awareness’’ activities. 

Question 2: What lessons did the VA learn from the suicide prevention outreach 

pilot? 


ebenthall on DSK9Q6SHH1PROD with HEARING
88 

Question 2(a): How is the VA planning on utilizing the lessons learned going forward? 

Response: VA learned the following lessons as a result of the suicide prevention 

outreach pilot: 

• A lesson learned early on from Veterans’ focus groups was the need to prevent 

possible feelings of shame and stigma from being attached to a Veteran’s possible ‘‘emotional problems.’’ The lesson was that careful selection of slogans 

served both to reaffirm the Veteran’s positive character traits, while simultaneously promoting the acceptability of calling the suicide prevention hotline 

when having symptoms of mental distress. This helped us to select the campaign’s central message and slogan ‘‘It takes the courage and strength of a warrior to ask for help’’. • Veterans’ feedback noted it was important to deflect attention away from the 

Veteran as the exclusive target audience. Thus, rather than focusing solely on 

the Veteran as the one most likely to need help dealing with depression, the 

campaign message became ‘‘If you or someone you know is in an emotional crisis, call . . . ’’ This allowed the Veteran the option to refer a military ‘‘buddy’’ 

to the suicide prevention hotline but did not rule out that he or she could also 

call the hotline for their own personal needs. • We learned that an aggressive outreach to our target audiences ‘‘wherever they 

are’’ was needed. Accordingly, the Transit Authority Suicide Prevention Campaigns used thousands of Transit Authority vehicles of various kinds, metro and 

bus station dioramas, ‘‘street furniture’’ provided by the Transit Authorities for 

advertisements, metro rail cars, etc. Feedback from Veterans, however, included 

advice to use fewer words on these materials. This will be implemented in the 

future. We observed that television and radio were potent means for outreach 

to Veterans in their homes and cars. • We also learned that the choice of a spokesperson for a Public Service Announcement (PSA) is important. The PSA featuring actor Gary Sinise may appeal to older Veterans, but younger Veterans from Iraq and Afghanistan have 

noted in testimony that they do not relate to this actor. Experts advise that 

many effective and memorable PSA’s do not rely on ‘‘talking heads,’’ and we 

have learned that it is important to work through experienced professional communications experts to develop our next campaign. We will seek to collaborate 

with organizations such as The Ad Council, which has been effective in developing and promoting PSA’s directed at Iraq and Afghanistan Veterans. Our inhouse pilot efforts resulted in 17,000 airings for the Gary Senise PSA, but we 

know collaboration with communications experts will help us to obtain the hundreds of thousands of airings needed in an effective national effort. • We also learned that early notification should be given to the Suicide Prevention Hotline responders regarding PSA airing schedules. The first time the 

PSA’s were shown on local TV stations there were significant increases in the 

numbers of calls to the Hotline. This coordination will be implemented in the 

future campaigns. 

• Finally, we learned that it is extremely important to do the analysis and planning for advertising to reach targeted audiences—both Veterans who may be at 

special risk as well as those who can influence and intervene on behalf of Veterans—so that we can, in turn, use professional industry analysis to evaluate 

the effectiveness of our efforts. Our initial research in the pilot activity does, 

in fact, show an encouraging relationship between our print and other communications and the number of calls to the Hotline. But there are many intervening variables that effect social behavior outside the realm of our pilot communications. We will ensure that our future efforts include expert formative research; careful, evidence-based logic models that show how our communications 

actually affect our specific target audiences; and model-based evaluative research that can show clearly our success. We will engage social marketing experts in our partnership with the Office of Public and Intergovernmental Affairs 

through a new National Outreach Contract. This will add considerably to our 

capabilities to document, evaluate and strengthen our delivery of effective 

health and wellness messages to priority audiences. 

Question 3: In your testimony you state that in 2009, VA launched the Veterans 

Chat Program to create an online presence for the Suicide Prevention Hotline. Do 

you think this initiative is doing what it was designed to do, and how do you track 

whether this initiative is succeeding? 

Response: The Chat Program has been hugely successful. It was designed to provide an alternative mechanism for Veterans to seek help in times of emotional need. 


ebenthall on DSK9Q6SHH1PROD with HEARING
89 

Since its inception in 2009, over 7,000 Veterans have opted to seek help over the 

Chat Service. We have been able to transfer almost 800 of these chatters to the Suicide Hotline for immediate services and we have provided on-line support for the 

other Veterans. The number of Veterans who use this service continue to grow and 

we feel the Veterans Chat Program is in a position to accept more and more ‘‘chatters’’ as younger Veterans need services. We will continue to expand this program 

as need dictates. Our on-line relationship with the Lifeline has also allowed us to 

market the Chat Service and the Hotline through non-VA social media sources 

which helps us reach groups of Veterans who are not already enrolled or looking 

for VA care. Most of our ‘‘chatters’’ are non-enrolled Veterans and we hope we are 

providing a new avenue for them to seek services. 

Question 4: You stated in your testimony that all Vet Center staff members have 

been trained in the Gatekeeper suicide prevention model and the Vet Centers participate in outreach and community education projects. Do you think there is a better way for VA to do this by using the power of multi-media? If so, in what ways? 

Response: It will take a combination of both personal outreach and the use of 

multi-media and social-media venues to reach everyone. There are still large numbers of people who respond best to personal interactions and there are people who 

respond better to media and non-personal approaches and marketing. We have to 

use all of our people and technological resources. VA employees at both the Medical 

Centers and the Vet Centers are being given access to social media venues and we 

are learning how to use them to reach out to people. We are using broadcast media 

to promote selected aspects of our services such as the Hotline. We will continue 

to explore new venues. 

Question 5: How was the hand off of the success of the pilot program carried out 

in the transition of power from the last administration to the current one? 

Response: The hand-off between the two administrations went smoothly. The 

Transit Authority Suicide Prevention campaign concept that was piloted in Washington, DC, between July and October of 2008, was expanded in the summer of 2009 

to seven metropolitan markets including: Dallas, TX; Las Vegas, NV; Los Angeles, 

CA; Miami, FL; Phoenix, AZ; San Francisco/Oakland, CA; and Spokane, WA. 

Further, we entered into a contract with BluLine Media to provide interior bus 

advertisement space on municipal buses in many markets around the country. VA 

Suicide prevention advertisements were displayed on 21,000 public transit buses in 

124 cities in over 42 States across the country. The 3-month campaign started in 

the summer and extended into the fall of 2009. 

In addition, the airings of our PSA’s featuring actor Gary Sinise and TV personality Deborah Norville, which started airing at the end of 2008, continued and in 

fact greatly expanded (particularly the Sinise PSA) in 2009. 

Question 6: During the July 15, 2008 hearing on Media Outreach, then Ranking 

Member Ginny Brown-Waite asked if there was a prohibition on using email addresses, or social media sites such as Facebook or Twitter to contact Veterans regarding services available to them. At that time, Ms. Mondello, the Assistant Secretary of Public and Intergovernmental Affairs for VA stated that VA is working to 

enable Federal representation of citizen information on social Web sites, and is planning an initial social media presence of four of the most popular networking Web 

sites: Facebook, MySpace, YouTube and Second Life. What is the current status on 

the use of these Web sites by VA, and how is VA integrating its suicide prevention 

outreach into these social media? 

Response: VHA currently has an active and dynamic presence in the most popular social media sites, Facebook, Twitter and YouTube. Veterans Health Administration and nearly 25 medical centers use Facebook as a form of outreach, and, 

mindful of the audience of Veterans at risk, as well as family members, they have 

made suicide prevention one of the recurring messages. VA Medical Centers that 

use Facebook routinely monitor the comments from readers that have sometimes indicated an emotional crisis. The Suicide Prevention Hotline staff use Facebook and 

also monitor VHA Facebook pages to directly engage with Veterans and family 

members who may need help. 

Twitter messages regarding suicide prevention resources are very widely read and 

shared with other Twitter readers. We also continue to have a presence on the virtual world of Second Life. 

Question 7: Members of your staff recently briefed the Senate and House staff 

on the progress being made by the Suicide Hotline in preventing suicides amongst 

Veterans. Included in the discussion was an update on the calls to the hotline durVerDate Nov 24 2008 15:07 Jan 03, 2011 Jkt 058058 PO 00000 Frm 00093 Fmt 6621 Sfmt 6621 I:\VA\58058.XXX GPO1 PsN: 58058

ebenthall on DSK9Q6SHH1PROD with HEARING
90 

ing times when VA made a concerted effort to advertise the hotline in major media 

outlets, including the Public Service Announcement (PSA) featuring actor Gary 

Sinese. These statistics showed that during peak advertising periods, the rate of 

calls to the hotline increased. What is your plan for your outreach and advertising 

campaign for 2011? 

Response: We are in the process of developing a contract with a public relations 

company that will assist us in interpreting the results from the media campaign 

evaluation, as well as various focus groups that we have conducted. We will use the 

input we have received about our current products to develop a plan for FY 2011 

that will specifically help us address our identified target groups and reach as many 

people as we can. We know that what we have done so far has allowed us to reach 

many people but we do not know that it allowed us to reach as many Veterans as 

possible. We expect that contract to be in place very shortly and that the plan will 

be developed by the end of the calendar year. In the meantime we are re-distributing the Public Service Announcement and running a second mass transit campaign this fall to maintain the momentum. The contract for this campaign has been 

awarded and we anticipate the posters will be placed in buses in late September. 

Question 8: Is there a one-stop shop, so to speak for an individual to go to when 

they are feeling depressed, want someone to talk to, and need help regardless of 

whether they are a Veteran, a Servicemember, a guard or reservist, or even just a 

regular citizen on the street? What occurs when someone calls into your existing 

hotline who is not a member of the armed forces, or a Veteran? 

Response: The Hotline is available for anyone to call. We provide services to all 

who call or enter the chat service. Rescues are provided to everyone who is in imminent danger. Referrals are made to whoever can help the caller. For non-Veterans 

‘‘Warm transfers’’ are made to community Lifeline crisis centers—who in turn send 

Veterans and Servicemembers to us if they did not directly call the VA Center. 1– 

800–273–TALK is indeed a national one-stop shop for American citizens and we are 

proud to be a critical part of this national program. 

Question 9: The New York Police Department has a partnership with an organization called POPPA, Police Organization Providing Peer Assistance, to help the 

NYPD officers deal with stress of their jobs. This mainly serves as a 24-hour 

helpline staffed by other police officers who volunteer to act as suicide counselors. 

Officers often feel most comfortable talking anonymously to fellow members of the 

force. The POPPA helpline is credited with saving the lives of 80 NYPD officers in 

the last 14 years, and the rate of suicides within the department has fallen 40 percent. What efforts has the VA made to make peer-to-peer counseling available to 

Veterans? Are there any plans to expand this, and has the VA considered 

partnering with other organizations that have developed such programs? 

Response: We work closely with community organizations such as POPPA. 

POPPA also has a Veterans line that routinely refers Veterans to the Hotline or the 

local VA for care. We will continue to work with these very critical community based 

agencies and support their efforts. Our Vet Centers also provide peer counseling 

services and we do refer Veterans to the Vet Center Call Center for help in noncrisis situations or their local VA Medical Centers if they want longer term peerto-peer counseling services. Approximately 30 percent of our Hotline staff is Veterans and within the Hotline, calls are transferred to responders who may relate 

well with the caller. We agree that these are valuable services and we will continue 

to seek out partnerships and ways to work together. 

Æ 


ebenthall on DSK9Q6SHH1PROD with HEARING