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STOPPING SUICIDES: MENTAL HEALTH CHALLENGES WITHIN THE U.S. DEPARTMENT OF VETERANS AFFAIRS

 


 HEARING

BEFORE  THE

COMMITTEE ON VETERANS' AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION


DECEMBER 12, 2007


SERIAL No. 110-61


Printed for the use of the Committee on Veterans' Affairs

 

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COMMITTEE ON VETERANS' AFFAIRS

BOB FILNER, California, Chairman

 

CORRINE BROWN, Florida
VIC SNYDER, Arkansas
MICHAEL H. MICHAUD, Maine
STEPHANIE HERSETH SANDLIN, South Dakota
HARRY E. MITCHELL, Arizona
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
SHELLEY BERKLEY, Nevada
JOHN T. SALAZAR, Colorado
CIRO D. RODRIGUEZ, Texas
JOE DONNELLY, Indiana
JERRY MCNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
CLIFF STEARNS, Florida
JERRY MORAN, Kansas
RICHARD H. BAKER, Louisiana
HENRY E. BROWN, JR., South Carolina
JEFF MILLER, Florida
JOHN BOOZMAN, Arkansas
GINNY BROWN-WAITE, Florida
MICHAEL R. TURNER, Ohio
BRIAN P. BILBRAY, California
DOUG LAMBORN, Colorado
GUS M. BILIRAKIS, Florida
VERN BUCHANAN, Florida

 

 

 

 

Malcom A. Shorter, Staff Director


Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.

 

       

C O N T E N T S
December 12, 2007


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

OPENING STATEMENTS

Chairman Bob Filner
        Prepared statement of Chairman Filner
Hon. Steve Buyer, Ranking Republican Member
Hon. Stephanie Herseth Sandlin, prepared statement of
Hon. Harry E. Mitchell, prepared statement of
Hon. Cliff Stearns, prepared statement of
Hon. Leonard L. Boswell
Hon. Donald A. Manzullo


WITNESSES

U.S. Department of Veterans Affairs, Ira Katz, M.D., Ph.D., Deputy Chief Patient Care Services Officer for Mental Health, Veterans Health Administration
    Prepared statement of Dr. Katz


Bowman, Mike and Kim, Forreston, IL
    Prepared statement of Mike and Kim Bowman
Coleman, Penny, Rosendale, NY, Author, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War
    Prepared statement of Ms. Coleman
Meagher, Ilona, Caledonia, IL, Author, Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops
    Prepared statement of Ms. Meagher
Zivin, Kara, Ph.D., Research Health Scientist, Health Services Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs
    Prepared statement of Dr. Zivin


SUBMISSIONS FOR THE RECORD

U.S. Department of Veterans Affairs, Michael Shepherd, M.D., Physician, Office of Healthcare Inspections, Office of Inspector General, statement


American Legion, Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, statement
Disabled American Veterans, Joy J. Ilem, Assistant National Legislative Director, statement
Iraq and Afghanistan Veterans of America, Todd Bowers, Director of Government Relations, statement
National Coalition for Homeless Veterans, statement
Vietnam Veterans of America, Richard F. Weidman, Executive Director for Policy and Government Affairs, statement


MATERIAL SUBMITTED FOR THE RECORD

Additional hearing material:

Hon. Michael J. Kussman, M.D., M.S. MACP, Under Secretary for Health, U.S. Department of Veterans Affairs, sample of letter sent to veterans, informing veterans of the National Suicide Prevention toll-free hotline number, 1-800-273-TALK (8255), and pocket-sized card with VA Suicide Crisis Hotline phone number/information, as well as a Crisis Response Plan

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

Post Hearing Questions and Responses for the Record:

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. Gordon H. Mansfield, Acting Secretary, U.S. Department of Veterans Affairs, letter dated December 14, 2007, and VA responses.

Hon. Harry E. Mitchell, Member of Congress, U.S. House of Representatives, to Hon. James Peake, M.D., Secretary, U.S. Department of Veterans Affairs, letter dated February 8, 2008, and response letter dated February 27, 2008, following up to request additional information not supplied in earlier VA responses to questions for the record.

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to John D. Daigh, Jr., M.D., CPA, Assistant Inspector General, Office of healthcare Inspections, U.S. Department of Veterans Affairs, letter dated December 14, 2007, and response letter dated January 24, 2007.

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, letter dated December 21, 2007,  and response letter dated February 5, 2008, requesting additional data on suicide rates among veterans.

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Rick Kaplan, Executive Producer, CBS Evening News With Katie Couric, letter dated December 21, 2007, and response letter dated May 16, 2008, from Linda Mason, Senior Vice President, Standards and Special Projects, CBS News.


STOPPING SUICIDES: MENTAL HEALTH CHALLENGES WITHIN THE U.S. DEPARTMENT OF VETERANS AFFAIRS


Wednesday, December 12, 2007
U. S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.

The Committee met, pursuant to notice, at 10:10 a.m., in Room 345, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.

Present:  Representatives Filner, Snyder, Michaud, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Rodriguez, McNerney, Space, Walz, Buyer, Stearns, Boozman, Brown-Waite, Bilirakis, and Buchanan.

Also Present:  Representatives Boswell, Manzullo, and Kennedy.

OPENING STATEMENT OF CHAIRMAN FILNER

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

I appreciate your attendance, and I appreciate your interest in this very important issue of mental illness, particularly of the suicides that have occurred in our veterans' population, especially those involved in combat situations. 

So this is going to be a very tough hearing, an emotional hearing.  It is an issue the military, the U.S. Department of Veterans Affairs (VA) and the American public does not like to talk about.  Yet, we owe it to our fighting men and women.  We owe it to their families.  We owe it to our future mental health as a Nation to explore this issue in as much depth as possible. 

This year, as we try to deal with the influx of veterans who are coming from Iraq and Afghanistan, plus the needs of our older veterans, which continue, it has been a great challenge for this Committee and for this Congress and for this Nation. 

Earlier in the year, and in a series of articles since, The Washington Post reporters dealt with the terrible scandal at Walter Reed which had the effect, as other local newspapers around the country did stories, on their military and veterans' hospitals, of a wake-up call, for all of America.  Their veterans, their troops coming back from the current war were not getting the treatment, the care, the respect, the honor and the dignity that Americans thought they deserved. 

Because of that awareness that really spread throughout America, this Congress was able to add almost $13 billion of new money for healthcare for veterans, an unprecedented increase of 30 percent or more, based on the public perception that we had to do more. 

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

One of the television networks, ABC, whose reporter Bob Woodruff had suffered a blast injury and traumatic brain injury (TBI) in Iraq, opened up that subject to millions of Americans.  And we know more now about TBI and how to treat it. 

Recently, the CBS network opened up again to millions of Americans the issue of suicides amongst our veterans.  They had a great deal of difficulty getting information from the authorities or from the U.S. Department of Defense (DoD) or from the Department of Veterans Affairs.  That is one of the issues we are going to explore today, the issue of information and the tracking of these issues.  But they had to spend 5 or 6 months tracking down statistics in different States because nobody seemed to be interested in Washington, of understanding the statistics. 

Their report of several weeks ago again opened the eyes of millions of Americans to statistics, which went way beyond what people had thought or imagined as to the number of suicides, not only amongst our returning vets but amongst veterans from previous wars.  I think it is now recognized that as many Vietnam veterans have now committed suicide as had died in the original war.  That is a terrible, terrible statistic and says we have to do more. 

So what we are going to do today is try to open up this subject which is very difficult for the families involved and for our government.  We want to talk about the statistics.  Why doesn't the VA do more about trying to understand the nature of the issue?  We leave it to citizens like Ilona Meagher, who will be testifying later, to keep a Website for tracking suicides, of which she is one person with limited resources.  This is what our government should be doing. 

We want to talk about the stigma of mental illness and how we try to deal with this as a Nation.  We want to talk about the apparent inability of the military to look at mental illness and people's honest attempts to deal with it as something to be recognized, promoted, encouraged.  It is denied.  Anybody who admits mental illness is threatened with no promotions or no jobs in law enforcement when they leave the military. 

It is an issue for all of us in America but particularly for those in the military, and we have to face it honestly and come to grips with it.  That is what we hope to do today. 

We have a brave mother and father who have decided that their son's suicide must be talked about and understood to help others, and other families, prevent that.  We have citizens, authors who have dealt very directly with this issue and, of course, the professionals within the VA system and those in the veterans service organizations (VSOs) who try to help their members deal with these issues. 

So we will have a very tough hearing, as I said earlier, but it is an important hearing.  America must look at these issues.  We have to decide that we have to deal with them in a far more open and dedicated manner, and that is our objective today. 

I would yield for an opening statement to the Ranking Member, Mr. Buyer.

[The statement of  Chairman Filner appears in the Appendix.]

OPENING STATEMENT OF HON. STEVE BUYER

Mr. BUYER.  Thank you, Mr. Chairman. 

Some in this room today, including several of our witnesses, have been personally devastated by the loss of a loved one who has chosen to take their own life.  Before I begin, I want to personally thank you for testifying about your extremely personal and painful experiences.  While I know nothing can compensate you for the loss of your loved ones, we can hopefully find ways to help deter another soldier from succumbing to such tragedy. 

I hope that, as we delve into these sensitive matters, we do not lose sight of the fact that every case that we will discuss here today represents a human life, a veteran, a family, and a tragedy.  Discussing the tragic circumstances surrounding a suicide of one who has worn the uniform should be done with great respect and in recognizing also their service to our country.  We must search for answers and solutions to veteran suicide. 

As most of our witnesses will attest this morning, tracking suicide rates nationwide is very difficult, and it is clear to me that the data we currently have does not give us a definitive understanding nor a scope of the problem.  There seems to be significant variations among the data provided by CBS News, the VSOs, the DoD and the VA.  These veterans' lives were important, and it would be a dishonor to them and to their service if information is not accurately portrayed.  Accurate information is crucial to identifying risk factors, to providing better prevention and treatment protocols. 

Therefore, it is imperative that the VA have a better method to systematically collect and to track suicides so we can get a true understanding and scope of our challenge.  It is my understanding that the VA is beginning to work with the DoD to do this, and I applaud them.  But, again, I cannot overstate the urgent need to do it quickly.  When decision makers do not have accurate data, we must rely on anecdotal evidence.  While this can raise awareness, it does not help us make informed decisions on how best to develop strategies to diminish the risk and to prevent the events of suicide. 

Notwithstanding the tragic stories that surround this hearing, I believe we can point to the steps that the VA and the DoD have taken to help veterans and servicemembers deal with mental health challenges. 

The VA has already formulated a comprehensive strategy for suicide prevention, focusing on the needs of both new veterans from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) and on those of prior conflicts.  The specific program for suicide prevention is based on public health and clinical models and activities both within the VA facilities and the civilian medical community. 

The cornerstone of this program is the VA's new 24-hour veteran suicide prevention hotline, which opened its lines in July of 2007.  Since its inception, the VA reports that they have made more than 1,300 referrals to suicide prevention coordinators and have rescued 317 veteran callers.  Veterans experiencing thoughts of suicide can call 1-800-273-TALK for help. 

We have seen clearly that early intervention and treatment has a significant and demonstrated impact and is crucial to preventing suicide.  It is important to recognize the warning signs and to ensure that servicemembers receive the treatment they need right away. 

This starts with DoD.  I am very encouraged that a new training program called BattleMind, developed at the Walter Reed Army Institute of Research, that is being developed and is working to help soldiers transition from the combat zone to the home front. 

Mr. Chairman, I would sum this up with this.  VA and DoD have made strides in the treatment of mental health disorders that can lead to suicide.  However, until families like the Bowmans no longer bear such pain, not enough is being done.  I welcome their testimony here today, and I hope this hearing can help us gain a better understanding of how to offer more effective and timely assistance for those troubled servicemembers to prevent them from turning to such a tragic option. 

On a personal note, as I see the parents sitting in front of me, your quest for answers will never end, and probably on your last breath there will still be the thoughts of your son.  At the age of 16, my best friend committed suicide.  His baseball cap sits in my office.  I think people walk in, and they think it is my baseball cap, but it is that of a very dear friend.  I constantly search for answers because none of us knew, even as close as we were to him.  And, of course, the parents would drill us all the time about the signs.  What were they?  And there were no signs.  There were no risk factors.  It was just one of these bizarre strikes of the mind that just—I do not have an answer.  I just want you to know I carry the pain of suicide, and I am in constant search of answers.  And I am haunted, haunted by suicide.  Even among my colleagues—if you want to talk about something that is not discussed, in the 15 years I have been in Congress, it is the number of suicides of sons and daughters of Members of the Senate or of the House, and it is not discussed—or the attempts.  It is that dark side. 

So you know what?  It is not just us, and it is not just those in the military.  You can touch any sector of our society.  So, as we delve into this issue, we have to also be very sensitive, because I recognize there are anti-war advocates who also want to say that these individuals who then commit suicide and who have worn the uniform are somehow victims, and that is not right either, as we are trying to find out actually how can we prevent and how can we be helpful to someone who thinks that suicide is some form of option that can help them. 

So, on a personal note, I thank you for your bravery to come here and to talk about your son, and I know you are doing this because you absolutely believe that your testimony here today can help someone else. 

Thank you.  I yield back.

The CHAIRMAN.  Thank you, Mr. Buyer. 

Our first panel will be Mr. and Mrs. Mike Bowman, whose son, Tim, an Army specialist in the Illinois National Guard from Bravo Troop, 106th Calvary, committed suicide. 

Before that, if you will allow me, Mr. and Mrs. Bowman, to ask our colleague Mr. Boswell if he would just step forward for 2 minutes.  He is the author of Public Law 110-110, the Joshua Omvig Veterans Suicide Prevention Act, named after a young man in his own district, whose parents have now become friends with the Bowmans. 

The Bowmans are being introduced by our other colleague from Illinois, Mr. Manzullo. 

Mr. Boswell, please. 

OPENING STATEMENT OF HON. LEONARD L. BOSWELL

Mr. BOSWELL.  Thank you, Mr. Chairman, Ranking Member Buyer and Members of the Committee.  I appreciate your holding this hearing and your leadership on this issue. 

To Mike and Kim, we extend our hand in friendship, our concern and sympathy for the loss of your son, Tim, and we pledge to do our best to stop this. 

As we all know, suicide is sweeping through our veteran population, and the Committee has shown leadership in addressing the issues our veterans face today.  I want to thank you again for allowing me to speak on this important issue. 

Suicide is an epidemic which is encompassing much of our veteran population.  For too long, suicide among veterans has been ignored, and now is the time to act.  We can no longer be afraid to look at the facts, and the sad fact is we are missing adequate information on the number of veterans who commit suicide each year. 

I was shocked, and I am sure all were, when we saw the CBS Evening News report focusing on veteran suicides.  They found that in 2005, over 6,200 veterans committed suicide—120 per week.  The report also found that veterans were twice as likely to commit suicide as nonveterans.  These statistics are devastating. 

As a result of this report, I immediately introduced H.R. 4204, the "Veterans Suicide Study Act," which several Members of the Committee have cosponsored.  If time had permitted, there would be many, many more, because no one—no one—who I approached chose not to sign on. 

This legislation will direct the VA to conduct a study to get the real facts on the rate of suicide among veterans.  It is just one step that we must do to ensure that we have adequate information so we can treat our veterans as they return from combat. 

I would also like to personally thank the Chairman and the Ranking Member on the full Committee for their action in support of the Joshua Omvig Veterans Suicide Prevention Act earlier this year.  Now that this crucial piece of legislation has been signed into law, I am confident our veterans will begin to receive more of the vital care they need. 

While the Joshua Omvig bill puts in place a comprehensive approach in treating high-risk veterans, we still need to know the facts.  So I implore the Committee, and the Congress, to act swiftly on H.R. 4204 so we can ensure we have the data we need to treat our Nation's heroes.  Our veterans have dedicated their lives to keep our great Nation safe, and it is now our duty and our time to protect them. 

So I want to thank you again for allowing me to share this time with you, Mr. Chairman, and I am sorry I have to go to a markup.  Thank you very much.  

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

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

Thank you for being here with us. 

OPENING STATEMENT OF HON. DONALD A. MANZULLO

Mr. MANZULLO.  Thank you, Mr. Chairman.  I have the honor today of introducing, three constituents who are testifying before the Committee today. 

In inverse order, on the second panel is Ilona Meagher.  Ilona's father was a Hungarian freedom fighter and also became a member of the United States Armed Forces, so he is a veteran of both the Hungarian and the American Armed Forces.  Ilona is a tremendous campaigner, a seeker of truth, and she wrote this book, "Moving a Nation to Care," about the very subject of which we are discussing this morning. 

The other two constituents really exemplify the people about whom Ilona Meagher is concerned, and they are the Bowmans from Forreston, Illinois.  Kim and Mike live about 10 miles from my farm in the same county in northern Illinois.  Their testimony is nothing less than startling and compelling.  They would rather be anywhere in the world than here today to talk about what happened in their lives and to their precious son. 

I encourage the Members of this Committee to continue their leadership, to draft legislation or whatever is necessary, in order to make sure that the Bowman’s testimony is not in vain and that their son's life is not in vain and that the lives of other young men and women who have taken their lives, will be used in order to prevent those situations from occurring in the future. 

The CHAIRMAN.  Thank you, Mr. Manzullo. 

Mr. and Mrs. Bowman, you are recognized for your testimony.  I had a chance to talk to you yesterday and to understand a little bit more about Tim, about the incredible job he was doing overseas, about the soldier that he was, about the close relationship you had with him, about your patriotism and his.  So, again, I cannot say I am looking forward to your testimony, but I just thank you for having the courage to be here and for making sure that Tim's life and death will be used to help other people. 

Please, Mr. Bowman.

STATEMENTS OF MIKE AND KIM BOWMAN, FORRESTON, IL (PARENTS OF SPECIALIST TIM BOWMAN, U.S. ARMY, ILLINOIS NATIONAL GUARD, BRAVO TROOP, 106TH CAVALRY)

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

As my family was preparing for our 2005 Thanksgiving meal, our son Timothy was lying on the floor of my shop office, slowly bleeding to death from a self-inflicted gunshot wound.  His war was now over; his demons were gone.  Tim was laid to rest in a combination military-firefighter funeral that was a tribute to the man that he was. 

Tim was a life-of-the-party, happy-go-lucky, young man who joined the National Guard in 2003 to earn money for college and to get a little structure in his life.  On March 19th of 2005, when Specialist Timothy Noble Bowman got off the bus with the other National Guard soldiers of Foxtrot 202 who were returning from Iraq, he was a different man.  He had a glaze in his eyes and a 1,000-yard stare, always looking for an insurgent. 

Family members of F202 were given a 10-minute briefing on post traumatic stress disorder (PTSD) before the soldiers returned, and the soldiers were given even less.  The commander of F202 had asked the Illinois Guard Command to change their demobilization practices to be more like the regular Army, only to have his questions rebuffed.  He knew that our boys had been shot up, had been blown up by improvised explosive devices, had extinguished fires on soldiers so their parents would have something to bury, and had extinguished fires on their own to save their lives.  They were hardened combat veterans now, but were being treated like they had been at an extended training mission. 

You see, our National Guardsmen from the F202 were not filling sandbags.  They departed in October of 2003 for 6 months of training at Fort Hood and Fort Polk.  On Tim's 22nd birthday, March 4th of 2004, Foxtrot left for Iraq, where they were stationed at Camp Victory.  Their tour took them directly into combat, including 4 months on the most dangerous road in the world, the highway from the airport to the Green Zone in Baghdad, where Tim was a top gunner in a Humvee.  Tim, as well as many other soldiers at F202, earned their Purple Hearts on that stretch of road known as "Route Irish."  We are still waiting for Tim's Purple Heart from various military paperwork shuffles. 

My wife and I are not here today as anti-war protesters, and let me make that very clear.  Our son truly believed that what his unit did in Iraq helped that country and helped many people that they dealt with on a daily basis.  Because of his beliefs, I have to believe in the cause that he fought and died for.  That does not mean I do not feel that we lost track of our overall mission in Iraq. 

When CBS News broke the story about veterans suicides, the VA took the approach of criticizing the way the numbers were created instead of embracing it and using it to help increase mental healthcare within their system.  Regardless of how perfectly accurate the numbers are, they obviously show a trend that desperately needs attention. 

CBS News did what no Government agency would do.  They tabulated the veterans suicide numbers to shed light on this hidden epidemic and to make the American people aware of this situation.  The VA should have taken those numbers to Capitol Hill, asking for more people, funding and anything else they need to combat this epidemic.  They should embrace this study, as it reveals the scope of a huge problem, rather than complain about its accuracy. 

If all that is going to be done with the study is to argue about how the numbers were compiled, then an average of 120 veterans will die every week by their own hand until the VA recognizes this fact and does something about it.  The VA mental health system is broken in function and understaffed in operation.  There are many cases of soldiers coming to the VA for help and being turned away or misdiagnosed for PTSD and then losing their battle with their demons. 

Those soldiers, as well as our son Timothy, can never be brought back.  No one can change that fact.  But you can change the system so that this trend can be slowed down dramatically or even stopped. 

Our son was just one of thousands of veterans that this country has lost to suicide.  I see every day the pain and grief that our family and extended family go through in trying to deal with his loss.  Every one of those at-risk veterans also has a family that will suffer if that soldier finds the only way to take battlefield pain away is by taking his or her own life. 

Their ravished and broken spirits are then passed on to their families as they try to justify what has happened.  I now suffer from the same mental illness that claimed my son's life—PTSD from the images and sounds of finding him and hearing his life fade away, and depression from a loss that I would not wish on anyone. 

If the veterans suicide rate is not classified as an epidemic that needs immediate and drastic attention, then the American fighting soldier needs someone in Washington who thinks it is.  I challenge you to do for the American soldier what that soldier did for each of you and for his country:  take care of them and help preserve their American dream as they did yours.  To quote President Calvin Coolidge, "The Nation which forgets its defenders will itself be forgotten." 

Today, you are going to hear a lot of statistical information about suicides, veterans and the VA, but keep one thing in mind.  Our son, Specialist Timothy Noble Bowman, was not counted in any VA statistic of any kind.  Let me repeat that.  Our son is not included in any VA count.  Now, why, you ask?  He had not made it into the VA system because of the stigma of reporting mental problems.  He was National Guard, and he was not on a drill weekend when he took his life.  Therefore, he was not counted as active duty.  The only statistical study that he was counted in was the CBS News study.  And there are many more just like him.  We call them KBAs, killed because of action, the unknown fallen. 

I challenge you to make the VA an organization to be proud of instead of the last place that a veteran wants to go for help.  It is the obligation of each and every one of you and all Americans to channel the energies, the resources and the intelligence and wisdom of this Nation's best and brightest to create the most effective, efficient and meaningful health-care system for our men and women who have served. 

We must all remove the stigma that goes with the soldier's admitting that he or she has a mental issue.  Let those soldiers know that admitting they have a problem with doing the most unnatural thing that a human being can do is all right.  Mental health issues from combat are a natural part of the process of war and have been around for thousands of years, but we categorize that as a problem. 

Take that soldier who admits a head and mental health injury from combat and embrace him as a model for others to look up to.  Let the rank-and-file know by example that it is okay to work through your issues instead of burying them until it is too late.  Grab that soldier and thank him for saying, "I am not okay," and promote him.  A soldier who admits a mental injury should be the first guy you want to have in your unit, because he may be the only one who really has a grasp on reality.  But instead, he is punished and shunned, and by that example, he has become the model for PTSD and suicide. 

While we are at it, why do we call it a disorder?  That title, in itself, implies ramifications that last forever.  It is an injury, a combat injury, just like getting shot.  And with proper care and treatment, soldiers can heal from this injury and can be as productive and as healthy as before. 

We, as a country, have the technology to create the most highly advanced military system in the world, but when these veterans come home, they find an understaffed, underfunded, underequipped VA mental health system that has so many challenges to get through it that many just give up trying.  The result is the current suicide epidemic among our Nation's defenders, one of which was our son, Specialist Timothy Noble Bowman, a 23-year-old soldier and our hero.  Our veterans should and must not be left behind in the ravished, horrific battlefields of their broken spirits and minds.  Our veterans deserve better. 

Thank you, Mr. Chairman.

[Applause.]

[The statement of  Mr. and Mrs. Bowman appears in the Appendix.]

The CHAIRMAN.  Mrs. Bowman, do you have anything to add?  Thank you for being here with Mike.  And, again, thank you for your courage in being here. 

Mr. Michaud, you are recognized. 

Mr. MICHAUD.  Thank you very much, Mr. Chairman and Mr. Ranking Member, for having this very important and timely hearing today. 

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

Thank you, Mrs. Bowman, for coming. 

Our soldiers, as you know, put their lives in harm's way to protect our country.  Not all wounds are physical.  The memories of the war do not disappear when they take off the uniform.  A lot of us have seen the casualties of war.  Maine recently lost one of its sons to suicide.  Kyle Curtis, who served in Iraq, took his own life, like your son. 

My question is:  When your son came back, did he try to get some assistance from the VA?  Did either one of you notice any changes in the way your son was acting?  Did you try to see or to encourage him to get help? 

Mr. BOWMAN.  Timothy was a very smart kid, for one thing, and that gave him the ability to—as soon as he would start to open up in a situation where he thought his anger or his drinking problem or any sign that he was having trouble was going to be visible by us, he would immediately change the subject, or if we were sitting around our patio, he would go home.  He would find a way to leave that situation that was putting him in that position, so that he could close that door in the back of his mind again and go on to something else. 

He had shown us small signs but not enough to trigger anything, because we did not know what we were looking for.  And we, as National Guard families, are never educated on what to look for, because it is volunteer.  You know, you show up at a readiness group meeting, and there is somebody there who gives us a 10-minute briefing.  That was 2 months before the guys got home.  Then you go through the process of the homecoming, and you realize that they are going to be changed when they come out of combat.  That is fact.  So then they hit your back door, and sure, there are some issues that you see, yet they think it is normal, and they portray it as being normal, and they tell you that it is normal.  "This is just the way I am now." 

Now, he showed us one little sign.  He showed certain friends other little signs.  If we had all gotten together, we would have seen a larger picture, and we would have known he was in more trouble.  But he was so good at hiding that that nobody knew for sure. 

And he was a model employee.  He worked for me in the family business.  We have an electrical contracting business.  He would have been the third generation in 40 years.  He was an absolute model employee.  He went to work every morning regardless of what happened the night before or anything else.  So, you know, you would discount any problem he was having at night because he did such a good job during the day.

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

Mr. MICHAUD.  Not knowing where you live in relationship to the VA hospital, other than providing resources to the VA so they can hire staff to take care of the need that is out there, as well as to provide additional resources so if you live in a rural area, they could contract with providers in a rural area, do you think it would be helpful if the VA established a program for those individuals who might not want to go to the VA facility to have counseling online, on a computer? 

With technology today, a lot of individuals, particularly our younger individuals, are on the computer all of the time.  Do you think it would be helpful if the VA established a program where someone could actually access help from home, whether it is to a clinic or to the VA hospital? 

Mr. BOWMAN.  I would say, yes, definitely.  As in the case with Tim and with a lot of his unit buddies, they are very well-computer-connected.  They stay connected with us now via e-mail and by all kinds of ways through the computer. 

I would think that would be an easy way, especially as long as they can enter it anonymously, because you have the stigma of, if you walk into a VA clinic, somehow that information is going to get back to your commanding officer.  And until that stigma is removed, that you have just admitted to having a mental health issue, they have to be able to find help in some way so it is not going to come back to haunt them in their careers. 

A lot of these guys who come home from Iraq, a lot of the guys in Tim's unit are 10-years-plus in the National Guard.  They want to get to their 20 years.  They do not want to get out.  So they do not want to have a problem with their careers down the road, which means they also do not want to have a problem with promotions.  And it is a known fact that if you voluntarily admit that you have a mental health issue that your chance of progression in the military ranks at that point is pretty well shot. 

So, with the computer, it is if you can make it anonymous and can make it helpful.  By "helpful," I mean it is peer-to-peer counseling. 

We had a discussion this morning about this very issue.  The Vet Centers were a wonderful idea, but then all of a sudden, the VA comes along and they decide they have to have a guy with a title and a suit as a counselor at the Vet Center.  Now, what did that do?  That took that soldier who was walking in with that issue and made him on the defensive right off the bat.  He was not talking to his peer anymore.  He was talking to somebody who was sitting at another level above him. 

If you take a Vet Center and you make it a room with a couch and a pop machine and you put guys in there who are not in uniform and who are not in a suit or anything else and they just sit and talk, you will have veterans opening up.  But if you take a guy with PTSD and you shove him in a room with a doctor in a suit, he is going to shut that door. 

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

Once again, I am sorry for the loss of your son, but I really appreciate both of you and your willingness to come forward to talk about your tragedy in order to help others who have not taken their lives.  Hopefully, we will be able to move forward in a positive, productive manner. 

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

Mrs. BOWMAN.  Thank you. 

Mr. MICHAUD.  Thank you, Mr. Chairman. 

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

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

Mr. and Mrs. Bowman, all of us here who are parents can only imagine what it is like to lose a child.  It is the toughest thing that a parent ever does. 

One of the questions that I was just asking counsel was—I do not believe, in many of the Community Based Outpatient Clinics (CBOCs) where they offer mental healthcare, that that information gets back to the commanding officer.  And I think we need to look at that.  I know the CBOCs in my district consider anyone who seeks mental health or any kind of care as a VA case, and it is not reported to the National Guard commanding officer or to the Reserves or even if the person is ready reserve call-up. 

Tell me why you believe that—tell me why veterans who have served believe that the information gets back to the commanding officer.

Mr. BOWMAN.  The 118 soldiers who were in F202 have basically all—they have all adopted us.  We are their adoptive parents now, and they are all our adopted sons.  I talk with these boys all the time, and they open up to me because they know that I will understand about their mental status.  They ask me questions about Tim. 

I have a list as long as my arm of soldiers in that unit who are all seeking counseling of some form or another privately, all away from the military, away from the VA, some as far as 100 miles away from home, to make sure that that information does not get back to their unit. 

Now, you say that that information should be kept anonymously by the VA and should never make it back.  If that is true, then you are not—I am sorry, not "you"—then they are not educating the rank-and-file soldiers to let them know that it is safe to go to the VA.  You have to change that stigma.

And I know for a fact that I can call four or five guys right now who will tell you the same thing.  They are all active-duty National Guard.  They will not go to a VA center for this because they are going back.  My son's unit is going to Afghanistan in the spring, and they do not want to risk a redeployment opportunity by having a mental health issue all of a sudden show up on their records.

Ms. BROWN-WAITE.  Please do not misunderstand me.  I am not questioning it.  I am just saying what I believe is the policy.  I will certainly check on that, as to if someone goes to a VA hospital or to a CBOC, that that information is kept private.  Certainly, under Health Insurance Portability and Accountability Act (HIPAA), for example, which covers the privacy of medical records, that would be absolutely prohibited unless the patient releases any information. 

So what I am saying is, believe me, I do not think there is a person on this panel on either side of the aisle who would ever stand for, if that is the policy, its continuing.  If it is not the policy, I agree with you, it needs to be out there loud and clear, absolutely loud and clear, to our military. 

The last casualty in my district happened to have been someone who was active-duty who committed suicide.  I do not believe that the people who are active-duty even are properly informed.  In this case, the young man was crying, and one of his buddies came up to him and said, "Can I help you?  Do you need to talk to someone?"  He said, "Yes."  So the buddy left to go get the chaplain, and in the meantime, this young soldier committed suicide.  What should have happened was, if it were just the two of them, he should have stayed there with him and should have gotten, called, you know, just perhaps gone outside the door and called for help.  So there are certainly ways that we could do a better job at suicide prevention. 

Again, thank you very much for coming and for sharing your story.  And I will follow up on that issue. 

Mrs. BOWMAN.  Thank you.

Ms. BROWN-WAITE.  Thank you. 

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

By the way, I would not just concentrate on the official records, on whether they are sealed or not.  It is the knowledge of when someone walks into a clinic.  People talk; their buddies talk.  The information is there even if the exact record may not be held.  It is that information and that sense that seeking help is itself the problem for the military. 

So, you know, when you are in a small community like this, everybody knows what everybody is doing.  I would think that that is more of the sense than someone's individual record being given. 

Would you agree, Mr. Bowman? 

Mr. BOWMAN.  Yes, it very true, especially in a National Guard unit because, traditionally, those men are closer than a regular military unit because they all live in the same neighborhood also.

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

Mr. HARE.  Thank you, Mr. Chairman. 

I want to thank the Bowmans for their courage in coming today and for telling the story, the chilling story, about your son, Tim.  I had the opportunity to sit with both of you this morning with my friend, Representative Manzullo.  I cannot begin to express my sorrow for your loss.  My son is about the age of your son. 

I find it appalling that you have not received the Purple Heart for your son, and I want you to know, this morning, Representative Manzullo and I will work very hard, and we promise you that we will get this situation taken care of quickly.  I cannot imagine that that is something that has not already been done, but we will work on that. 

Your son was a brave young man.  He served this country honorably.  We talked a lot about some of the things, about Iraqi veterans and Afghanistan veterans coming back.  One of the things that you talked about, Mr. Bowman, too, was about how on a Monday you are in Iraq and on a Thursday you are home.  You may be playing soccer or watching your kid's soccer game or doing things, but it is a very different war, and it has put tremendous stress upon people. 

I just want to ask a couple of things of both of you.  We talked about this this morning, but I think, for the record, it is important. 

You know, the Chairman has a wonderful idea, and that is to screen every person who comes back for PTSD.  You know, Representative Murtha said if you are in combat for more than 6 months you are a prime candidate.  For those particularly in the Guard and in the Reserves who have to come out and say, "Hey, I think I have a problem here," they are really setting themselves up, as you said, for a possible loss of employment, a possible loss of being redeployed again in their units.  So I wonder if you think that makes sense, from a perspective of testing everybody. 

But also, I was amazed when you said you only had a 10-minute briefing prior to your son's coming home.  A lot of parents—I know Mrs. Bowman this morning was obviously very upset.  You do not know what to look for.  This is not just an individual problem.  It seems to me, Mr. Chairman, this is a problem that affects the entire family.  How do you know what to look for if you do not know what to look for or know what the signs are? 

So it puts you at a handicap, and then the parents and the family end up feeling like somehow they could have intervened or should have intervened, but if you do not know what you are looking for, you are relying upon bits and pieces.  Like you said, Mr. Bowman, different groups of people had to come up and say, hey, Tim said this or Tim said that. 

So I don't know.  If you would spend maybe just a couple of minutes talking about the need—and I thoroughly agree with the Chairman that every person coming back should be screened.  I think we should look farther down the road, because it does not necessarily manifest itself within 30 days of coming home.  It could be 4 or 5 years.  We have seen this. 

Then also, maybe, just how little knowledge you had or the families had before your sons and daughters were coming back from this war to know even what to look for. 

Mr. BOWMAN.  The redeployment process, basically reintegrating back into society—we were talking with Chairman Filner last night about the unboot camp, the reverse boot camp.  It is something that we have lobbied with the Illinois National Guard for a long time.  You cannot just educate the soldier; you have to educate the family. 

Now, obviously, I am speaking from the standpoint of a National Guard parent, but Army Reserves and Marine Reserves would pretty well fall into the same category.  I have a young Marine Reservist who lives right up the road from me who is going through the same type of scenario right now. 

You cannot make it optional.  Our education meeting from the State Family Readiness Group was optional.  You did not have to be there as a family member.  So, out of 118 families, we might have had half of them there, so there were 50 families who were there.  The meeting was about an hour long. 

We spent, I would say, about 10 minutes with a brochure on PTSD, and then the rest of the time dealt with the health insurance, because, see, a lot of these guys have families.  They need to know when the health insurance runs out, their last check.  They need to know all of the financial aspects.  When does my husband have to go back to work?  When does my son come off of Federal title and go back onto State title?

It is all of these questions because, at that point, those are much higher on the priority list than PTSD.  So you start out the meeting talking about health issues, and that gets shoved off to the side.  Then they hand you a magnet with a bunch of phone numbers on it that says, "Here is where you call for help." 

It does not work because the excitement of the moment, the excitement of the homecoming overtakes everything.  So you have to come back to the issue after they are home.  There is a 2-week period of coming home.  Let them be with their families for a couple of weeks, and then bring them back.  It has been a long-talked-about idea through a lot of families.  Bring the families with them, and do not make it optional.  Yes, you are going to have to pay for it because a lot of these guys have kids, but what would you rather pay for, a couple of weeks in a camp where you can educate the family and the soldier or looking at another statistic and another news report where you have lost another veteran to suicide who took his own life? 

You have to make it appealing to people.  You cannot make it something that is so absurd or grueling that nobody is going to pay any attention. 

Mrs. BOWMAN.  It is one more battle.

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

There are ways to do that.  You know, you get the right people involved in the situation.  You look at how you can educate kids with cartoons and video games and how they excel with that type of training because they relate to it.  And that is the kind of re-education that not only the soldier needs but the families need and all of the family. 

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

With regard to the price, the price that your family has had to pay, and particularly for those people who have lost their lives because they did not know where to go, I do not think we even ought to be quibbling over whether or not we can afford to do this.  This is something that I think we have a moral obligation to do for the men and women who serve this country. 

So, with that, I yield back.

The CHAIRMAN.  Thank you, Mr. Hare. 

Mr. Stearns? 

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

Let me echo sincerely the comments of my colleagues, in which we are very sorry for this tragedy.  Having three boys, I think anybody who has children certainly identifies with the grief that you are going through. 

But I would say to you, in all candidness, that your coming here is good for us, but it is probably good for you to talk about it and to tell us, in the ways that you are doing, so that we better understand.  As to the actual telling of it to us by you, I think and hope and pray that it helps you too, as you mentioned that you have post traumatic stress symptoms yourself.  Obviously, every death is a tragedy, but losing those who fought so bravely to protect us in this room, and in this country, is something that we cannot discount and that we cannot brush aside. 

In hearing from your testimony that he was one of those who spent four months on the most dangerous road in Iraq, going from the airport to the Green Zone, Members of Congress go to Iraq, but we fly by helicopters from the airport to the Green Zone, so we are not in that dangerous zone. 

I read also that you indicated that his Purple Heart has still not arrived.  Is that true? 

Mr. BOWMAN.  That is correct.

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

The thing that struck me about this is—and Members will talk about this.  Mrs. Bowman, is it possible I could ask you a question and get your feeling too?  I notice your husband is doing all of the talking. 

When you look back at it, do you think the Veterans Administration, if they sent people to your home—I know I asked the staff here, does the Veterans Administration have counseling?  It says they provide readjustment counseling and outreach services to all veterans who serve in any combat zone.  Services are also available for their family members for military-related issues.  Veterans have earned these benefits, and these services are provided to them, but, I mean, that means you have to go to the Vet Center to get it. 

So, Mrs. Bowman, in retrospect, is there something that the Veterans Administration could have told you or something that you could have done, where you felt that you just did not have the psychological skills or that you did not have the education?  I mean, is there a void there that we, as Members of Congress, could legislate and could tell the Veterans Administration that we are not going to wait for the families to come to the Vet Centers and that we are going to send the people to you once we identify those individuals coming back? 

Mrs. BOWMAN.  Right.  It is just like my husband said.  If we would have been included with Tim in some kind of a program where we had to report back to someone, where we had some kind of screening or a one-on-one with all three of us or with the two of us, as far as what we have seen or have not seen, and Tim on his own, so that we could, you know, get together and realize there is an issue here and that they could now help us deal with this and give us the tools to do that. 

Mr. STEARNS.  I have been in hearings for something like this, and I chaired a Subcommittee on Commerce, Consumer Protection and Trade, and we dealt with families who had children who took steroids and who committed suicide.  So I have looked at this. 

What I found is that, if there is employment for the individual, that is a big step—but Timothy had employment—and if he is adequately compensated and has enough cash flow or something so that he at least is not on the edge there.  Secondly, it is that he has significant counseling by folks, and if necessary, he is provided medication. 

Was he provided medication? 

Mrs. BOWMAN.  He did not ask for medication.

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

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

Mr. STEARNS.  So he did not even realize that this post traumatic stress disorder was affecting him, and he was not receptive to counseling or to the medication? 

Mrs. BOWMAN.  No.

Mr. STEARNS.  Okay.  Then the last thing I found was some kind of education.  Did he have a high school degree? 

Mrs. BOWMAN.  Yes.

Mr. STEARNS.  He did.  Okay. 

So, once those three are in place, then the building of the self-esteem is the key.  And the parents somehow have to convince him or her that everything is going to be all right; we are going to work through it.  In this case, it did not happen, and it is so tragic and sad. 

I think, as legislators, we can direct the Department of Veterans Affairs to not only brief you but to come into your house and set up perhaps a casual type of counseling where the veterans themselves, who are back and who are, shall we say, aware of this problem, can sit down with Timothy and say, "Okay, let's shoot the breeze here and talk about it.  What is happening in life?  Who are you dating?" and things like that.  So, I mean, that is what you are telling me would have been a big step. 

My last thought here is that both of you feel that you were—or were not—adequately briefed enough to know how to help Timothy.  Can you just elaborate on that a little bit? 

Mr. BOWMAN.  No, we were not briefed on what direction to send him.  The only information we got was, like, of a mandatory nature.  Before you could do anything, as far as getting him help, you had to get him registered with the VA.  He had to go to the VA office with his DD-214 and get registered there, and then you could start the process. 

He came home with a battlefield injury that was going to be with him for the rest of his life, a broken hand that was a little bit handicapped after combat.  So he needed to go to the VA because there was some follow-up surgery that was going to need to be done in a couple of years.  In order to do that, you have to register.  Well, he finally did that, but he was home for about 7 months before he registered. 

A lot of the guys who came out of combat were like that.  They would not take that step to go get registered at the VA.  It was almost kind of a mental block that they just kind of did not want to do it.  Then one of the guys in the unit started working at the VA office, and then all of a sudden they all started rolling in, because everybody started pushing them. 

Tim had an appointment with the VA that was actually scheduled for a couple of weeks after he died.  We got a reminder letter in the mail that, you know, gave me the appointment time and stuff.  And I stopped up at the clinic in Freeport to see what it was about, and of course, they couldn't tell me because of HIPAA, so we don't know if that was about his hand.  It would have been his first appointment.  We don't know if that was his hand or what it might be. 

As long as we have brought the VA registration issue up, one of the things that has always kind of bugged me about this is that a veteran has to go to the VA office with his DD-214.  Why isn't the VA sitting there when they get off the bus when they are coming home from Iraq?  There are 118 guys coming off of three buses at a National Guard armory.  Why don't they have somebody at that armory with a computer and a desk, registering them before they can go home? 

They are coming out of combat.  You know that they are going to need help.  Sign them up right there.  That way, you know where they are, you know who they are, and they are in the VA system right away.  Don't make it so that the soldier has to go to the VA.  Make the VA go to the soldier.

[Applause.]

Mr. STEARNS.  Thank you, Mr. Chairman. 

Just a point in passing for Members.  There are tests, written tests, that soldiers can take when they get out that, once you take these tests—it is just a question and answer over a period—they take this test, it will tell them of their post traumatic stress disorder, tell them of their depression and their emotional disability.  And once they know that I would think that would be a step, too.

The CHAIRMAN.  But, Mr. Stearns, we have lots of evidence that those are not, one, filled out accurately.  Because, again, the soldier knows if he checks anything he is going to have to stay and not get home; two, his deployment is threatened; and, three, commanding officers have called in soldiers who have made the wrong check on those questionnaires and said you are going to have problems unless you change that.  So, as I said in my opening statement, the whole culture of the military is set against him. He is not encouraged nor shown the importance of talking about this and getting help. 

Mr. STEARNS.  Thank you, Mr. Chairman.

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

Mr. RODRIGUEZ.  Mr. and Mrs. Bowman, first of all, thank you very much for your testimony.  I know that it is difficult, and it is also hard to hear these types of tragedies.  But it is something that we have to dialogue about and hear about in order for us to start doing something about it, and I want to thank you for coming forward. 

I have had a situation in Eagle Pass, Texas, where one of my soldiers had communicated with his family and seemed in good spirits and then the next day committed suicide.  And he was a soldier.  So when you commit suicide and you are in the military, that person's body was brought back and was treated in a very different way.  Here is a soldier who committed suicide while in duty. 

And I just had another request from another community on a soldier whose parents noticed—this was going to be either the third or fourth time they were going to go to Iraq—noticed that there was something very different about their son.  And I made some calls, and I had difficulty trying to see if we can just get some treatment for this soldier prior to getting sent to Iraq again.  And I know the family, so there was no issue as it dealt with the courage that was needed in order to go there or anything like that.  It had to do with some mental health problems that they had encountered.  And so, somehow, that issue of stigma has to be something that we need to work on. 

And as indicated earlier, I know our Chairman, Bob Filner, has talked about providing treatment for every single soldier; and that way that stigma would not be there for a period of time.  And sometimes you are not able to pick up on that diagnosis initially until much later, and so we have to be able to come back a year later. 

And I just wanted to see if you might have any reflections on that?  How long before you witnessed anything or you were able to pick up on something from the very beginning and how long was he out from the military before. 

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

Mrs. BOWMAN.  Nineteenth.

Mr. BOWMAN.  Okay—and he died on November 24th of 2005.  So he was only home for 8 months before his demons took him over. 

And, like I said before, his symptoms, he concealed them so well that we could see that there were maybe some problems, but you couldn't identify—you couldn't put the pieces together to make the picture clear enough to be able to push him towards a certain area, certain direction. 

The check-ups—the after-action check-ups when they come home, we feel, are extremely important.  When they get off the bus, get them in the system, get them home for a couple of weeks, bring them and the family back, go through the demobilization, unboot-camp process with everybody, however long that takes. 

But then bring them back in 90 days.  Bring them back in for one day, a Saturday, a Sunday, then wait another 90 days, and then maybe you stretch it out to 6 months the next time.  But don't just come to a point and stop and then throw them away. 

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

And you don't make it optional, which means you have to pay them for it.  It goes back to the price, but the price is small compared to what the veteran will pay and his family.  Bring him back in.  The symptoms of PTSD will manifest themselves anywhere from 30 days to 5 years.  So you have got to know what you are looking at, and you have to be able to see down the road, and the evaluations have to mean something.  They can't be that four-page test that Tim took when he was at Fort Carson.  I have got that test.  It is a joke. 

Mr. RODRIGUEZ.  Let me also thank you for your testimony and also indicate—and I want to take this privilege to recognize Umberto Aguirre from Del Rio, who is here, and the GI Forum.  Will the members of the GI Forum please stand? 

I want to personally thank them, because they have been working with our veterans.  I know we have some homeless shelters throughout the country and some training programs and these veterans have continued to reach out to a lot of the veterans out there.  And I want to personally thank the GI Forum.  Thank you for being there and all the leadership of the GI Forum and thank you very much for your testimony.

The CHAIRMAN.  Thank you, Mr. Rodriguez. 

Mr. Boozman? 

Mr. BOOZMAN.  Thank you, Mr. Chairman. 

I just want to thank you for your testimony.  It was very helpful.  We certainly appreciate the sacrifice of your son and sacrifice of your family.  My dad did 20 years in the Air Force. 

And, again, it is a matter of resources.  We need to put a lot more resources in the area.  Your son, you know, we can talk about, oh, not reporting for a variety of different reasons; and, you know, I didn't have the privilege of knowing him.  But sometimes it is that you are afraid of it being a stigma on your report for future promotion or whatever. 

And then a lot of times with guys—and a lot of my friends were this way—it is also an admission of a personal weakness perhaps that you didn't think you ought to be having.  I don't mean that as a personal weakness, but the connotation, you know, I am having these feelings that I shouldn't have, and I am a tough guy and you don't—you know, like I say, tough guys are like that. 

So we just need to get it figured out.  We need to put a lot more resources.  Some States are doing a much better job than other States right now.  We need to look at the States who are doing a really good job.  And then, again, when it comes down to it, require a very high level of care, a very high level of how we attack this problem, and then just mandate that we get it done and provide the funding. 

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

Mrs. BOWMAN.  Thank you.

The CHAIRMAN.  I just want to ask unanimous consent that our colleague from Rhode Island, Mr. Kennedy, who is the author of the Mental Health Parity Act, be allowed to join us, at the dais for the Committee hearing today.  Hearing no objection, it is so ordered. 

I know recognize Mr. Mitchell, who is Chairman of our Oversight and Investigations Subcommittee, and was the first one to make sure that we followed up on that CBS News report with this hearing, thank you.  Mr. Mitchell? 

Mr. MITCHELL.  Thank you, Mr. Chairman. 

First, Mr. and Mrs. Bowman, I want to offer my condolences.  I want to thank you for having the courage to come forward today and share your son's story. 

You spoke in your testimony about the VA's reaction to the CBS News investigation about veteran suicides, and I guess I would like to know this.  How did you feel when you heard the VA's reaction and did it make you feel like the VA was working to help families like yours? 

Mrs. BOWMAN.  No.

Mr. BOWMAN.  My wife can attest to the fact that when I saw Dr. Katz's reaction on the TV, the first thing I wanted to do was reach through the screen and choke him.  That as a family member was my reaction to their response to that number.  Why not take that number and say, you know, oh, my God, we have got a problem here.  Let us do something about it.  This is obviously an issue.  But instead it is, let us pick on the guy who put the number together. 

You know, I don't get it.  As a family member, I was appalled.  I was absolutely appalled.  It is just one more case where the VA let the veteran down.

Mr. MITCHELL.  Thank you.

The CHAIRMAN.  Thank you Mr. Mitchell. 

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

Ms. BERKLEY.  Thank you, Mr. Chairman.  I appreciate the fact that you have scheduled this hearing, and I appreciate Mr. and Mrs. Bowman for being here.  I know it can't be an easy thing for you, but we appreciate it very much. 

When somebody dies from my home State of Nevada in the line of duty, I call the family, and it doesn't matter whether they live in my district or not.  I think it is the only right thing to do, to offer my condolences, not only as a congresswoman but as a parent and a mother who has sons of her own. 

Earlier this year, I had the occasion of calling a grandmother who raised her grandson.  He had served one tour of duty in Iraq; and he had come home to Pahrump, Nevada, which is a very small bedroom community outside of Las Vegas, and was emotionally a mess.  And he told his grandmother he cannot go back.  He cannot go back.  He doesn't care if goes to jail.  He doesn't care if this happens, if that happens. 

Now, the military's response to him was to give him Valium and send him back.  He was back for 24 hours, and he blew his brains out.  It was in this context that I spoke to his grandmother to offer my condolences.  Now, I could talk to this woman for the rest of her life and I could never heal the hole in her heart that she will have for the rest of her life. 

There are so many statistics.  I have got pages of them in front of me now, and you are living this.  And it is important for us to recognize, and I think just by holding this hearing and bringing this to the attention not only of the American people, but of Members of Congress, we are making a giant leap forward.  Because a generation ago, even a decade ago, this conversation could not have taken place.

Mr. BOWMAN.  You are right there.

Ms. BERKLEY.  I came from the Vietnam era.  That was my war.  I was in college.  Now, I meet with my Vietnam vets all the time back in Las Vegas.  Most of my homeless in Las Vegas are Vietnam-era vets.  I talk to them.  I have normal conversations with them as if I was sitting there talking to you. 

But they came back messed up, and we didn't recognize that there is a mental health price to pay for service to our country.  You can recognize a wound and treat it, but we were so ignorant of the fact that people, men and women, are coming back with wounds that we cannot see. 

Taking care of these veterans, taking care of our National Guard members, taking care of our military is the cost of waging war; and this is not an area that can be short-changed.  It should not be short-changed. 

Now, I had another constituent, Lance Corporal Justin Bailey.  He returned from Iraq with PTSD.  He developed a substance abuse problem.  And he came from a nice middle-class family.  His father is a teacher in my district.  They are normal, average, good Americans that believe in this country, believe in the cause and believe that their son was serving his country. 

He came back with undiagnosed PTSD.  They know it now.  He developed a serious substance abuse disorder.  They begged him to get help through the VA.  He didn't want to go.  They convinced him to go.  He went.  Now, he was on five different substances when he checked himself into the VA.  The VA gave him two more medications, and 24 hours later he was dead at the VA. 

I tell you this because if we don't have—we can pass every law in the world here, but if we don't have adequate education, if we don't have adequate training, if we don't have adequate personnel that can recognize the problem when they see it and confront it, nothing we are doing here is going to make much of a difference.  So I have introduced a Mental Health Improvement Act which aims to improve the treatment and services provided by the VA to veterans with PTSD and substance abuse disorders; and I am hoping that my colleagues, particularly here on the Veterans' Affairs Committee, will join me in co-sponsoring this legislation. 

It isn't enough to recognize the problem, although we are moving forward in that direction, and I think it is good.  It is not enough to pass legislation.  We have to ensure that once these young men and women get into the system that the system knows what to do with them, and this legislation I hope will help that. 

I want to thank you again for being here and hope that your tragedy will kick-start this legislative process so that we can protect our men and women in the military when they come home from their service.  Let us eliminate the stigma attached to mental health problems and mental health issues. 

And you are so right, and so many of my colleagues that have mentioned this, you are right in saying the VA and the Department of Defense need to go to our fighting men and women, not the other way around.  We will save countless numbers of lives and improve the quality of their lives for the rest of their lives.  And I thank you very much.

Mrs. BOWMAN.  Thank you.

Mr. BOWMAN.  Thank you.

The CHAIRMAN.  Thank you. 

Mr. McNerney? 

Mr. MCNERNEY.  Thank you, Mr. Chairman. 

I don't have any questions, really.  I just want to thank the Bowmans for your courage in coming today, and I think it reflects honor upon your son.  Now it is our duty to learn from your experience and see that some of these changes are implemented that will make a difference in people's lives, particularly your observation that help should be anonymous and helpful, as well as your suggestion that post-deployment treatment be mandatory.  We will be taking a look at those. 

Thank you for your courage. 

That is all.

Mrs. BOWMAN.  Thank you.

Mr. BOWMAN.  Thank you.

The CHAIRMAN.  Thank you. 

Mr. Walz, who, I just want to tell the Bowmans, is the highest enlisted man ever to be elected to Congress and has lots of experience, decades with the Minnesota National Guard.  And also, they have a program that he might want to describe, the Yellow Ribbon Campaign, which tries to deal with the returning servicemembers in a way that at least starts on the path that you have suggested. 

Mr. Walz, thank you for your efforts. 

Mr. WALZ.  Thank you, Mr. Chairman; and thank you, Mr. and Mrs. Bowman, for being here.  There are no words that are going to be said here that are going to ease the pain of your loss, and we clearly understand that.  I have to say, though, especially Mrs. Bowman, you occupy one of the highest and most respected positions in this society as a Gold Star mother.  And I have to tell you as a Member of Congress and as a veteran and a retired sergeant major and a citizen, I am ashamed that you have to come here today, that the idea that you would have to come here and ask this Congress to do the right thing for your son is absolutely appalling. 

And with all due respect to our news organizations, while I am happy they broke that story, there is not a single person in this room that doesn't know this was an issue.  There are Members, there are people sitting behind you, veterans and advocates that have fought decades on this very issue; and I have worked with them.  They have advocated for this, they have spoken about it, and we have seen year after year after year not addressing this in a real comprehensive manner.  And that is simply appalling, and it is a shame. 

And I can tell you there is not a Member up here especially, and there is not a Member in Congress, that hasn't stood in front of soldiers, talked about them, talked about how great they are, but time and time and time again this Congress, and all of us are guilty of this, have simply failed to move things forward that make a difference.  And that is an absolute shame. 

And I have said that there is no one in this country again that should ever allow anyone to stand in front of a soldier if they are not going to stand behind him and move this, never.  We have seen those yellow ribbons.  Many of them are very faded now, and you can barely read them, and the fact of the matter is we haven't done what they said.  We haven't addressed these issues.  We haven't taken this in. 

Senator Dole occupied the same position of both of you, and Ms. Shalala, and they sat here and addressed the issue at Walter Reed.  And Senator Dole was very clear in what he said.  He said, you spent billions putting them in harm's way.  Spend billions in whatever it takes to get them out.  And that is very clear to us what we need to do.  So there are things here.  And Mr. Kennedy is going to speak in a little bit, and I think this is an very important piece of this puzzle. 

And both of you with your keen understanding of how this works, especially from National Guard families, I can tell you this.  Having been one of those that came back—we were in support of OEF, but sitting there with OEF/OIF veterans when we came back, they showed us the Horse Whisperer and told us to be nice when we went home, and that was the extent of it.  That was in 2004. 

Now I am proud to say that, because of the people sitting in here and people who came before me, things have changed over the last 4 years.  They have not changed enough.  But Mr. Kennedy is following and moving something forward that the late Senator from Minnesota, Senator Welch, advocated so clearly, mental health parity and this issue of understanding and destigmatizing mental health. 

And I being in there and knowing as a first sergeant knows exactly what you are saying and watching as people aren't trained on this, that there is a discrimination that goes against a soldier who has the courage, the fortitude and, as you said, the insight to admit this. 

So there are a couple things I want to ask you, because I think you do have a keen understanding on this.  We started noticing this in Minnesota; and the State of Minnesota, under the Adjutant General and the Governor, did something that actually I guess in letter of the law violated VA recommendations.  We set up a program that said, do you know what?  This hands-off policy, it is what soldiers think they want.  The last thing you want when you come home is to set meetings and things like that or to talk to anybody. 

What we found was and what the research shows is that most of these patterns of behavior and most of this PTSD gets worse in the first 90 days.  If you can address it early on, while it is fresh, in an environment that is nonthreatening and everybody is in it together—we have what we call Beyond the Yellow Ribbon Campaign, and we bring them back right away, and we reevaluate them, and we do something this Congress is going to do now to put forward.  We make sure we are testing them for traumatic brain injury. 

As many of us know—it was the Blind Veterans of America that brought it to our attention earlier—we are starting to see a lot of veterans with eye troubles that were actually mild traumatic brain injury and those types of things.  So we are starting to screen them early, we are starting to put them in front of the right people, and we are starting to bring their families in to understand. 

As you said so clearly, many of us were much older and we had children at home.  Many of these guardsmen have not only small children, they have teenage children that clearly understand what is going on. 

What we are trying to do and will vote on this later today is to get the money to do a pilot program to take this thing nationwide.  My question to you is, do you think this is the way to go?  Is this the way to address it? 

Mrs. BOWMAN.  Absolutely.

Mr. BOWMAN.  And you need to bring all the soldiers in.  One of the stigmas that has always been held up, especially with National Guard, is they will bring a chaplain or a counselor in for drill weekend.  And anybody who wants to see the chaplain, he is over in room 105.  And everybody looks at who is going to walk in that door.  They know who is going in that door.  And the Guard says, you know, they have to come to us.  So our thought from the very beginning is bring them all in.  Everybody gets a screening.  You don't single out the guy who has a problem.  You screen everybody.  Because half the people who don't walk in the door have the biggest problems, and you have to screen everybody.  That way there is no stigma among the unit.  Everybody walked through that door and saw that counselor.

Mr. WALZ.  Well, once again, thank you.  And, again, this group behind you, this group sitting out here, they are the ones that are going to assure accountability on this.  I think the time of lip service has pretty much run its course, and there is going to be a day of reckoning if we get this thing right or we get it wrong.  Because we can't continue on like this.  Especially, as I said, everyone in this room knows it is an issue.  Now let us fix it. 

I yield back, Mr. Chairman.

The CHAIRMAN.  Thank you, Mr. Walz. 

Mr. Hall?

Mr. HALL.  Thank you, Mr. Chairman; and thank you both, Mr. and Mrs. Bowman, for coming here.  My condolences for your loss, and my thanks to your son for his service to our country.  My apologies, as my colleague, Mr. Walz, said, that you should have to be in this position. 

All of us who represent the different districts around the country have veterans come to us, I am sure, with all kinds of problems and especially with PTSD; and no small number of those are either suicidal impulses or other clearly identified PTSD symptoms. 

I have a friend who is a Vietnam vet who was diagnosed with post traumatic stress syndrome.  At the time, it was called PTSS.  And you said, Mr. Bowman, you thought that the term "disorder", it was counterproductive because it seemed to describe it as something being wrong with a person, as a malady, and it should be more treated as an injury of war so that it wouldn't carry the stigma. 

So I am wondering if perhaps a wording change like that, that we do—because words do matter.  And what the government calls things, the labels we put on them as a society or as a branch of government or the VA, for instance, or the medical community can stigmatize more or less.  So I am curious if you would think that something like post traumatic stress syndrome would be better than, say, disorder. 

Mr. BOWMAN.  I think anything that makes the term something that is not permanent.  The term "disorder" applies to muscular dystrophy, multiple sclerosis, something like that, a debilitating disease that once you get it, you have got it for the rest of your life.  Now that doesn't mean that PTSD goes away.  But it is an injury that, if it is dealt with in the first 90 days, again, if you can combat it early enough, you can reduce its impact to the point where you have got a healthy, fully functioning soldier who is actually better off now than he was when he went to combat because he has gone through the battlefield, he has gone through the mental anguish of war, and now he has found a way to deal with it.

Mr. HALL.  Thank you. 

And I think it is important that, until we are able to do that, we not redeploy combat soldiers who have PTSD.  So it is doubly important that we identify all of them, which would reinforce the concept that you have both spoken to, and Congressman Walz and others have spoken to, of bringing all soldiers in for screening, rather than just say "go to door number five," or whatever it is, so that they are watched and identified. 

I don't really have more questions for you.  I just thank you for being here. 

And I want to say that in my short time in office, my staff has helped servicemembers, veterans, ranging from 84 years old, a World War II veteran, within the last couple of weeks who we got 100 percent clarification for PTSD for a soldier who had two ships sunk out from under him in the Pacific Ocean in World War II and twice found himself floating in the ocean with body parts and sharks and other comrades around him and so on and was rescued twice.  Until two weeks ago, having tried repeatedly since the 1970s with his friends and with people who were trying to help him, and it was just this year that he finally was classified. 

On down through Vietnam-era veterans right up to a 25-year-old, twice-deployed soldier who came back from Iraq and spent 2 years looking for a PTSD classification.  He had all the classic symptoms: an exaggerated startle reflex, suicidal tendencies, couldn't go to sleep without seeing in his mind's eye the picture of his fellow soldiers being killed or of an innocent Iraqi girl who was caught in the crossfire in Fallujah and other things.  They are images that are hard to get out of one's mind once you have been through that experience.  And we were able to get him—because he came forward to us, we were able to get him the classification, 100 percent PTSD classification. 

But it is the ones who, because they are trying to be strong and because they can hide it, as you said, are hard to identify; and that is why I think it is critical that we screen everybody.  The percentages are running so high that I think that is really the only way to be safe and to make sure that we don't let soldiers like Timothy slip through the cracks. 

And, once again, thank you for being here; and, Mr. Chairman, thank you for holding this hearing. 

I yield back.

The CHAIRMAN.  Thank you. 

Mr. Snyder? 

Mr. SNYDER.  Thank you, Mr. Chairman and Mr. Buyer, for this discussion today. 

And I want to thank the both of you, as others have, for being part of this national discussion.  I hope you are pleased with the kind of comments and discussions that you have triggered here today. 

I did not know your son.  My guess is that he would be proud, as a 23-year-old, of what you are doing today.  Because you are not doing it for him.  You are doing it for the sons and daughters of everyone else around the country. 

I also appreciate the context that you have put this in, which is the absolute finality of devastation of suicide is terrible for that person and for the family and friends of that person.  But in your very last line you say, "Our veterans should and must not be left behind in the ravished, horrific battlefields of their broken spirits and minds." 

Because somebody does not commit suicide does not mean they are out of the ravished, horrific battlefields of their broken spirits and minds.  And there is a lot of human misery that is out there, and we know it is out there.  I suspect there is some in this room or has been some in this room. 

We don't do the thing saying, will everybody who needs mental health counseling right now or in the last year please stand up and go to the door if you would like to be interviewed.  Because we all have our private moments of devastation.  But for some of us human beings that becomes something that just eats at you hour after hour, day after day, week after week, month after month, year after year and, unfortunately, tragically results in suicide in some.  But it is also tragic if it is untreated for those months and years and decades, as you have pointed out in your statement. 

Mr. Kennedy, who I hope we will be hearing from here shortly, has recognized through his work for some years now that in the private sector, the nonmilitary, nongovernment part of our lives, we have not solved this issue of how to deal with mental health challenges.  A lot of insurance doesn't cover it.  We have a lot of human misery out there that goes untreated because people don't know how to get it and pay for it, and that is a problem that we have in this country. 

But thank you for your service and being part of this national discussion and debate.

Mrs. BOWMAN.  Thank you.

The CHAIRMAN.  Thank you. 

Mr. Kennedy, thank you for your work on mental health parity.  You and I have talked about these issues for a long time, and I will recognize you for any statement or for questions. 

Mr. KENNEDY.  Thank you, Mr. Chairman. 

I also want to join my colleagues in offering my condolences to you for your terrible loss and say that it is this personal story that you have offered that I think is going to be the catalyst for the change.  Tragically, in this country, the statistics don't move people, but a personal story like yours does. 

The statistics in this country, suicide is twice the rate of homicide in this country.  We read about murders every day, but we don't read about suicides every day.  It is the silent killer in this country.  It is epidemic.  But your story here today is helping to highlight something that is an untold story that is too often the case for so many families and now, especially, amongst our returning veterans. 

So you are, as my colleagues have said, really profiles of courage in really sharing your story to benefit other families from having to go through what you have been through.  So I really salute you and thank you for your son's service. 

My colleagues have referenced the mental health parity bill that Senator Paul Wellstone originally introduced that is now actually in the midst of being considered between the Senate and the House.  And it has a lot to do with your story because many of these returning veterans, they are all going to be returning to the private work force.  And, as you know, the stigma continues.  And this Committee has set up what are known as Vet Centers because of the stigma, because they know many veterans won't go to the VA for their mental health services because they are afraid it will show up on their record, and so they set up Vet Centers for that purpose. 

Because of that, you can understand that many veterans may not even choose to avail themselves of anything having to do with the VA when it comes to mental health; and they may, as now private sector employees, choose to get their mental health services through the private sector. 

That is why it is even more important that we pass mental health parity legislation.  Because all these returning veterans will need to be covered as private-sector employees, and we have a chance now to pass this sweeping parity bill that basically says mental health should be treated like every other part of your healthcare in a holistic way. 

And it is so very important because of the facts that I have just stated, but I wanted to ask you, with respect to families, veterans' families, do you think the VA is doing enough to address the families' mental health needs as a means to address the veterans themselves, mental health needs?  In other words, one of the ways that veterans suffer so greatly is when they return their families are suffering themselves, having had a very difficult time themselves being away from their loved one. 

And what ways do you think, also—do you think that peer-to-peer programs like the vet-to-vet support groups are effective?  And do you think that the VA ought to be taking these programs to scale?  Meaning do you think that we ought to really ramp them up so that they are not just here and there, but they ought to be national, and so that every veteran returning gets to talk to another vet, and that we in the Congress support these veteran-to-veteran peer support programs? 

If you could comment on those?

Mr. BOWMAN.  As far as the VA help for the families, I have never seen a VA person approach me in my entire life.  Nobody even came to us after Tim died.  Nobody offered us family counseling.  His battalion commander was checking to find out if we qualified for family counseling after he died, and there is nothing out there for us, even though he gave his—as I feel he gave his life for his country. 

So I can't comment on what the VA is doing for families, because I have never seen it.  And as being in the National Guard array with a lot of the kids that I know, they haven't seen it either, because they are stretched out.  Out of 118 soldiers in my son's unit, there were from 78 or 79 different towns spread across Illinois, Iowa, some small towns, some big towns.  But nobody has ever jumped up and said, hey, somebody came to me with some support information.  And we know these families because we have stayed in touch with them.  So that to me is a gray area.

Mr. KENNEDY.  And you think the families could be a big help to the returning veteran.  If they knew in advance when their loved one was returning more about mental health because they had received some preparation and had gotten some support, they might be the greatest resource in that regard.

Mr. BOWMAN.  Yes.  Especially with Guard and Reserve.  Because, as I said, and we saw it with Tim and I have seen it with other Guardsmen.  They can suck it up for a weekend drill.  And they will go in and spend a weekend drill and they will look like the most normal human being you ever find.  Well, who has them for the other 28 days out of the month?  The family.  That is when you are going to see the breakdowns, the nightmares, the night terrors, the sweats, the screams, the swinging in the middle of the night, sleeping in the closet with a 9mm.  All those signs are going to be seen by somebody other than Guard people. 

So if you educate the family on those signs then at least they have a chance to locate some help for them before it turns into a disaster.

Mrs. BOWMAN.  And we ourselves chose to go on our own and get counseling.  We have been in grief counseling for a year, both of us now, as well as our daughter.  And it has made a huge difference for us.

Mr. BOWMAN.  And mental healthcare for—well, we discussed this earlier.  I went to our local mental health association, which has offices all over our area.  They are supposed to be the place to go.  And by the time I got done with their initial screening paperwork, the financial paperwork, the pre-interview with the caseworker and all the other stuff—and I told him right up front, I don't qualify for any financial assistance whatsoever.  I am going to pay for this visit.  Just walk me into a counselor.  And by the time I got all done and I did get to the counselor I was so mad at the system of trying to get there I told her if I was standing on a ledge right now I would have already taken the step because I can't believe what you just put me through.  And that is what I am supposed to go to as a citizen in my own neighborhood. 

Then I go off the grid and find somebody that is a licensed private counselor, and she won't work in that system because of all that paperwork, and she has got all kinds of patients that she sees, and she has been very successful.  It is frustrating just in the mental health aspect of it.

Mr. KENNEDY.  Well, you just made a great case for mental health parity; and we will work on that, too.

The CHAIRMAN.  Thank you, Mr. Kennedy. 

Mr. Buchanan, do you have any questions? 

Mr. BUCHANAN.  No.

The CHAIRMAN.  Mr. Buyer? 

Mr. BUYER.  Thank you very much. 

And once again, Mr. and Mrs. Bowman, thank you very much for being here. 

I would like to make an association toward the comment of Dr. Snyder.  And you are absolutely correct.  We as a country do not do well in not only a tracking system with regard to suicides but on the issue on prevention, identifying risk factors and things.  So, as a country, I agree with you we don't do well; and it is a subject matter that we also don't discuss much. 

So, as I look at the Center for Disease Control, they put out their study, the National Violent Death Reporting System.  So, as you look into this—now, this is using their reports and status from 2001, their latest numbers, among Americans ages 15 to 24, homicide is the second leading cause of death; homicide was contributing, an average, of 14 deaths per day in this age group of 15 to 24.  Suicide was the third leading cause of death; and, on average, we have 10 deaths per day in this age group of 15 to 24 for suicides as a country. 

Then when you look at the propensities—I continue on—the males take their own lives at nearly four times the rate of females.  So 78.8 percent of all U.S. suicides are males.  Now, of all males, suicide is the eighth leading cause of death, and it is the sixteenth leading cause of death for females. 

Now when you look at these statistics—and what is kind of interesting about statistics and numbers and how you analyze these things, you also have to look at this a little bit further.  Males, when they have made this compulsive decision to commit suicide, are more effective.  Why?  Because they use guns.  Women don't use guns.  Women use pills.  And they aren't as successful at this compulsive decision to end their life.  And then it reinforces the other statistic that shows that women have a higher statistical average to repeat an attempt on suicide. 

So it is interesting when you start reading these statistics, yes, they begin to tell a story, but it is not a whole story because we don't have a very good tracking system.  We don't do very good statistics.  As a matter of fact, when I looked at this national reporting system, really not many States report.  You can see that. 

So that is why I agree and associate myself with Dr. Snyder.  He is absolutely correct.  We, as a country, on this particular issue are not doing well. 

So in your statement when you said when CBS News broke the story about veteran suicide, the VA took the approach of criticizing the way the numbers where created instead of embracing it, well, I just want you to also know that CBS News—there are other writings out there that have highly criticized CBS News and their story and the way they came up with their own statistics.  My gosh, you have the New York Post.  Their headline is—they called it bogus.  I mean, they went after the way CBS News came up with statistics. 

What I enjoyed about your testimony today is that, regardless of statistics and the war of statistics and how you come up with them, there is a challenge in front of us. 

I loved your use of the word "injury."  And I have heard Bob Filner also talk about if you use the word "disorder" there is a stigma that is attached with it and we have to come up with a better language.  And he is absolutely correct.  That needs to be done.  And we are going to need to work with the great minds of mental health to come up with the right language. 

And to my good friend, the Sergeant Major, this is an issue that didn't happen just because CBS News broke the story in November.  We are going to have the testimony coming up here by the Inspector General (IG), and the IG is going to talk about their report on implementing VHA's mental health strategic plan initiative for suicide prevention. 

Sergeant Major, this was started in the year 2004.  And I would agree with you, Sergeant Major, that the VA was very slow in getting this on the ground.  And so there I would agree with you.  We are going to have some testimony coming up on these initiatives, and I welcome your participation in that panel. 

I yield back.  Thank you.

The CHAIRMAN.  Thank you, Mr. Buyer. 

I would offer, since the television program CSI is so successful, stress injury is pretty descriptive, but it is hard to change such a thing. 

Mr. BOWMAN.  Again, all you have to do to change that term is do it right now. 

The CHAIRMAN.  All right.  We will talk about CSI, combat stress injury.  I think the next panel may be a—have a—

Mr. HARE.  Mr. Chairman, would you indulge me for just one second here? 

Let me just say this to all of you, and I appreciate the Ranking Member, but your figures on pieces of paper do not reflect people.  And, ultimately, just listening to this testimony today, families are not brought into this loop when it comes to their servicemember having problems.  The servicemember is not screened when they come back.  There is a stigma attached to all of this. 

I agree with my friend from Minnesota.  What we have to do at the end of the day is to say, "this is enough."  We have hit the wall with this issue here, and we have to look at what we are doing.  The VA has to be much more proactive than they are.  These are great cards, but if they don't work they don't work, and we have to figure out what does work. 

So I would just again say to you I want to thank you so much.  I am so sorry about what happened to you.  But we have, as I said to you in my office, a moral obligation to try everything we can possibly try to make this better.  And if it costs us a few more bucks, so be it.  But, ultimately, at the end of the day, our job as I see it is to make sure other families like yourself don't have to go through the pain that you have had to go through.  And I think, to be honest, the VA has a whole lot of work they could do in educating the parents and making sure our troops are not singled out. 

So I just want to thank you so much for coming today, and we will get this done one way or another.  We will get it done.

The CHAIRMAN.  Again, you all have obviously thought a lot about this since Timothy's death.  You are very articulate, and you have helped us all understand this issue. 

Two major things strike me, in conclusion, about your recommendations.  Number one, I think the President and the Administration have been dead wrong in trying to wall off this war from public consciousness.  They are so afraid of opposition that they don't want to educate people as to what is going on. 

If all of us—parents, teachers, ministers, employers—know what PTSD is, know what TBI is, traumatic brain injury, we can all help Timothy; and that is a public education campaign. 

People all over the country want to help.  I sat down with the Outdoor Advertising Association of America.  If they were asked, their billboards would be useful for getting people to understand what PTSD is, just knowing where to turn to get information.  That is a public education campaign that I think we have to do.  And if the President just called any of these people in his office they would do it for free as a service to their Nation and to Timothy and his comrades. 

In addition—and I have been trying to get this into this year's budget—it is clear from what you say and everything we have learned that it should be a part of active duty on either return from combat or separation from service—and it has to be not only active duty but the Guard and Reserves—go through a process.  I have called it a "deboot" camp.  I have called it basic untraining, decompression.  I am now focused on a heroes homecoming camp.  That as part of your active duty, for whatever number of weeks we can get the VA and DoD to agree to, that every soldier with his or her unit, with his or her family, gets diagnosed for both PTSD and traumatic brain injury. 

Because, as policymakers, I think we have to assume that everybody has it unless we find out they don't, as opposed to you prove to us that you have it and then we set up all kinds of things.  You don't have PTSD, you have personality disorder and get rid of you that way.  So it has to be mandatory; and that allows early treatment, which is absolutely necessary. 

In addition, if you had this heroes homecoming camp, you could do job counseling and credentialing and educational counseling.  All the spouses would be together for mutual support.  All the soldiers would be together for that kind of comradeship, which was so important for them in combat. 

And I think we just have to do this.  We expect kids, as you said, to be in Baghdad one day and taking their kids to soccer two days later.  It is absolutely contrary to anything that the brain can accomplish. 

So I hope that we can move in those areas.  We have to change a culture. 

But Dr. Martin Luther King once said, you can't make a man love me, but you sure as hell—I don't think he said "sure as hell"—but you sure can make him stop lynching me.  That if we have certain laws and behaviors, that will contribute to the change of the culture. 

I think your testimony has brought us a long way.  You have a chance for any last-minute statement.  You have been here for almost 2 hours.  That is a long time for congressmen and women to stay and talk to you, but it shows how powerful your testimony has been.  And any last statement we would welcome.

Mr. BOWMAN.  Just a couple of things. 

One, I truly—we truly are honored to be here today.  We decided after Tim died that his death was not going to be for nothing, that good would come of his death.  It is the only way that we can deal with his death. 

This has been therapeutical for us.  There is no doubt about it.  Because we know that his name has meant something.  We know that he has already saved lives. 

On another note, I am an Assistant Illinois State Captain for Patriot Guard Riders.  If you are familiar with that organization, we are the people who stand between funerals and protestors.  That is my therapy that I have taken on so that I can survive day in and day out. 

We have done two funerals in Illinois that were soldiers that took their own lives, and I have never been so embarrassed by the military in my life as to see the way that those families were treated—no honor guard, no flag folders, no pall bearers, nothing.  Patriot Guard Riders folded the flags.  We carried the casket. 

There is no reason that every person who served a day in the military in this country should not be accorded the military funeral rights that every soldier should be given, and that includes the most honor you can hand them.  Because that honor at graveside is what that family will remember.  And if you want to help that family heal, the country has to remember that they need to thank that family for that soldier, and they have to thank that soldier.  And the only way you have to do that is at the graveside and at the funeral. 

And I implore anybody who can work on anything to do that, is to make that happen.  Because a suicide carries a bad enough stigma with it as it is.  I was told after our son died, before his funeral, do everything you can for him now, and we did.  And his unit was home.  So all of his unit buddies were there.  He was also a member of the fire department.  Between the two of them, they coordinated everything and made it just an absolutely beautiful service for 2 days. 

But not everybody is that lucky, and I am asking you to help those that don't have those connections. 

Thank you.

The CHAIRMAN.  Thank you.  You have honored your son and your family, and we thank you so much. 

We will ask the second panel to come forward. 

Again, thank you, Mr. and Mrs. Bowman.  We thank both of you for joining us.

The CHAIRMAN.  Again, I must introduce you with a personal thank you as you all have educated me with your books about combat stress injury and suicide. 

Penny Coleman, whose husband, a Vietnam vet, committed suicide, is the author of Flashback: Posttraumatic Stress Disorder, Suicide and the Lessons of War

Ilona Meagher is the author of Moving a Nation to Care: Posttraumatic Stress Disorder and America's Returning Troops and has taken upon herself to have Web sites which track suicides because her government does not.

The CHAIRMAN.  With that, you have the floor, which—I don't know how you arranged which to go first, but please, Ms. Coleman, you are next.

STATEMENTS OF PENNY COLEMAN, ROSENDALE, NY, AUTHOR, FLASHBACK: POSTTRAUMATIC STRESS DISORDER, SUICIDE, AND THE LESSONS OF WAR; AND ILONA MEAGHER, CALENDONIA, NY, AUTHOR, MOVING A NATION TO CARE: POST-TRAUMATIC STRESS DISORDER AND AMERICA'S RETURNING TROOPS

OPENING STATEMENT OF PENNY COLEMAN

Ms. COLEMAN.  Mr. Chairman, Members of the Committee, fellow panelists, good afternoon. 

I am the widow of Daniel O'Donnell, a Vietnam veteran who came home from his war 38 years ago with what is now known as PTSD and subsequently took his own life. 

I use the term PTSD grudgingly, like Mike Bowman.  It is the official term, but it is deeply problematic.  My husband did not have a disorder.  He had an injury that was a direct result of his combat experience in Vietnam.  Calling it a disorder is dangerous.  It reinforces the idea that a traumatically injured soldier is defective, and that idea is precisely what keeps soldiers from asking for the help they need. 

I met Daniel 6 months after he returned from Vietnam, and I married him a year later.  The man I fell in love with was gentle and playful and very funny on good days.  But there were other days when he would fly into rages over trifles and more than a few nights when he would wake up screaming and sweating and fighting something terrible that wasn't there.  Or he would take to his bed with the blinds drawn sometimes for days, and all he would tell me was that he didn't want to live. 

I thought that if I loved him enough I could fix him.  I was wrong.  I had no idea what I was up against.  After Daniel died, I tried to blame him, but I ended up blaming myself. 

For my book Flashback, I interviewed other women who lost loved ones to suicide in the wake of Vietnam.  In addition to their grief, these women, like me, lived with guilt and shame and isolation.  I now believe that our isolation was exploited to help camouflage a terrible tragedy. 

Unlike Agent Orange vets or Gulf War vets, who have never stopped demanding that the VA take responsibility for their illnesses, in the case of veteran suicides the most logical advocates were dead.  We, their widows, did not become advocates.  We believed their deaths were our fault, and we each thought we were the only one. 

It is more than 30 years since the war in Vietnam ended, and still no one has any idea how many Vietnam veterans have taken their own lives because no one has ever tried to track or count them.  The 1990 National Vietnam Veterans Readjustment Study mandated by Congress and government funded, the study that proved the syndrome now called PTSD, never even mentioned suicide, in spite of the fact that suicide was central to every study that preceded it, including those on which it was based.  No data, no proof; no proof, no problem. 

The United States invaded Iraq—

Mr. KENNEDY.  Would you repeat that again? 

Ms. COLEMAN.  Which piece?  The last paragraph? 

Mr. KENNEDY.  What was left out.  What was that study? 

Ms. COLEMAN.  The National Vietnam Veterans Readjustment Study, which claimed to be the biggest study that had ever been done on any demographic group and claimed to address all of the issues, the healthcare issues of Vietnam veterans, never mentioned suicide or suicidal ideation.

Mr. KENNEDY.  Wow.

Ms. COLEMAN.  It is an astonishing omission.

The CHAIRMAN.  And what year was that? 

Ms. COLEMAN.  1990 it was published.  The research was done between 1986 and 1988, I believe.

The CHAIRMAN.  Thank you.

Ms. COLEMAN.  The United States invaded Iraq in March of 2003, and by August, so many American soldiers had killed themselves that the Army sent a mental health advisory team to investigate.  Their report confirmed a suicide rate three times what the military considers statistically normal.  It also acknowledged that one-third of the veterans who are being—of the psychiatric casualties who are being evacuated had suicide-related behaviors as part of their clinical presentation.  Nonetheless, the team's conclusion was that soldiers were killing themselves for the same reasons that soldiers, quote, typically kill themselves, personal problems. 

A supplement to the report listed things that soldiers most often identified as stressors—seeing dead bodies, human remains, being attacked, losing a friend.  But the report itself only mentions marital problems, financial problems, legal problems, what they call underdeveloped life coping skills.  Translation, soldiers are dying because they are managing their lives and their affairs badly. 

Every year since 2003, the suicide rate in the military has increased; and another team of military psychiatrists have been dispatched.  Their conclusions are always the same:  insufficient life coping skills. 

As recently as August, Elspeth Ritchie of the Army Surgeon General's Office insisted that, in spite of the suicide rate that had reached a 26-year record high, Pentagon studies still haven't found the connection between soldier suicides and war.  There are various possible explanations for the Pentagon's refusal to accept that connection, but one of the most compelling is certainly budgetary. 

To cite just two examples, soldiers often resort to self-medication when they are denied or discouraged from treatment, and that is commonly used to justify a dishonorable discharge, and that means that a soldier will be deprived of healthcare benefits.  Or VA claims that somehow more than 22,000 soldiers, most of whom had already been diagnosed with a post traumatic stress injury or a traumatic brain injury, have been dismissed from the service with a diagnosis of personality disorder which is considered a preexisting condition, which also therefore absolves the VA of any responsibility for their future care.  Such cynical cost-saving measures are devastating to the lives of soldiers and their families. 

There is currently no cure for post traumatic stress injuries.  Though many learn to manage their symptoms, far too many will suffer the effect of their combat experience for the rest of their lives.  They will continue to have nightmares and flashbacks.  Many will continue to be hypervigilant, have startle responses that are often violent.  Many will have trouble managing their anger and their relationships for the rest of their lives.  Many will try to self-medicate to help them forget.  And far too many will die by their own hands. 

But that sad truth cannot be used as an excuse for inaction.  Our soldiers and our veterans need all the help they can get as soon as possible.  Their psychic injuries may not be curable, but they are treatable.  Their lives and the lives of their families can be made infinitely less difficult if they are given the care and support they have earned. 

They can be assured that their suffering is a normal response to an abnormal situation.  They can talk to other veterans and practice compassion for themselves by feeling it for others.  They can be taught proven techniques for managing their stress and their anxiety.  And they can be relieved of the added burden of financial worry, all of which may help dissuade them from suicide. 

This is a public health issue of monstrous proportion, and I am here to bear witness to the fact that military suicides are not a new phenomenon.  They are old news.  This has happened before, and it should never have been left to citizens to sound the alarm. 

The disingenuous surprise and denial from official sources is simply unacceptable.  I am deeply concerned that the issue is being politicized, that sides are being taken, lines drawn that make it appear as though there are two sides to this issue.  There are not.  There can't be.  These are our soldiers, our veterans.  They are also our husbands, our wives, our parents and our children; and they are dying by the thousands. 

I am grateful to CBS News that they have finally given us some solid numbers.  Six-thousand two-hundred fifty-six veteran suicides in one year.  Those numbers are astonishing.  They cannot be justified or ignored.  Our soldiers and our veterans are not disposable, and yet that is how they are being treated.  More than 6,256 veteran suicides a year, and each one of those numbers represents an individual beloved face and a life-shattering experience. 

I know that Daniel came back from Vietnam with an injury that finally and directly caused his death.  I believe that he decided that he deserved to die because he had suffered too little or that he wanted to die because he had suffered too much.  We call his death a suicide, but I have come to believe it was either an execution or euthanasia or some tragic combination of the two, and that continues to break my heart. 

I am grateful to this Committee for holding these hearings.  May only good come from your efforts.  Thank you.

The CHAIRMAN.  Thank you.

[The statement of  Ms. Coleman appears in the Appendix.]

The CHAIRMAN.  Ms. Meagher?

OPENING STATEMENT OF ILONA MEAGHER

Ms. MEAGHER.  Thank you, Chairman Filner, Ranking Member Buyer and other distinguished Members of the Committee.  I thank you for the opportunity to appear before you today. 

To open, I would like to briefly share my thoughts on why I think I am before you. 

I am not only someone who spent 2 years researching and writing about post traumatic stress and our returning troops.  I am also a veteran's daughter.  My father was born in Hungary, served 2 years in an antitank artillery of a Hungarian conscript, fought against the Soviet Union on the streets of Budapest during the 1956 Hungarian Revolution, later fled to America and in 1958 again became a soldier, this time wearing a United States Army uniform and serving as a combat engineer in Germany. 

My father's unique experience of having served on both sides, both East and West, in such differing armies during the Cold War gave him a unique perspective on military life.  And so growing up, my sisters and I often heard my father say you can always tell how a government feels about its people by taking a look at how they treat their troops.  Looking at our returning soldiers and their widely reported struggles with the military and with the VA healthcare systems they rely on, of being stigmatized from seeking care or of being placed on lengthy VA waiting lists when they need immediate help, some even committing suicide before their appointment dates arrive, has raised this citizen's alarm bells. 

For years, we have had a "see no evil, hear no evil" approach to examining post-deployment psychological reintegration issues, which includes suicide.  After all we have learned from the struggles of the Vietnam War generation and the ensuing controversy over how many of these veterans had or had not committed suicide in its wake, why is there today no known registry where Afghanistan and Iraq veterans' suicide data is being collected?  How can we ascertain reintegration problems, if any exist, if we are not proactive in seeking them out? 

As late as May 2007, the Department of Veterans Affairs spokeswoman Karen Fedele told The Washington Post that there was no attempt to gather Afghanistan and Iraq veteran suicide incidents.  Quote, "We do not keep that data," she said.  "I am told that somebody here is going to do an analysis, but there just is nothing right now."  That was in May 2007. 

Meanwhile, the Army reported that its suicide rate in 2006 rose to its highest level in 26 years of keeping such records.  Last month, at long last, the Associated Press revealed that the VA is finally conducting preliminary research.  They have tracked at least 283 OEF/OIF veteran suicides through the end of 2005.  I have a note here.  I have seen that the VA testimony may include a different figure than this, so we are already disputing this figure.  The Associated Press reported 283 OEF/OIF veteran suicides in the VA system.  That figure was nearly double the rate of the additional 147 suicides reported by the DoD's Defense Manpower Data Center. 

Looking only at these two suicide figures from the VA, 283—and from the DoD, 147—there have been at least 430 Afghanistan and Iraq veteran suicides that have occurred either in the combat zone or stateside following their deployments.  Lost in the VA and DoD counts, as the Bowmans discussed, are those veterans who have returned from their deployments, who are still in the military and who are not yet in the VA system.  The DoD says they do not track those incidents, and I assume neither does the VA. 

Many of the 430 confirmed suicides that we now know about are as a result of our wars in Afghanistan and in Iraq.  They should, but will not, be listed with the DoD's official OEF/OIF death toll, which, yesterday, stood at 4,351.  If they are 430 confirmed OEF/OIF suicides, that translates to an additional 10 percent of the overall fatal casualty count of these wars that are due to suicides, 10 percent.  Therefore, dismissing the issue of veterans' suicides in the face of this data is negligent and does nothing to honor the service and sacrifice of our veterans and families and communities that literally are tasked with supporting them once they return. 

Yet, prior to last month's CBS News investigation, which we have heard about, one additional note in that CBS News investigation noted that 20- to 24-year-old Afghanistan and Iraq veterans are two to four times more likely to commit suicide.  They are not the only ones who have talked about its being double the rate of suicide for our veterans.  There was a June 2007 study as well—we could talk about that—that showed that the veterans' suicide rate is double the rate of the civilian population. 

In my written testimony, I have included 75 suicides that I and other citizen journalist colleagues have been tracking since September 2005 and which, today, reside in the ePluribus Media PTSD Timeline.  They offer only a small and incomplete sliver of insight into how some of our returning troops are faring on the home front, especially in light of the fact that at least another 355 incidents could be added among them according to the VA and the DoD.  I believe they collectively, though, tell an even greater tale about the failure of us as individuals and as a society to ensure that our returning warriors are cleansed completely from the psychological wounds of war.  They also reflect the failure of our government institutions to protect those who protect us. 

While I realize that these distressing stories are the exception and not the rule, to our exceptional military family members and their having to deal with the deterioration of a loved one they thought had safely returned from combat, they are the rule.  In 1956, the same year that my parents fled to this incredible country, the 84th Congress in this very House that we sit in today had this to say in a presidential commission report on veterans' benefits: "The government's obligation is to help veterans overcome special, significant handicaps incurred as a consequence of their military service.  The objective should be to return veterans as nearly as possible to the status they would have achieved had they not been in military service, and maintaining them and their survivors in circumstances as favorable as those of the rest of the people.  War sacrifices should be distributed as equally as possible within our society.  That is the basic function of our veterans' programs." 

Finally, I am not a pedigreed expert or a government official.  I am shaking in my seat.  I am not seasoned in testifying before Congress, so I do appreciate the opportunity to stand in for the civilian population and to represent them, but those who are the professionals and the seasoned, pedigreed officials from the U.S. General Accountability Office, the Congressional Research Service and even to the Veterans Administration have sat in this very seat over these past years, and they have told you that we are falling far short in providing the resources and programs that our returning veterans need and military families need to successfully return to their personal lives following their service to this Nation. 

To those who resist hearing the cold, hard truth of where we are today, I have only one thing to say:  The time is here to stop fighting the data.  Let us, please, start fighting for our troops.  This is America.  We can do better.  We must do better.  Thank you.

[The statement of  Ms. Meagher appears in the Appendix.]

The CHAIRMAN.  Thank you both very much. 

Dr. Snyder, do you have any questions? 

Mr. SNYDER.  I was browsing through your book.  I wanted to ask:  Is it May-ger? 

Ms. MEAGHER.  Mee-ger.

Mr. SNYDER.  Meagher.  I am sorry.

Ms. MEAGHER.  That is fine.

Mr. SNYDER.  You gave a series in your statement here of very specific things.  I appreciate what you say, by the way, about shaking in your boots.  We do that quite a bit here because sometimes we are not sure what way to go either with some of these things.  But one of the issues, in fact, was referred to earlier by Representative Kennedy here.  You talked about outside community-based resources that are available, and I recognize that there—I think there are a lot of communities that are trying to step forward right now to help families the best they can.  I think about what happens as the years go by.  Sooner or later, the war in Afghanistan and Iraq will be a historic event, and years will go by, but we know these problems that you all are dealing with and talking about, both of you, do not go away. 

So we come back to this issue of having services available, not just for the individual veteran but also for that veteran's family.  It may be issues of marital difficulties, of substance abuse, of anger management, of the fact that the veteran still does not realize that what is haunting him is what happened before, and so we still come back to this issue of the inadequacy of our mental healthcare system in the United States. 

If both of you want to discuss that broader issue, it is that which is not just for the veteran, himself, and that we expect to give the highest care to the veterans' healthcare system or to the military retiree system of healthcare, but it is for our system nationwide.  I have directed this to Ms. Meagher, but I would like you to comment also on it if you would, Ms. Coleman. 

Ms. MEAGHER.  I do have some comments because I approach this from—of course, I am a veteran's daughter, as I said, but I am a concerned citizen, so I am not a journalist.  I did what is called "citizen journalism" because I saw a problem.  And the problem that I saw was that we were not, first of all, in our Nation, called up to pay attention to the issue.  Our soldiers are returning, and there are no victory gardens being planted.  There are no war bonds funding drives.  There is no indication that we are at war.  That translates into the same things that are happening in communities.  While there are incredible organizations and people in pockets all across the country whom I met while I was on my book tour and learned a lot from who are ready and willing to do something, they do not have the ability to tap into who the veterans who are in the community.  So I heard over and over from these incredible people doing incredible things that we are ready and waiting, but they are not coming in. 

Now, nobody asked them to do these things, and it is unfortunate that our leadership did not ask because it would have made for a stronger country.  I believe that many of the things that I comment on cannot be legislated, and I cannot, I think, say—

Mr. SNYDER.  Did you say "cannot be"? 

Ms. MEAGHER.  We need to move our society forward and ask them to pay attention to this issue and to take it seriously.

Mr. SNYDER.  I agree with that.  I think of things, though, like—you mentioned your father today.  My father died, who was one of Patton's guys, and he got involved, and he would talk to me sometimes.  Like after I went into the Marine Corps, we would talk about some of this stuff—about the burial details he got involved in.  He just felt that, someday, one of those guys might be him.  He would go down into these burned-out tanks and would have to bring out these bodies of Americans, and it would just haunt him.  He could never watch any show on television but a game show—no cop shows, no crime shows, no westerns, no war movies.  It was only game shows because they had no violence in them. 

Well, I do not think he knew what was going on, but I think it was you, Ms. Coleman, who talked about the person who sleeps in his closet or maybe it was the Bowmans or both of you.  Okay.  Well, I also think that there are going to be children in those households who are around this stuff, and there are these veterans who know that they are having problems that may be impacting negatively on those children.  Well, we do not have a system where the children could go down to the VA hospital where they could get good quality mental health counseling for a 5-year-old or for a 9-year-old or for a 12-year-old or for a 15-year-old.  Again, we get back to Mr. Kennedy's work here. 

So that is what I was getting at, the community-based resources.  Even now, you are talking about our not really being called forward as a country, but think of where we will be 5 and 10 and 15 and 20 years from now when memories will have faded about our responsibilities, and we are still going to have families from these folks who are going to have these needs. 

I think it is on the second page where the two of you recommend and you talk about complimentary counseling to all immediate family members.  That is what triggered my thought because we need to have a system in this country of providing better mental health coverage because that need is going to be there for a lot of years for these families, and it may be generational.  And I think that we are going to be grappling with it on this Committee, but we need to be grappling with it in our entire healthcare system. 

Ms. MEAGHER.  I do have one suggestion that could be easily done, and I would have done it myself if I only had the opportunity.

Mr. SNYDER.  Yes.

Ms. MEAGHER.  I think it could be easily done. 

All of these resources that are out there—now, I am from Illinois, and the Bowmans are as well.  We have National Guard troops.  They come from the community.

Mr. SNYDER.  Right.

Ms. MEAGHER.  So they know the community.  The community knows them.  And there are resources available to them, but there is not a database.  There is nothing where somebody who is sitting in Texas or in Illinois can simply just go to a database to see "what is available in my community."  The military is not giving the information to the soldiers, and the soldiers do not know where to go often.  They do not know that there are psychologists who are at the ready to donate their services.  There are programs.  There are all types of programs.  So there could be a database.  There could be something that is put together that has resources for people.

Mr. SNYDER.  In fact, the problem that we run into with our Reserve component—and Arkansas has had a lot of Reserve component troops, both Guard and Reserve.  What they run into is they may come from communities where, in fact, the healthcare providers there are not part of the military healthcare system because they have not had to be.  Nobody has come in and said, "Do you accept TRICARE?"  Now they are going through, "What is TRICARE?  Why is that important to us?"  "Well, it is, because we have been mobilized as a family, and that is now our healthcare system because my husband or wife is not on their work-related healthcare system anymore.  This is our healthcare system.  If you do not take it, it means I cannot get healthcare, and I am going to have to go someplace that takes my insurance."  So we run into those kinds of issues. 

My time is up, Ms. Coleman, but I wanted to give you a chance to comment. 

Ms. COLEMAN.  I think that one of the saddest things about these wars has been the fact that we have been invited not to participate.

Mr. SNYDER.  I am sorry.  I could not hear you.

Ms. COLEMAN.  I think one of the saddest things about these wars has been that we have been asked not to participate, that we have been deprived of the image of funerals and of coffins and of tears and of wounds even.  I think that has deprived us of the opportunity to check in with our consciences, and I think it has deprived us of the opportunity to help those who have been wounded to carry the burden of their pain.  And I think it has not contributed to a reinforcement of our social fabric, and I think that is too bad.

Mr. SNYDER.  Thank you both for being here. 

Thank you, Mr. Chairman.

The CHAIRMAN.  Thank you. 

Ms. Herseth Sandlin? 

Ms. HERSETH SANDLIN.  Well, thank you to both of you. 

I was going to pose a question or two with regard to what you two have seen or as to, in your conversations with others, whether or not there is a difference either in the experience or in the numbers of active duty versus the National Guard and Reserve.  We have done a lot of work on this Committee over the last couple of years in examining that question in a lot of different contexts. 

On the one hand, you could say, well, perhaps it is our National Guardsmen and Reserves because the community itself, the entire community, is affected by that or a set of communities is by a particular unit's being deployed, and so that support network is particularly strong among the families during deployment and when those men and women return home, and there would be a greater likelihood that they would be somehow finding or maneuvering through the community, given the support of that community, to find resources to meet their needs.  At the same time, I hear you saying that there are some communities, particularly larger ones, perhaps, and they are unlike those that I represent in South Dakota or perhaps some in Arkansas, where the unit is from five or six different very small communities versus a larger community or a community where there is a larger base. 

Have you noticed a difference?  How do we best address that situation?  Perhaps a database is good in terms of the resources that are available in a community for National Guardsmen and women, but what other issues do we have to get over for active duty in response to—of course, we have talked about the stigma in the past and the concern that these men and women have as it relates to seeking those resources and a fear about how it affects their military careers. 

So can either of you talk about the differences that you think exist?  Are there numbers broken down to suggest that we have higher rates of suicide among active duty versus National Guard and Reserve, or is it exactly the opposite? 

Are there other hurdles that we can help address based on the constituencies that we all represent here and the different constituencies that we represent back in our districts to help you and to, again, be part of that network within a community to facilitate information and to reach out and to know who these people are and to make them aware of the services that are available to them? 

Ms. COLEMAN.  The information that has been available since the beginning of these wars about active duty troops has been very hard to get a hold of.  Newspaper reporters have had to file Freedom of Information Act (FOIA) requests to find out what was happening in terms of suicides among active duty troops. 

When The Hartford Current did a series of articles in May of 2006, by submitting FOIA requests, they got information about several suicides.  I think when CBS News was trying to initiate their report, they also submitted a FOIA request to the Department of Defense.  And the Department of Defense gave them some number of active duty troops, but told them that veteran suicides were just something that they were not keeping track of.  I do not know. 

Ms. MEAGHER.  There are some stats and some specific changes and differences as far as Guard and Reserve troops, how their experience unfolds. 

According to the DoD, they did a Pentagon task force study on the troops in the summer of 2007, and they reported that 38 percent of soldiers—31 percent of Marines—showed symptoms of PTSD, psychological problems.  Meanwhile, 49 percent of the National Guard and 43 percent of the Reserves did. 

Now, as to some of the reasons that I have seen in the data that I have read, there are a few things that are happening there.  When Reserves are called up, they may have their own businesses.  Those businesses may go under if they have been deployed two or three times.  Although the Bowmans spoke about their own family support since they are in the same community, it is not like a base.  There are not specific places where the family members can go to get support.  So some do not come in like that half of the base that did not come in that the Bowmans mentioned, and some might come in for these little impromptu gatherings, but there is not one area where everybody can support each other.  So that is significant. 

There are also differences in—I have seen in reports of National Guard troops that they may deploy all as one unit, but often, especially with individual ready Reserves that are activated, they are used as fillers, and so they are going with people who they might not have trained with.  There are also a lot of other issues that revolve around insurance issues, but worries about financial—if you have lost your business, that is an added stress.  It is not PTSD per se, but it is an added, additional stressor.  There are worries about their families at home, and many of them have kids that some of the younger active troops do not have. 

Ms. COLEMAN.  One other thing, suicide statistics are renowned for being difficult to gather.  The Center for Disease Control and Prevention (CDC) says that they expect that it is somewhere between 10 and 50 percent underreported.  If a veteran drives the family car into a tree or overdoses or gets into a confrontation with a policeman, those are not necessarily going to be recorded as suicides, and they are what Mike Bowman called a "killed by" service.  I think that it is very difficult to actually get a handle on the number of suicides. 

When CBS News asked State governments to give them the number of suicides that they had recorded, those were the suicides that family members chose to acknowledge, and a lot of States do not consider something as suicide unless there is a note that has been left.  I think that the numbers that we do have are as good as we can get. 

Ms. HERSETH SANDLIN.  Thank you both. 

Thank you, Mr. Chairman.

The CHAIRMAN.  Mr. Kennedy? 

Mr. KENNEDY.  Thank you. 

I just want to follow up on my initial point, when we were speaking with the Bowmans, and it was with regard to the family issues, the thought that the Bowmans were paying out of pocket right now for counseling was really troublesome to me.  You know, here they are trying to get counseling for the loss of their son who suffered as a result of his service, and they are paying for it personally rather than the United States paying for it.  I mean, I think that we owe it to the families to be paying for their mental health counseling as a result of the loss that they suffer when they lose a father, a spouse, a loved one in the line of service.  In the case of a suicide, certainly, this ought to be extended to families as well, and it is just absolutely incredible to me that we do not have this extended to family members. 

I would like to ask you to comment on—you know, the Kaiser Foundation just completed a study of adverse childhood experiences.  In California, they have measured the trauma dose, basically, of children who come from families where they have high doses of Cortisol.  Basically, it is a child who comes from a family where there is domestic violence.  You know, the fight-or-flight instinct in a human being means you have high doses of Cortisol if one is threatened.  For children, if they hear loud screaming, if they see violence, Cortisol is released in the brain just as it would be for any one of us and just as it would be for a veteran or for anybody in a situation where it is fight or flight.  This creates changes in the brain. 

In any event, they have measured this in families where children come from homes where there is domestic violence, where there is drug or alcoholism, where there are these kinds of high-risk situations.  These children are at much higher risk for suicide themselves, for drug abuse, for a whole list of things down the road, and this has been borne out by evidence now. 

So what strikes me is not only are we going to see a wave of challenges with veterans down the road, but we are going to see a wave of challenges with their families.  We are talking now about a registry for trying to track veterans' suicides.  It would seem to me we ought to be getting a registry of tracking the children of these veterans.  Can you comment on that?  I mean, we have got a whole generation of the children of these veterans, and they have been seeing their parents go off for two or three tours of duty. 

In dealing with that kind of trauma, what do you think we are going to deal with with these kids down the road with their parents' coming back and having suffered all that they have suffered and the impact on them? 

Ms. COLEMAN.  After the war in Vietnam, 20 years after the war in Vietnam, the Australians created what they called a "nominal role."  They got in touch with all of their Vietnam veterans, the ones who were still alive, and they have yearly contact with them, and they keep track of what is happening not only with them but what is happening with their children.  And one of the things that they found was that those children were three times more likely to kill themselves than their peers, which was an eye opener and a tragedy. 

Ms. MEAGHER.  That is one of the things, the secondary PTSD of the family members.  After reading an article about a cluster of suicides and of murder-suicides that had taken place at Fort Lewis in 2005, that is what brought me into the issue.  I read in that article that the reporter had listed how many other family members—how many wives, how many children—were affected, and that is when it really clicked with me that this is a larger issue than just the mere data, than just the mere stats of the individual people. 

What makes military suicides different than any other suicide that might be in the general population is that we have a responsibility for these family members.  If a person—and I have a sister who committed suicide, so I know that that is another additional reason why I was emotionally very attached to the families who were dealing with this issue, because I knew the stigma that our family had to go through.  While my sister was not a veteran, she was a private citizen, and there is no obligation for the government to do anything.  There is no obligation for the community to care—my family cared—but for our soldiers and for our military family members, we have an obligation to them.  So that is what makes it different. 

As far as things that you could legislate, we have not really talked much about what we can do to prevent and to protect and to shore up our veterans for this new type of warfare that they are in.  I know that there is a Psychological Kevlar Act.  There are only, I believe, ten cosigners.  Phil Hare, Representative Hare, is one of them, and I am proud to be from his State. 

I think we need to look into proactive measures to be able to help our troops from basic training onward.  We need to push the military culture to change and to grow in their idea of what it means to prepare a soldier for battle.  It is not just to pull the trigger.  It is also to be able to live with that, that work. 

Mr. KENNEDY.  I appreciate your mentioning the Psychological Kevlar Act.  That is my bill. 

It seems to me, if we put our soldiers through strenuous boot camp, that ought to be not only for the physical but for the psychological nature.  They ought to be prepared for what they are going into, and we ought to have mental health literacy as well as physical literacy when we go in. 

I was really struck, Ms. Coleman, by the fact that children of veterans of Vietnam in Australia were three times more likely to commit suicide than their counterparts.  That is pretty—

Ms. COLEMAN.  We do not have those same statistics.

Mr. KENNEDY.  We do not have the same statistics here, but that is in Australia.  Whether this is a question of our Veterans Affairs Department, it seems to me it is a question of our national interests.  It is properly, maybe, an issue that has to do more with our U.S. Department of Health and Human Services—another area of our governmental policy—but it is an issue that we have to address as a Nation and that we should address as a Nation. 

Ms. COLEMAN.  Coming off of what Ilona said about it's being really important that we focus on preventative care, it seems to me—think about this.  What if we immediately granted full disability to all combat veterans who submit a claim through an appropriate VA representative?  Those benefits would continue until the VA succeeds in denying the claim after all of the appeals have been resolved.  The VA would then have an incentive to streamline their process, but it would also put the emphasis on prevention as opposed to diagnostic and curative, which is public health.  I know that the flagship suicide prevention hospital in the VA is the Canandaigua Center for Excellence, and all of their literature emphasizes public health outreach.  It seems to me, if there were not an adversarial relationship between veterans and the VA, that that would make it much easier for them to get the care they need, and that would probably make it much less expensive to take care of them over the long run. 

The CHAIRMAN.  Thank you, Mr. Kennedy. 

Mr. Buyer? 

Mr. BUYER.  Ms. Coleman, I would like for you to know that information that we obtained to help prepare for this hearing we got readily available off the Web, so we contacted the Defense Manpower Data Center.  Anyone in the country can get on the Web, and they can pull down the statistics.  So, in your testimony to us that they are hiding this information, I just want you to know that it is readily available to people. 

Secondly, I would like to add, Ms. Meagher, that I want to thank you for your contribution.  I think it was therapeutic to you, as this experience had to be.  Now, as a policy maker, the challenge is the many types of disease groups that we deal with.  Name a disease, and then we have to do this analytical overview of populations and their propensities to have come down with, say, cancer even if they had not been in the military, because then we try to examine, if it was something caused by military service, and the causal connection, the link, because then there are dollars attached to those kinds of things.  So we study all of these things. 

On this issue, with regard to suicide, we recognize that as a society.  I will go back to Dr. Snyder's comment as being absolutely correct that, as a society, we have a challenge, and it is the propensity of these young adults, 15- to 24-year-old males, to committing suicide in our society, and when it is one of the top ten killers, we have a problem in our society. 

Then you do the overlay of obligation.  I agree with you.  When you put on the uniform and we do the inculcation and the matriculation process, our obligations to care for them will continue.  The overlay on what we have just discussed and what makes it really challenging is what I brought up earlier:  There are individuals who want to use that data for their own causes and antiwar themes.  What happens is that we then get away from what we really want:  What do I want for my comrades? 

What I want for my comrades is I want them to be able to go obtain their mental health without a stigma, and that is why I really dislike the word "disorder."  There is this whole balance that we have to go through between the military.  Dr. Snyder has to struggle with this being on the Armed Services Committee.  You have got a responsibility here as commanders to develop military cohesion that will be effective on the battlefield right?  If you are effective and you have got the cohesion, you are also saving lives because buddies look after buddies.  Balance that with the privacy then of a soldier.  Now, commanders also have played an integral role.  Because they are responsible for military cohesion, they need to know about the mental status of their soldiers so they can define the cohesion to be successful.  So somewhere in here is this challenge of providing mental health services so that the commanders can also have a comfort zone.  It is not only the commanders.  It is the buddies, the man to their right and left; are they okay to carry a weapon?  You know, this is very challenging, and I think the military is doing a better job today than what they have done in the past on their abilities to have soldiers talk about their experience when they debrief.  It used to be John Wayne.  You know John Wayne.  "I went in.  I did bad things.  I feel good.  I am fine.  I am going back to my job."  No.  It is okay to talk about it. 

In listening to the professionals—the psychiatrists, the psychologists and the counselors—they talk about early intervention is, in fact, the best.  The reason it is the best is that, as to these risk factors that we all are in search of, not everybody shows it, and that is what is so hard.  You have done that through your own life in struggling with, "What could I have seen about my sister?"  I do that about my friend.  What was there?  You know, my brother and I have these conversations.  We did not know.  We did not see.  We were with him.  I never saw it until he did something impulsive. 

So I think the Chairman is on the right track here in trying to come up with some form of a classification where soldiers and our veterans when they return home—our Guardsmen, Reservists—have a comfort zone where it is okay to obtain mental health counseling; at the same time, our commanders are in a comfort zone that the individual is not imbalanced—do you know what I mean, that he is okay?  It was okay to talk about, when I went into the room, bad things that happened. 

"Oh, bad things happened?  No.  What exactly happened?" 

"I shot and killed two." 

"How did you feel about it?"

"I did not like it.  It was my job.  It was my duty.  I had to do it, but I keep thinking about it." 

"Well, what do you keep thinking about?"

So you are forced to talk that thing through, and that is helpful, and commanders are trying to do that kind of thing.  The more we move to that prevention aspect of it, I think the better off we are going to be in the end. 

So I compliment you, Mr. Chairman.  I yield back.

The CHAIRMAN.  Thank you. 

I wish all commanders were as open as you suggest.

Mr. Kennedy? 

Mr. KENNEDY.  Yes.  We are working on a network of care—an Internet-based, comprehensive resource—for those who can access it both for providers and for those trying to get help, and that is going to be available, hopefully, throughout the VA system.  We are working on that.  That is a very good suggestion.

The CHAIRMAN.  I want to give you both a chance to comment on the data question that Mr. Buyer raised. 

It has been my experience that this data is not available.  We have asked people sitting in your chairs for data.  They have not provided it from the VA and from the DoD. 

When I read your Web site, Ilona, it brought to mind, you know, what if the Pentagon had to raise its money through bake sales?  You know, you are trying to do something that the government should do, and your resources are very limited to do that, but the government is not doing it, and it seems absolutely necessary that they do.  They do not want to know, it looks to me.  I mean, this could be tracked.  We can do this.  We do not want to know the answer as far as I can tell. 

Would you comment on the availability of data, both of you? 

Ms. MEAGHER.  Well, I can say this, that I am just a private citizen who, in 2005, was interested in the topic and thought to myself, Well, there is this cluster of suicides and murder-suicides, and some of them were highly decorated in Fort Lewis in Seattle.  I wanted to see, is it just happening there, or is it happening elsewhere? 

So I used simple search engine technology.  I just started Googling, and I started to find different incidents all across the country reported in local media.  Now, large Web sites like The New York Times and The Washington Post, they are able to archive all of their incidents.  Small, local communities do not.  So, a couple of months later, maybe that police standoff—we are not just talking suicide here.  Of course, we are for this hearing, but there are a lot of things that are going on, and we try to track them all, and it is not meant to stigmatize.  Obviously, there is a larger portion of troops who have the support services that they need, who have the family in place to help them, to make the right decisions, to make the right calls, but for those families who are having these problems—the suicides, the police standoffs, the drunk driving incidents, the domestic violence and on and on—those things need to be tracked and preserved, not to point a finger but just so that we can have some data for them to do some research on, have the people who know how to do this research do it, and if it is lost, then it is lost, and we lose an opportunity to preserve that.

Mr. KENNEDY.  So we should track it within the corrections system, too? 

Ms. MEAGHER.  Yes.

Mr. KENNEDY.  And we are not.

Ms. MEAGHER.  If I can make one more point about law enforcement, there are a lot of things the communities can do, and I have already seen them happen.  In my area in Dixon, the Mayor has tried to be proactive by bringing in law enforcement and educational institutions and churches and healthcare organizations.  Law enforcement needs to be, in many ways even, a safe haven.  We need to have military families be able to pick up the phone—be it to law enforcement or to their healthcare providers—and not have to fear that, if they do pick up the phone again, there is the stigma. 

If I pick up the phone and if one is having a PTSD episode, if a loved one is having an episode, one should not be penalized for having to pick up the phone before it gets to this pancaking of, you know, one incident after another, and then we have a bad record, and then we have lots of problems.  That just increases stress.  We need to think about ways to prevent that.

Mr. KENNEDY.  In my State, my municipal police academies have gotten together and have put their own debriefing and program together at their own expense because so many of the Guard and Reservists are, obviously, first responders.  When they come back, if the VA is not doing it, they are going to do it themselves to help reintegrate these Guard and Reservists back into the first responder community.  Of course, the issue of those ending up Guard and Reservists and others ending up in prison is also something we are doing as a State initiative.  We are trying to track those who are ending up in our corrections system because of the issue of reacting badly because of the problems that they are facing emotionally and psychologically. 

Ms. COLEMAN.  In August of 2007, the Army released a 165-page suicide event report for the year 2006, and that was described in all of the reports that I read as a first time ever public analysis of what the Army called "confidential data" submitted by units from across the Army over the past 2 years.  I think it included previously unreleased statistics on attempted suicides, and it found hundreds of attempted suicides, particularly among active duty soldiers who had returned from the war, and an increase in the number of soldier suicides in Iraq from the previous year.  I do not think those figures had been available before. 

The Department of Defense's Web site, up until very recently, had two, three, four acknowledged suicides among active duty troops, and there were a lot of noncombat accidental deaths but almost no suicides.  This is a very different picture of what has been happening within the service. 

The CHAIRMAN.  We thank you for your testimony.  There is a lot of movement here because we have votes over on the floor for which we have to take about a 30- to 35-minute recess.  We will decide how we are going to conclude the hearing when we get back. 

Both of you have done tremendous work in trying to have this Nation understand these issues, in trying to get a sense of both raising the consciousness about the issue and speaking to our consciences to respond to it.  These are our young men and women, and we have an obligation to them, and we have to understand the extent of the problem and face it squarely and then figure out what we are going to do about solving it.  So you have done a great service to the Nation with your books, with your articles, with your Web sites.  We look forward to working with you when we have any needed legislation that we are going to do here.  Thank you so much. 

We are going to recess for 35 minutes.

[Recess.]

The CHAIRMAN.  Again, I apologize to our witnesses for the recess.  And also we tried to, I think, do too much in one day.  So I think, with the agreement of all the participants, we are going to move on to panel five for the Department of Veterans Affairs to present its testimony.  And then early next year we will hold another hearing for other testimony to continue. 

I think the morning testimony was very compelling and took a longer time than we had imagined.  We thank you for waiting this long. 

Dr. Katz, Deputy Chief, Patient Care Services, Office of Mental Health in the Department of Veterans Affairs; and Dr. Kara Zivin, Research Health Scientist with the Health Services Research and Development of the Department of Veteran Affairs. 

You are recognized, Dr. Katz.

STATEMENTS OF IRA KATZ, M.D., PH.D., DEPUTY CHIEF PATIENT CARE SERVICES OFFICER FOR MENTAL HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY ROBERT ROSENHECK, M.D., DIRECTOR, DIVISION OF MENTAL HEALTH SERVICE AND OUTCOMES RESEARCH, VETERANS HEALTH ADMINISTRATION; LAWRENCE ADLER, M.D., DIRECTOR, MENTAL ILLNESS RESEARCH EDUCATION CLINICAL CENTER, VETERANS INTEGRATED SERVICES NETWORK 19, VETERANS HEALTH ADMINISTRATION; AND FREDERICK C. BLOW, PH.D., DIRECTOR, SERIOUS MENTAL ILLNESS TREATMENT RESEARCH AND EVALUATION CENTER, ANN ARBOR VETERANS AFFAIRS CENTER FOR CLINICAL MANAGEMENT RESEARCH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND KARA ZIVIN, PH.D., RESEARCH HEALTH SCIENTIST, HEALTH SERVICES RESEARCH AND DEVELOPMENT, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS (ON HER OWN BEHALF)

OPENING STATEMENT OF IRA KATZ, M.D., PH.D.

Dr. KATZ.  Thank you, Mr. Chairman and Members of the Committee. 

I want to begin by expressing my most profound condolences to Mr. and Mrs. Bowman and to Ms. Coleman.  What they have spoken of is important to me personally and to all of my colleagues.  I want to assure them that we have taken their words to heart, and so has the Department of Veteran Affairs. 

I want to thank you, Mr. Filner, for holding this hearing.  The discussion represents an important day for mental health in America. 

I want to go over my prepared oral testimony, but to say that, especially after the discussion this morning, it is only a fraction of what I am personally feeling, and it is also only a fraction of what VA is doing. 

There is no question, suicide among veterans is a tragedy.  The Department of Veterans Affairs recognizes our obligation to work to prevent suicide, both in individual patients and in the entire veteran population.  We are concerned about epidemiology.  We are more concerned about people and the tragedies that they represent.  But we focus on epidemiology because findings in this area can guide prevention. 

VA has a long track record of research and publication in this area.  One of our leaders is Dr. Han Kang, who is here.  Others are on this panel with me. 

One peer-reviewed publication from a long-term, 20-year follow-up of Vietnam-era veterans reported that the rate of suicide among veterans who were deployed to Southeast Asia did not differ statistically from veterans of the same era who were not deployed.  Another published study of veterans from the first Gulf War provided similar findings. 

VA and Dr. Kang have just completed a preliminary evaluation of suicide rates among veterans returning from Iraq and Afghanistan.  From the beginning of the war through the end of 2005, there were 144 known suicides among these new veterans.  This number translates into a rate that is not statistically different from the rate for age-, sex- and race-matched individuals from the general population. 

However, suicide rates among veterans are too high.  The population receiving care from the Veterans Health Administration has more risk factors for suicide than the general population.  Most veterans are male, and men have higher suicide rates.  Those who come to the VA for care tend to be older, less well-off and more likely to have a mental health condition or another chronic illness.  Those with the greatest need for care are those who are most likely to come to VA.  And this increased need is associated with increased risks of suicide.

The CHAIRMAN.  I am sorry to interrupt, Dr. Katz.  I just don't understand that conclusion, that those with the greatest need are those who are most likely to come. 

We have talked for three hours about the reasons why people don't come.  And I could make the same case, since you are making a hypothesis here, that there is no real data that the people most in need don't come.  I could make the very same argument. 

So, why do you think that?  I don't understand it at all.  You don't know who is coming or why those who are not coming aren't coming.  You don't know that.

Dr. KATZ.  I will take the question for the record and get back to you, post hearing.

The CHAIRMAN.  I am just asking.  You drew a conclusion which I think is wrong, and you can't argue for it?  I mean—

Dr. KATZ.  Well, those who come—for example, there are the demographic issues—age, sex and all.  But, most significantly, those who come to VA for care are more likely to have mental health conditions than others.

The CHAIRMAN.  But you are not giving me any basis for making that statement.  I don't know why that is the case.  Again, those who have been subject to arguments that, you can't come if you are weak and they accept that, no matter how difficult—I mean, the suicides we heard about in the morning session, they never got in touch with the VA, and they had pretty difficult situations.  So I just don't know why you would just make that assumption.

Dr. KATZ.  Well, it is not just an assumption.  There is no question that there are many people in need who don't come to VA for care.  That is a problem, and it is a problem that we have to solve.  But, on a statistical basis, those who do come to us have major care needs and, with those major care needs, increased risks for suicide.

The CHAIRMAN.  But those who don't come could even be in greater need.  You say the reverse here, and I don't know on what basis you are doing that. 

Especially, in light of the little bit of data here, 144 known suicides.  We have heard arguments all morning that your data is probably incomplete.  There is unreported stuff.  There is underreported stuff.  There is not tracking.  I mean, you are not anxious, it doesn't seem to me, to go after this stuff.  So you are basing your conclusions on very suspect data to begin with.

Dr. KATZ.  Mr. Filner, I would like to get back to you about your concerns.  But I want to stress that the issue is prevention.  Arguing about rates isn't the issue.  The issue is—

The CHAIRMAN.  You are the one that is arguing the rates.  Every one of your paragraphs ends with a thing about the rates—every one of them.  You are not talking about prevention here at all.  I read your whole thing, and I couldn't figure out what you were doing to stop suicides, frankly.

Dr. KATZ.  Well, I will tell you, our suicide-prevention activities are based on the principle that decreasing suicide requires both enhancing overall mental healthcare and programs specifically designed to prevent suicide. 

Part of the training for all staff has been to teach that even strong and resilient people can develop mental health conditions.  We also teach, both within our facilities and in the community, that care for these conditions is available and must be provided quickly.  We also teach that treatment works. 

The VA Suicide Prevention Program includes two centers that conduct research and provide technical assistance.  It also includes a suicide-prevention call center and suicide-prevention coordinators located in each of VA's 153 hospitals.  All together, 200 staff members, 200 mental health professionals in VA, have suicide prevention as their major responsibility. 

The Department is partnered with the Lifeline Program of the Substance Abuse and Mental Health Services Administration to develop a suicide hotline for VA as part of the national 1-800-273-TALK system.  Since it began, there have been more than 6,000 calls from veterans, 1,300 referrals to suicide-prevention coordinators, and more than 300 rescues where police or ambulances were called, any one of which may have been life-saving.

The CHAIRMAN.  Any suicides amongst those? 

Dr. KATZ.  In our current follow-up, we haven't seen any.

The CHAIRMAN.  I am sorry? 

Dr. KATZ.  We haven't seen any.

The CHAIRMAN.  You have 6,000 calls and you are giving me all this data of 1,300 referrals, 300 rescues.  But you haven't seen or you don't know if there are any suicides? 

Dr. KATZ.  We are doing follow-up of those who have called, and have been referred to VA facilities and the results from the follow-up will be available soon.

The CHAIRMAN.  These are obvious questions.  I don't know why you don't have them before you come in.  You give us all this data, which is a lot of activity, but I don't know about any results.  I can't tell from your report that we have any results here.  You are giving me a whole bunch of numbers, and usually that is a reason why you don't—

Dr. KATZ.  Mr. Filner, with permission, I could send to you the stories of a number of people who have called the hotline, so you could see the dedication and skill of VA professionals in action. 

The CHAIRMAN.  I am not arguing that at all.  The people who are doing this are wonderful people.  They are dedicated.  They are doing their job. 

We heard testimony that something like 6,000 veterans have committed suicide last year, or 2005, the year that CBS News was doing it.  What about that?  I mean, there is nothing in here that talks about that statistic.  I mean, I don't even care if it is right.  It is somewhere close to the truth.  What about that?  You say you saved 300, but what about the 6,000?

Dr. KATZ.  Mr. Filner, VA has a major suicide-prevention program, the most comprehensive in the Nation.  The numbers, frankly, aren't the issue. 

The CHAIRMAN.  What if it was 3,000?  What if it was 1,000?  What is the difference?

Dr. KATZ.  If the number were 300, we would still be doing everything possible.

The CHAIRMAN.  But you are not referring to why.  Why do those 6,000 exist, with all this work you are doing?  What is the measure of your effectiveness if all these people didn't know the hotline number, they didn't call the hotline—

Dr. KATZ.  Sir, the 6,000 exists because mental illness is a real illness, and mental health conditions can be fatal. 

The CHAIRMAN.  I understand.  But to have credibility for what you are all doing professionally, you have to address these issues, and you are just ignoring them.  You don't have a word in here about that.  I mean, it takes away the sense of credibility that you are trying to raise here that you are doing all this, because we have both anecdotal evidence and now we have more statistical data that we are failing as a Nation.  Not you individually, not anybody who is on a hotline with anybody, but as a Nation we are failing.  And you are acting as if everything is goodness and light in this effort.

Dr. KATZ.  Sir, Patrick Kennedy talked about mental health in America, and he is right.  VA, in suicide prevention, is ahead of the rest of America, as we should be.

The CHAIRMAN.  I will accept that.  What happens to the 6,000 veterans who committed suicide last year, the 6,000 who committed suicide the year before and the 6,000 the year before that?  What is going on with them, if we are so successful? 

Dr. KATZ.  That is why we have the foremost researchers in America working on this problem.  That is why our mental health budget has increased 60 percent since the beginning of the war.

The CHAIRMAN.  I understand, but when you ignore these issues in a report that is supposed to talk about what you are doing, you damage your credibility, you damage whatever we are trying to do.  Because I have to say, you are ignoring the whole problem here with this report.  You are using  activity as a substitute for effectiveness.  Just because all these people are working doesn't mean they are effective.

Again, I don't know.  We have a National Guard, which you are not even discussing here.  We have all the people who are not enrolled in the VA, which we are not discussing here. 

Mr. Bowman is still here.  He made a really interesting suggestion:  Go meet these kids at the bus when they come off.  That is what I want to talk about.  You heard their testimony.  Throw this prepared testimony away and talk to the Bowmans, talk to Ms. Coleman, talk to Ms. Meagher, and say what we are going to do about these issues.  You are not doing that.  I mean, you had the advantage of listening to them.  Respond to them.

You are reading this report, which, you know, had so many questions to begin with, but I still don't know what you are doing for those people, I still don't understand it. 

You have a National Guard parent whose whole unit has never heard anything about how to help address possible suicide.  So what are we doing about that?  If you say, "Well, we are VA; we can't help the National Guard," then say that, and then I will be happy to figure out legislation that says, you know, how you can do that. 

Mr. BUYER.  Sir, can we have regular order and permit the witnesses to testify, please? 

The CHAIRMAN.  If they had regular order about how to write their reports, we would be okay.  I mean, it is not helpful, the way you are doing this. 

You can complete your testimony.

Dr. KATZ.  Mr. Filner, with your permission, could I yield time to Dr. Rosenheck? 

Mr. BUYER.  Dr. Katz, would you finish your statement, please? 

Dr. KATZ.  Sure. 

I was talking about the major programs for suicide prevention that VA is conducting complementing our major expansion of our general mental health programs. 

We have held two VA suicide-prevention awareness days for required education for all employees.  The first focused on enhancing awareness of the issue; the second, training staff on how to work with available prevention resources, including the hotline and coordinators. 

The coordinators get calls and referrals from the suicide hotline, as well as from providers.  They educate their colleagues.  Then

The CHAIRMAN.  Dr. Katz, did you study the well-publicized incidents when Marines or soldiers walked into a VA hospital saying they thought they had this PTSD thing, which they didn't understand, and were having suicidal thoughts?  They were told that there was nobody available, or an appointment would not be available for a month, and they went home and killed themselves.  Have you addressed that in here? 

I mean, you are telling me about in-service training.  That is great.  What happened about that training when these kids came into the hospital and then went out and killed themselves?  Do you address that? 

Dr. KATZ.  In this document, no.  In fact, the VA has—

The CHAIRMAN.  Why not?  Well, you are telling me about in-service training.  There are well-publicized incidents when that either failed or had not occurred yet.  Tell us what happened in those cases.

Dr. KATZ.  I will send you the case reports from the hotline.  They are incredible human stories. 

I also want to talk about policy, how, beginning this summer, we established a policy that any new request or any new referral for a mental health appointment has to have an evaluation within 24 hours to determine the urgency.  If there is an urgent need, care must be provided immediately.  If not, the patient has to be seen within 2 weeks.

The CHAIRMAN.  Did this happen after these incidents?  One in Minnesota, one in Florida, and, I think, there was another State.  And 2 weeks wouldn't have saved them anyway.  I mean, was this in response to that, so it wouldn't happen again? 

Dr. KATZ.  These policy advances were in response to new patients from Iraq and the needs of established veterans.

The CHAIRMAN.  Okay.  I will let you continue, but, look, if you don't deal with these stories and this evidence where we have failed our patients, then your credibility of what you are doing is zero.  It looks like you are just shoving them under the rug, you don't want to talk about them, you don't want to deal with them, and so you avoid them.  Some of us have memories about these things, and some of us have policy issues.  You don't enhance your credibility when you avoid them. 

Finish your testimony, please.

Dr. KATZ.  Well, Mr. Filner, you are being somewhat dismissive of a major public health effort in suicide prevention that VA is doing. 

The CHAIRMAN.  I am not dismissing the effort.  I am dismissing the way you are talking about it, as if everything is goodness and light, we have no problems, everybody is being helped, we saved all these lives.  We just had three hours of testimony that this is not true.  Respond to that.

Dr. KATZ.  I was profoundly affected by what I heard.

The CHAIRMAN.  But you are reading the whole report that you wrote before you heard them, as if they didn't testify.

Dr. KATZ.  My reaction is thank God we are doing what we are doing. I truly believe we are saving lives.

The CHAIRMAN.  I don't disagree with that.  I want to know, what about the lives we are not saving too? 

Dr. KATZ.  They affect all of us.

The CHAIRMAN.  Well, tell us about them.  That is all.  Enhance your credibility by dealing with all of them. 

You may finish.

Dr. KATZ.  I do want to end by mentioning that we applaud Congress for passing the Joshua Omvig Prevention Bill, recently signed by President Bush.  We have implemented essentially all of the provisions of the bill already, and, in fact, we did so before it was passed. 

We continue to do research to develop and implement new strategies to improve our ability to save lives by preventing suicide.  We believe our healthcare system can and must serve as a national model for mental healthcare and suicide prevention now and in the future. 

Thank you.

[The statement of  Dr. Katz appears in the Appendix.]

The CHAIRMAN.  Dr. Zivin? 

OPENING STATEMENT OF KARA ZIVIN, PH.D.

Dr. ZIVIN.  Good afternoon, Mr. Chairman. 

I would like to take this opportunity to express my condolences to all the families who have lost a loved one to suicide. 

I am honored to provide testimony to the Committee about suicide among veterans treated for depression in the VA health system.  I come before this Committee as a mental health services researcher who has conducted research on this topic.  The views and opinions are expressed on my own and do not necessarily represent those of my current employer, the Department of Veteran Affairs, or the views of the VA research community. 

I am here today to report on findings from a study that I conducted, along with my colleagues at the Department of Veterans Affairs, National Serious Mental Illness Treatment Research and Evaluation Center, SMITREC, and the VA's Health Services Research and Development Center of Excellence in Ann Arbor, Michigan, where I am a research investigator, as well as an assistant professor of psychiatry at the University of Michigan Medical School. 

We recently published a paper in the American Journal of Public Health examining suicide rates using data from the VA's National Registry for Depression for 807,694 veterans of all ages diagnosed with depression and treated at any Veteran Affairs facility between 1999 and 2004.  In all, 1,683 veterans in VA depression treatment died by suicide during the studied observation period, representing 0.21 percent of this treatment population. 

When we calculated the overall suicide rate in this population over the 5 1/2-year study period, it was 88.3 per 100,000 person years, which is approximately seven to eight times greater than the suicide rate in the general adult U.S. population. 

A higher suicide rate would be expected among a population of patients in treatment for depression than the general U.S. population, given that depression is a potent risk factor for suicide. 

Because most healthcare systems lack the capability of assessing suicide rates among their treatment populations, there are few points of comparison with nonveteran treatment populations.  However, at least one prior study reports a suicide rate for men receiving depression treatment in managed-care settings between 1992 to 1994 of 118 per 100,000 person years, a suicide rate which is somewhat higher than that observed in this veteran depression treatment population. 

In our study, we observed that the predictors of suicide among veterans in depression treatment differed in several ways from those observed in the general U.S. population.  Typically, people in the general population who die by suicide are older, male and white and have depression and medical or substance abuse issues.  In this study, we, too, found that depressed veterans who had substance abuse problems or psychiatric hospitalization in the year prior to their index depression diagnosis had higher suicide rates. 

However, when we divided the depressed veterans into three age groups—18 to 44 years, 45 to 64 years, and 65 years or older—we found that the younger veterans were at the highest risk for suicide.  Differences in rates among depressed veterans of different age groups were striking:  18- to 44-year-olds completing suicide at a rate of 95 suicides per 100,000 person years, compared with 77.9 per 100,000 person years for the middle-age group and 90.1 per 100,000 person years for the oldest age group. 

We did not assess whether individuals had served in combat during a particular conflict, although the existence of a military service-connected disability was considered.

In this VA treatment population, men veterans were more likely to commit suicide than women veterans.  Suicide rates were 89.5 per 100,000 person years for depressed veteran men and 28.9 per 100,000 person years for veteran women.  However, the differential in rates between men and women in this population of three to one was smaller than that which has been observed in the general population of four to one. 

We found higher suicide rates for white depressed veterans, 95 per 100,000 person years, than for African Americans of 27.1 per 100,000 person years and for veterans of other races, 56.1 per 100,000 person years.  Veterans of Hispanic origin had a lower rate, 46.3 per 100,000 person years, of suicide than those not of Hispanic origin, 86.8 per 100,000 person years.  Adjusted hazard ratios also reflected these differences. 

Surprisingly, our findings revealed a lower suicide rate among depressed veterans who also had a diagnosis of post traumatic stress disorder, PTSD, compared to depressed veterans without this disorder.  Depressed veterans with a concurrent diagnosis of PTSD had a suicide rate of 68.2 per 100,000 person years compared to a rate of 90.7 per 100,000 person years for depressed veterans who did not also have a PTSD diagnosis. 

We investigated further to examine whether specific subgroups of depressed veterans with PTSD had higher or lower suicide risks.  We found that concurrent PTSD was more closely associated with lower suicide rates among older veterans than among younger veterans.  This study does not reveal a reason for this lower suicide rate, but we hypothesize that it might be due to a high level of attention paid to PTSD treatment in the VA system and the greater likelihood that patients with both depression and PTSD will receive psychotherapy and more intensive visits.  In general, individuals with depression and PTSD diagnoses have higher levels of VA mental health services use than individuals with depression without PTSD. 

Interestingly, depressed veterans who did not have a service-connected disability were more likely to complete suicide than those with a service-connected disability.  This may be due to greater access to treatments among service-connected veterans or more stable incomes due to compensation payments. 

We hope that our findings will help inform clinical treatment and policy initiatives to reduce suicide mortality among veterans with depression. 

I thank you for this opportunity to testify and will be pleased to answer any questions that you have.

[The statement of  Ms. Zivin appears in the Appendix.]

The CHAIRMAN.  Mr. Mitchell? 

Mr. MITCHELL.  This question is for Dr. Katz. 

And I have read your testimony.  I didn't hear your testimony, but I read your testimony.  And one of the things I am concerned about is, throughout your testimony, you are talking about those programs you have in place, which is good, and that you are effective for those you have in place.

But what bothers me is, this morning we heard testimony from the parents of Timothy Bowman, whose numbers will not be in your figures.  He committed suicide.  He will not be part of the DoD or the VA's numbers.  And my concern is, unless somebody comes and registers with you, what outreach do you have? 

You know, this is a very serious problem, those who do not register.  All you have are figures of those who came in and registered with the VA.  Even in Arizona, this is a growing concern.  Veteran suicide rates in Arizona have risen 39 percent since 2003, and one-quarter of all suicides in Arizona are with veterans.  This is, I think, an epidemic.

And I know what you are saying with all of those figures that you have there, but my concern is, do you really have enough resources to go after the veterans who do not show up and are not on your figures, the figures either from DoD or the VA?  Because I think it is important that we go out and try to get the correct figures. 

Am I understanding that you have not really collected figures, total figures, on all those returning from Afghanistan or Iraq? 

Dr. KATZ.  Well, I want to begin by—actually it is  very ironic.  We know that Tim Bowman was a person and that his loss is terrible, and, as a Nation, we have to mourn him.  The question is, is he a statistic?  Is he counted in VA research?  And the answer is yes.  Dr. Kang's research counts all veterans, whether or not they have come to VA for care. 

This raises questions about, the people who don't come to VA for care, how are we reaching out to them?  Our Vet Centers have hired over one hundred peer counselors, ex-vets who go out to post-deployment health reassessment, who go to Guard and Reserve meetings, and who speak in community centers and related venues.  There are more than 90 returning veterans outreach teams in our medical centers and clinics.  We really have extensive outreach. 

Is it enough to enroll every veteran?  No.  Is it enough to prevent every suicide?  Apparently not. 

We have, thanks to you, considerable funds.  And our goal, our mission and our challenge is to use these funds effectively.  We really have to go reaching out to people and providing services, where mental healthcare has never gone before.  We have intensive research going on, and VA has, by necessity, become more adept at translating research into clinical and public health action than anyone else.  Are we there yet?  Of course not.  Have you given us enough resources?  Yes.  Our challenge is to use them to improve lives and save lives.

Mr. MITCHELL.  So, Dr. Katz, you are telling me that you have enough resources to do the job that is necessary to find these veterans and to treat these veterans.  You have enough resources.

Dr. KATZ.  Yes, sir.

Mr. MITCHELL.  Thank you.

The CHAIRMAN.  Mr. Buyer? 

Mr. BUYER.  You know, sometimes, Mr. Mitchell, it is not just a matter of resources, it is what are you going to do with them.

Mr. MITCHELL.  Yes.

Mr. BUYER.  When you look back, 3 years ago we gave them $300 million, and they couldn't even spend $100 million of it. 

Dr. KATZ.  Can I comment about that, sir? 

Mr. BUYER.  You may.

Dr. KATZ.  A year ago, the Committee raised concerns that there was underexecution of mental health enhancement funding.  I guess that is bureaucratic talk for under-spending of the resources. 

This past year, there were $306 million allocated for mental health enhancements in VA.  The actual spending was $325 million.  We overspent and, to be honest, we were congratulated by senior leadership for overspending, because nothing is more important than mental health.

Mr. BUYER.  I hate to get into the numbers and statistics, but I am going to do that for just a second, because, really, it is all sort of disturbing to me. 

I look at the Inspector General's (IG) report, and the IG says, all right, out of the 25 million veterans in the United States, they estimate as many as around 5,000 veterans per year are turning to suicide, of the 25 million.  Then CBS News, they throw out a number of 6,256 in 2005.  I mean, since this report came out, I mean, there is a difference of 1,200.  That is still a big number to me. 

But I am curious, do you know how CBS News came up with that number if the IG or the VA comes up with a different number?  Are you familiar with how they—has CBS News shared with you the methodology of how they came up with their number? 

Dr. KATZ.  They shared their algebra but not their raw data.  We want the numbers.  It could help to guide and fine tune our prevention efforts.  They handed me the numbers when I was interviewed, and then they took it back.  We requested it from the producers.  The Inspector General requested it from the producers.  They are not forthcoming about the numbers.  I would think that, as a matter of citizenship, CBS News should be required to provide these numbers, so VA can translate them into prevention.

Mr. BUYER.  Well, the numbers are important in how we get to them. 

Let me ask Dr. Zivin, is it important for us to understand the gender distribution in these numbers? 

Dr. ZIVIN.  The gender distribution, was that your question, sir? 

Mr. BUYER.  Yes.  Is that important for us to know as policymakers.

Dr. ZIVIN.  It is important for us to know all characteristics associated with suicide and how those may be similar or different in the VA or among all veterans than the general population.  And that is something we are studying.  We have both VA- and NIH-funded research to examine all characteristics associated with suicide.

Mr. BUYER.  Have you seen the CBS News report? 

Dr. ZIVIN.  I have seen it, yes, sir.

Mr. BUYER.  And what is your opinion regarding the fact that gender distribution would have been left out of their numbers?  What does that tell you? 

Dr. ZIVIN.  Sir, I would like to ask the members of this panel if they would like to comment on this, or perhaps we could get back to you about this.

Mr. BUYER.  Well, if anyone here on the panel has an opinion on it, please let us know.  Because I think it is rather bothersome that they would leave out gender distribution.  Does anyone have an opinion with regard to that? 

Dr. KATZ.  They controlled for gender but did so in a very strange way.  Their number for veteran suicides is not, in fact, an accurate reflection of the rates of suicide. 

Dr. Rosenheck, you wanted to comment?

Dr. ROSENHECK.  Well, actually, I wanted to shift gears a little bit.

Mr. BUYER.  No. 

Dr. ROSENHECK.  Okay.

Mr. BUYER.  I get to shift gears.

Dr. ROSENHECK.  In direct response, none of us feel we have seen a complete report of this data so that we, as professors, can judge the validity of the conclusions.

Mr. BUYER.  All right.  I am not going to challenge the intent of CBS News, because I am hopeful that their intent and motivation was pure.  And if it was pure, they have nothing to hide and should be willing to work with you, with regard to the numbers. 

Let me ask this question.  The Canadian Government uses the term "operational stress injury"—they don't use PTSD to describe their diagnosis.  Would that be useful and helpful to us, if we would turn to "operational stress injury" so we can maintain PTSD but come up with another type of description whereby it encourages soldiers and veterans to come in to discuss this without stigma?  Do you have an opinion with regard to that? 

Dr. KATZ.  Well, I think we heard from the world's experts about what we call it.  And in terms of what it is called and how people react to that, the world's experts are the consumers and the families.  If they want to change the name, we should change the name.

Mr. BUYER.  Mr. Chairman, with latitude, I have one last question. 

One of the concerns is being able to provide mental health services to members of the National Guard and the Reserve components when they return from their overseas deployments.  In Indiana, on January 2nd, I will stand with the 76th Brigade.  We are going to send an entire brigade to war.  Not since World War II. 

So what outreach programs do you, the VA, have in place for the National Guard and the Reserve? 

Dr. KATZ.  There are peer counselors from the Vet Centers who should be there, as should returning veterans outreach people from our medical centers and clinics.

Mr. BUYER.  How do we prepare the families while the soldiers are gone?  What do we do that is proactive? 

I think that is what the Chairman—my interpretation is, what are you doing on the prevention side?  Let's not just wait until they come home.  What are we doing to help prepare the families?

We do a lot with the families, not only their care packages, and they have their own support groups.  But what do we do, in being off our heels and on our toes, to be proactive on what they should look for?  What should they be doing to be helpful to them while they are deployed?  Are we doing anything? 

Dr. KATZ.  Vet Centers are authorized to provide outreach and education for families under specified circumstances while the veteran is deployed.  VA is not authorized by law to do so.

Mr. BUYER.  Under specified circumstance.  That is telling me that is some sort of limited service.

Dr. KATZ.  I am actually confessing my personal lack of knowledge about the specifics.  I am embarrassed.  I apologize for it.  We will have to get back to you.

Mr. BUYER.  I understand that these men and women are activated so now they are part of DoD.

Dr. KATZ.  Yes.

Mr. BUYER.  But we deal with the consequences of war, the consequences.  And it is easy to take care of them when we see the physical wound, so it is the mental wound that is our challenge. 

So this leads to the whole path of how we work cooperatively with DoD in trying to get bi-directional, on-time, real-time mental health data.  That is a real challenge. 

But here is what I want to do.  I want to do this with you.  We now know we have a brigade that is going.  I am going to work with you.  I want you to work with myself and the Chairman of this Committee, as we also work with DoD, and you tell us what we can do that is proactive with regard to this brigade as it goes, and what authorities do you need, what do you need from us.  You probably don't need much authority.  A lot of things you can do.  But tell me what you can't do, and we can break down these barriers. 

Will you take that on with us? 

Dr. KATZ.  Absolutely, with pleasure and with honor.

Mr. BUYER.  All right.  Thank you. 

I yield back.

The CHAIRMAN.  And I give the same answer, with pleasure and with honor.

Mr. BUYER.  All right.  Thank you.

The CHAIRMAN.  Let me just say a few words. 

Mr. Buyer mentioned that CBS News had 6,000 and IG had 5,000.  That is a big difference.  Both of those are a big difference, from what I see in this.  It is a different universe, Iraqi and Afghanistan, since 2005—144.  I mean, this is a purposeful putting forth the lowest figure that you could possibly get to.

Dr. KATZ.  No, sir.  Those are the full count of suicides in returning veterans.

The CHAIRMAN.  But you chose a universe on purpose that never would touch—how about 5,000 or 6,000?  That would get people annoyed.  144?  Oh, I can live with that.  You are giving numbers here that do not reflect reality in terms of the problem that we have to face and you have to face as policymakers. 

And, frankly, your statement, Dr. Katz, that "CBS News should be required to give the statistics"—

Dr. KATZ.  Yes.

The CHAIRMAN. —that is disgraceful from an organization, that they have to FOIA, we have to FOIA, a parent has to FOIA, to get any information on this. 

I have, from this chair to that seat—and maybe you were one who was there, I can't recall now—at least three or four different times in the last 7 or 8 months, asked for data on suicides from the VA.  They always said they will get back to me.  They have never gotten back to me.  You try to get data, you get all kinds of different numbers from different universes. 

And besides, the data you use, as we have heard this morning, is all slanted anyway.  I mean, it is a very specific definition of a suicide that you are using that is way underreported from the reality. 

CBS News tried to get the data.  They didn't want to spend 6 months going to States and do this thing.  They couldn't get the data from you because you don't track this stuff.  You simply don't track it.  You don't want to know about it.

And I had a whole report from Dr. Zivin, who—I never, by the way, ever heard somebody on the panel say they are not speaking for the Department of Veteran Affairs when you are here.  I mean, they must have approved this, but you are not speaking for them.  I don't know, that is strange. 

But you give four or five pages of data.  I don't see anybody on this panel, in prepared testimony, say what you are going to do.  How does this inform your treatment?  What prevention are you doing to do based on this? 

This is a bunch of numbers that is meaningless in the context that we are working in today.  That is, you had time to give this data to somebody to say, "What are we doing about using this data for actual clinical or preventive operations?"  And there is nothing.  It is just a case of – of "analysis paralysis."  It is just a bunch of statistics that you are going to throw out to us here and say that you have done your duty.  You guys have not done your duty.  You have not given us adequate numbers or even an explanation of the problem in getting those numbers. 

We haven't talked about, if there are 5,000 or 6,000 or 2,000 veterans that are dying every year, how are we going to get to them?  You tell me what you are doing, but you are not telling me about the evidence that we have that we are not being effective.  How are you dealing with that?  You have not done the job. 

We are going to have another hearing on this. 

[Applause.]

And I want you to come back with a better report.  This is not very useful.  Again, all you do is compare some things in a strange universe that does not come to grips with the issue. 

Dr. KATZ.  Mr. Filner? 

The CHAIRMAN.  Mr. and Mrs. Bowman this morning, and the other testimony, were crying out for help.  I responded to say, here is what I am thinking about to respond.  I don't know if it is good or bad.  I said we have to have a public education program.  I said we have to have mandatory diagnosis of PTSD and brain injury.  I said we have to do that in a unit with family there. 

You didn't come up with anything.  You didn't even respond to my meager suggestions.

Dr. KATZ.  Mr. Filner, I really need to respond to one specific issue.

The CHAIRMAN.  Respond to them all.  I don't care.

Dr. KATZ.  Well, we can provide additional numbers.

The CHAIRMAN.  You always say that, and we never get anything.

Dr. KATZ.  We can provide additional—

The CHAIRMAN.  I have done this for at least several years.

Dr. KATZ.  You are delivering the message to America that there are major problems in VA treatment.  I want to deliver the message that care is available and that treatment works.  We have programs in place that can help people.

The CHAIRMAN.  How would you have helped Timothy Bowman or the Timothy Bowman that is coming tomorrow?  Nobody has talked to them, nobody has done anything, nobody has counseled them, nobody made Timothy aware of anything, and nobody is making the Timothys of tomorrow aware.  So how are you responding to their cry for help? 

Dr. KATZ.  It is tragic that

The CHAIRMAN.  But what are you doing about it? 

Dr. KATZ.  We are doing the—

The CHAIRMAN.  But it didn't reach these people.

Dr. KATZ.  That is tragic.

The CHAIRMAN.  Well, then find a more effective way.  Don't keep telling us you are doing things when they are not effective.  It is proven not effective.  You reach a very small percentage of those who need help.  Why? 

Dr. KATZ.  Sir, I really think we want to emphasize the message that treatment is available and treatment works.  Because that message is a matter of public health, and that message can be life-saving. 

The CHAIRMAN.  Well, let me tell you the message that I want to send, that we have an epidemic, as has been said before, we have a public health crisis.  And no matter how hard you are working now, we are not doing the job.  We need to do more. 

And you need to tell us, rather than how much stuff you are doing, what we need to do to be effective.  You answered Mr. Mitchell that you had sufficient resources.  You don't have anybody to call up Mr. Bowman to even offer condolences, let alone help his counseling.  So, I mean, surely some more resources would be nice. 

Mr. Mitchell, you have a question?

Mr. MITCHELL.  Yes.  I would like to follow up on that with Dr. Zivin. 

According to your testimony, your study was based on veterans who had been diagnosed with depression and were treated at VA hospitals or VA facilities. 

What I would like to know is, what about veterans who don't fall in either of these categories?  What about the veterans who have not been diagnosed with depression or who have not been treated at VA facilities?  What about the veterans who are suffering from post traumatic stress disorder or haven't visited a VA facility? 

Could you shed any light on the scope of the problem facing these and other categories of veterans? 

Dr. ZIVIN.  It is true that we focus in this study specifically on depressed veterans treated in the VA population, and that represents only a fraction of all veterans who either have depression or PTSD or both.  And one of the things that we are doing as part of our ongoing research and what Dr. Katz was just alluding to is that we are now collecting and having data on all veterans, with or without depression, and rates of suicide. 

One of the other things to mention is that the VA has developed a comprehensive strategic plan which is specifically focused on treatment for PTSD, suicide prevention and a number of other initiatives specifically targeting at-risk veterans. 

And I will ask my colleagues here to comment further, if you have other questions.

Mr. MITCHELL.  Just one comment to add to that.  There are some people who come back who don't believe that they have a problem, and therefore, they don't register.  Maybe they don't fill out the forms or tests that I understand are necessary, yet they have it.  Is there any outreach? 

I understand, Dr. Katz, you said you have programs, but there are only programs if somebody comes in.  What about the people who have not been diagnosed yet who end up with this disorder months, maybe years, later?  What about those who have not registered with the VA? 

What kind of programs do you have in place, not just to reach those who have registered and who have been diagnosed, what kind of programs do you have in place to go beyond that? 

Dr. KATZ.  We are in agreement that a major challenge for us is reaching more people.  We have talked about what we do for those who enter our doors, either the Vet Centers or medical centers and clinics.  We have talked about the outreach that we are doing.  How do we effectively reach the rest of the community? 

Dr. Kussman is writing a letter that should go out this week or next to all veterans, raising these issues.  Other strategies are being developed including additional follow-up to the post-deployment health reassessment.  We recognize the need to do more to reach more people, yet we are working intensively—and we are working intensively on how to do it. 

Dr. Rosenheck reminded me of a fact from Dr. Han Kang's work that makes this issue very poignant.  Among returning veterans, among OIF/OEF veterans, the rates of suicide among those who come to us don't differ from the age-, sex- and race-matched individuals, but the rates of suicide among those who don't come to us are higher.  It is reassuring about what we are doing and a clear message about what we should be doing next.

Mr. MITCHELL.  Absolutely. 

And one last question, real quickly.  Do you believe that there is a suicide epidemic? 

Dr. KATZ.  There is a suicide epidemic in America.

Mr. MITCHELL.  Among veterans? 

Dr. KATZ.  The numbers—what are the numbers?  About 18 veterans kill themselves each day in America.  That is too many.  About four or five—

Mr. MITCHELL.  According to CBS News, it was 120 a week.

Dr. KATZ.  About the same.

Mr. MITCHELL.  That is not higher than the general population? 

Dr. KATZ.  Rates among veterans are somewhat higher than the general population because of demographics and increased in risk factors for depression, related conditions.

Mr. MITCHELL.  I think one way we can find out about that is if you have the data.  And I think that is—you know, one of the people were arguing about earlier was the methodology data that CBS News had.  And if we had the data, we could certainly refute or agree that there is or is not an epidemic and it is more so among veterans.  I think that is what we have been trying to find out.

Dr. KATZ.  Some of the Nation's foremost investigators in this area are before you. 

Dr. Blow, could you talk about some of the data? 

Dr. BLOW.  Sure.  Among veterans receiving services in VHA, so those actually touching the VHA, the rates are about 1 1/2 times age- and sex-adjusted population rates.  The rates for women are about two times that of that U.S. population overall rates for women.  So it is much higher for women than for men.

Mr. MITCHELL.  Again, these are people in your system.

Dr. BLOW.  That is exactly right, the 5.5 million veterans who actually we serve. 

Mr. MITCHELL.  We already heard about someone not in the system.  That is the purpose of what we are trying to find, people who are not in the system being treated.

The CHAIRMAN.  Mr. Mitchell, this room has been reserved for another committee, so we have to adjourn this. 

I have one last—you have a last statement.

Mr. BUYER.  Dr. Katz, I want you to go back from here and talk with your chief and your team, and I want you to be ahead of us.  Work with your counterpart in DoD between their Battlemind Training initiative that they have, along with your initiatives, and we will use that brigade as a cohort.  And we are going to circle back here next week, okay?  But get ahead of us.  All right.

Dr. KATZ.  Thank you.

The CHAIRMAN.  Thank you, Mr. Buyer. 

And let me again—I mean, I am very disappointed with the testimony.  When Mr. Mitchell gave you a chance just to talk about outreach, you said that the Deputy Secretary is writing a letter.  That doesn't do it. 

Look, I will just comment on one thing.  We know, we absolutely know as a fact—I don't care what any researcher tells methat the images of war in Iraq trigger PTSD reactions in people from earlier wars.  I could figure out a hundred ways for you to go out to those people now.  Just take the Vietnam vets.  Go out, find them and say, "We are going to help you." 

You have all this great stuff you are telling me about.  We know Iraq is going to trigger this from Vietnam vets.  Go find them.  Go to the Vet Centers, go to the Vietnam Veterans of America, go to the VSOs who are here.  Go to the major cities.  Set up a place where you can screen people more.  Go out to communities. 

You are doing this research which doesn't tell us anything, and you are not reaching the people who need the help.  We said it many times this morning.  We have an obligation.  You are not meeting that obligation.  You are doing stuff and you are spending a lot of money and you have all these professors, but we are not meeting the needs.  And until we do that, we are not going to be satisfied here. 

We are going to take this up early next year.  We will continue the hearing we started today.  But we are going to talk to the new Secretary, General Peake, and let him know how disappointed we are in this, and hopefully we can move to do our veterans a greater service.  We are not doing the job now. 

Mr. Kennedy? 

Mr. KENNEDY.  I would just like to ask that you apply the bottom line to the families of veterans so that they can better identify these symptoms amongst their own family members.  Right now they are not given the tools, so to speak, of being able to act as the identifier and supporter of their own loved one when they come home. 

Am I right? 

Dr. KATZ.  You are right.  Vet Centers, as well as DoD, can begin on it.  For medical center and clinic staff to do that would take an act of Congress.

Mr. KENNEDY.  But family members are the ones who spend the most time with their loved one.  They ought to be brought in and made a better and bigger part of this whole process.

Dr. KATZ.  Absolutely.

The CHAIRMAN.  And acts of Congress is what we do, so just tell us what we need to do.

Mr. BUYER.  Mr. Kennedy, that is exactly what we are going to try to do.

Mr. KENNEDY.  And finally are we tracking—as you said, women are twice as likely to have suicide rates within the VA as men.  Are we tracking women veterans within the VA separately from men and their issues, because I understand they have very specific and unique issues as to men veterans when they are in the VA system. 

Are we doing—

Dr. BLOW.  There are many initiatives in the VA to enhance services for women veterans with their special needs and especially with the special needs that they encounter because of their combat exposure. 

Mr. KENNEDY.  Yes, but are we tracking their women-specific issues, around their specific issues, mental health needs, issues? 

Dr. BLOW.  Yes, absolutely.  We have many different women’s mental health initiatives trying to find out what happens to them over time, and we try to address their specific needs in treatment. 

Dr. KATZ.  A minor correction.  The twofold is women in the VA relative to women in the general population.  It is still a lower rate than men. 

Dr. Rosenheck?

Dr. ROSENHECK.  I did want to talk to the Bowmans because I am the son of a veteran who committed suicide, and I have been now in the VA and have been a psychiatrist and have been a professor of psychiatry and epidemiology for almost 40 years, and my work is animated every day by the fact that my father was a veteran who had committed suicide.  I want to tell you that my colleagues in the VA come to this work with a personal sense of mission.  All of us, many of us—more than in any other group—are veterans, and more than any other group, we know and have been touched by mental illness and by all kinds of illness.  People do not come to the VA as a simple, professional job.  People who work in the VA are driven by a sense of mission and of caring, and I want to say, in shifting back to my capacity as program evaluator and as a scholarwell, I am staying with the personal—I started with the VA in 1973.  I was a first-year resident at the VA in Connecticut, and I was seeing veterans coming back from Vietnam.  I have worked at the VA for my whole career since then, and the change from 1973 to now is so astonishing.  When I was a first-year resident, I had no language.  I had no culture.  I had no background to understand the young men who were coming and sitting in front of me right off the battlefield.  We had no terms. 

Now, whether you talk about PTSD or PTSI, we have a language, and the whole country knows it.  I get called by reporters, "Can you get PTSD from watching the war on TV?"  Everybody knows about this syndrome, and they know about it because of the gift of the Vietnam veterans.  Every year, we are seeing more and more—I have been tracking it for 10 years, and the progress we are making in terms of the numbers of veterans we are seeing is astonishing, and the commitment of the organization from the bottom to the top to serving veterans who served in combat, I can just—

The CHAIRMAN.  We thank you for that.

Mr. KENNEDY.  I understand that we do not on the women's side—

The CHAIRMAN.  Mr. Kennedy, we have to end this. 

Mr. KENNEDY.  We are not tracking women-specific issues from the general veterans' population, and I hope that we do a better job of doing that.

The CHAIRMAN.  Let me just say in conclusion, Dr. Katz and your colleagues, nobody is disputing your personal commitment or your effectiveness in dealing with veterans.  What we are saying is how much of a—possibility exists in this country to deal with these issues.  That is the great disappointment to me.  We have the ability to do the job for everybody.  Although we have made progress and we have all of these dedicated people, we have not done the job.  And until we do the job, we are going to keep up the oversight that we have to do. 

This hearing is adjourned. 

[Whereupon, at 2:35 p.m., the Committee was adjourned.]


APPENDIX

Prepared Opening Statements:

Prepared statement of Hon. Bob Filner, Chairman, and a Representative in Congress from the State of California
Prepared statement of Hon. Stephanie Herseth Sandlin, a Representative in Congress from the State of South Dakota
Prepared statement of Hon. Harry E. Mitchell,  a Representative in Congress from the State of Arizona
Prepared statement of Hon. Cliff Stearns, a Representative in Congress from the State of Florida


Prepared Witness Statements:

Prepared statement of Mike and Kim Bowman, Forreston, IL
Prepared statement of Penny Coleman, Rosendale, NY, Author, Flashback: Posttraumatic Stress Disorder, Suicide, And the Lessons of War
Prepared statement of Ilona Meagher,  Caledonia, IL, Author, Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops
Prepared statement of Ira Katz, M.D., Ph.D., Deputy Chief Patient Care Services Officer for Mental Health, Veterans Health Administration, U.S. Department of Veterans Affairs
Prepared statement of Kara Zivin, Ph.D., Research Health Scientist, Health Services Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs


Submissions for the Record:

Prepared statement of Michael Shepherd, M.D., Physician, Office of Healthcare Inspections, Office of Inspector General, U.S. Department of Veterans Affairs
Prepared statement of Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, American Legion
Prepared statement of Joy J. Ilem, Assistant National Legislative Director, Disabled American Veterans
Prepared statement of Todd Bowers, Director of Government Relations, Iraq and Afghanistan Veterans of America
Prepared statement of National Coalition for Homeless Veterans
Prepared statement of Richard F. Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America


Material Submitted for the Record:

Additional hearing material:

Hon. Michael J. Kussman, M.D., M.S. MACP, Under Secretary for Health, U.S. Department of Veterans Affairs, sample of letter sent to veterans, informing veterans of the National Suicide Prevention toll-free hotline number, 1-800-273-TALK (8255), and pocket-sized card with VA Suicide Crisis Hotline phone number/information, as well as a Crisis Response Plan

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

Post Hearing Questions and Responses for the Record:

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. Gordon H. Mansfield, Acting Secretary, U.S. Department of Veterans Affairs, letter dated December 14, 2007, and VA responses.

Hon. Harry E. Mitchell, Member of Congress, U.S. House of Representatives, to Hon. James Peake, M.D., Secretary, U.S. Department of Veterans Affairs, letter dated February 8, 2008, and response letter dated February 27, 2008, following up to request additional information not supplied in earlier VA responses to questions for the record.

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to John D. Daigh, Jr., M.D., CPA, Assistant Inspector General, Office of healthcare Inspections, U.S. Department of Veterans Affairs, letter dated December 14, 2007, and response letter dated January 24, 2007.

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, letter dated December 21, 2007,  and response letter dated February 5, 2008, requesting additional data on suicide rates among veterans.

Hon. Bob Filner, Chairman, and Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Rick Kaplan, Executive Producer, CBS Evening News With Katie Couric, letter dated December 21, 2007, and response letter dated May 16, 2008, from Linda Mason, Senior Vice President, Standards and Special Projects, CBS News.