Statement of Jacqueline Maffucci, Ph.D.
Research Director, Iraq and Afghanistan Veterans of America
House Committee on Veterans’ Affairs
May 12, 2016
Chairman Miller, Ranking Member Brown and Distinguished Members of the Committee:
On behalf of Iraq and Afghanistan Veterans of America (IAVA) and our more than 425,000 members, thank you for the opportunity to share our views on the Department of Veterans’ Affairs efforts to reduce suicide among veterans.
In 2014, IAVA launched the Campaign to Combat Suicide. This was a result of our members continually identifying mental health and suicide as the number one issue facing post-9/11 veterans in our annual membership survey. This campaign centers around the principle that timely access to high quality mental health care is critical in the fight to combat veteran suicides.
The signing of the Clay Hunt SAV Act into law was an important first step to addressing this. We thank you for your support of this legislation, the VA for their commitment to fully implement this law and Richard and Susan Selke for courageously uniting us all to do the right thing. We knew it would take time to do so correctly and we’ve been pleased that the VA’s Mental Health Service team has included us in that process. While progress has seemingly been slow, we expected that this first year would be spent laying the foundation to implement the law and identifying funds to do so. We look forward to continuing to be a part of the implementation while working with the VA and Congress to continue working towards progress on this issue with new initiatives.
I’d like to focus today on four specific areas that IAVA feels are critical to this progress: Access to Care; Interdisciplinary Approach to Care; Research; and Supporting Those Most at Risk.
Access to High Quality Mental Health Care
IAVA’s Rapid Response Referral Program connects veterans and their family members to quality resources. Mental health and suicide challenges are among the top three issues our team is responding to.
In our most recent annual membership survey, over half of the respondents reported having a mental health injury and over 80 percent reported seeking care for that injury. For over 75 percent, the impact of a loved one suggesting they seek help made a huge difference and resulted in them finding that help. For IAVA this is a good news story. More of our members are seeking help, and the role of family and friends taking that first step is huge.
For those in care, three out of four are using the VA. And this year, we saw over 75 percent of those using VA mental health report little to no challenges scheduling an appointment, up 10 percent compared to last year and comparable with those using a non-VA clinician. The same number were also satisfied with that care.
The challenge associated with growing awareness of service-related mental health challenges and this improved care is an increase in demand for high quality mental health care rising both in- and outside of the VA. It is critical to ensure that the VA is properly resourced to provide high quality mental health care; a challenge made even more difficult by the dwindling supply of mental health professionals.
Efforts are underway to bolster the number of mental health professionals. The Secretary is carrying out the ever important task of recruiting medical students into the VA. Joining Forces has been critical in urging medical schools to improve curricula to ensure that that these students are better equipped to care for veterans and their families. But that’s not enough.
Beyond the challenge of a clinician shortage is the difficult task of hiring and retaining talent in VA. A recent VA OIG report that looked at hiring and loss rates of VA psychologists found that a significant percentage of the total gains from hiring was offset by losses. The VA needs to fully understand and address the reasons that staff leave and how to best attract and retain new talent. They need to do so with the knowledge of where the demand is for those professionals using updated models and real time data.
The federal hiring process can also be confusing and lengthy, which can deter candidates. And the VA itself, particularly in today’s climate, can be a challenging place to work. We often forget to praise the talented and dedicated staff who sacrifice in service of the VA’s mission, some of whom are IAVA members themselves. IAVA members have shared stories with me of the great work and dedication of these staff, telling me how these individuals have saved their lives or cared for them in some of their hardest moments. We all must do our part to help celebrate what makes the VA good while also focusing on how to make it better.
Finally, we need to ensure high quality care outside the VA as well. Just under 40 percent of the total veteran population seek care at the VA, which means the current community clinical workforce needs to be equipped to support veterans and their families. A recent RAND report estimates that only eight percent of community mental health providers are prepared to address the mental health needs of this population. It is not even standard practice to ask if a patient is has served in the military. This has got to change. New Hampshire is leading the way with its campaign, “Ask the Question.” But beyond asking the question, providers need to know how best to provide treatment once they have the answer. The VA and its partners (particularly its academic partners) are best equipped to lead this effort.
Interdisciplinary Approach to Care
But suicide prevention is not just about mental health care. In February, the VA hosted a Suicide Prevention Summit, and IAVA and Vietnam Veterans of America were both invited to speak. Together, we called upon the Secretary to elevate the VA’s Suicide Prevention Office from Clinical Operations under Mental Health Services in VHA to the Office of the Secretary, at the same level that DOD places the office in its structure. Our reasoning is simple: while mental health is a major aspect of suicide prevention, it is not the only aspect. There are social factors that can also impact these actions, factors such as employment, finances and social supports. This is why IAVA has been so focused on employment initiatives, defending the new GI bill and creating a network of support among our members.
Many of us have heard the tragic stories of Clay Hunt, Daniel Somers and other veterans who have died by suicide. Often these stories highlight not just the mental health challenges, but the challenges these individuals faced seeking care and obtaining VA benefits. The Suicide Prevention Office has to exist at a higher level, where it could impact both VHA and VBA. We are pleased that the Secretary has answered our call. We ask Congress to ensure that this office is fully resourced through a line-item on the budget so that it can be certain of its funding to carry out the critical mission with which it is tasked.
The Need for Research
We simply don’t know enough, yet, about suicide within the veteran population. We know that suicide impacts seniors disproportionately, but we don’t know why. We know that the women have a high rate of suicide, but don’t understand how best to intervene. We know that the post-9/11 generation is showing an increased risk, but are just starting to understand the risk factors that can really help us impact interventions. More research is critical to developing interventions. We cannot solve what we don’t understand.
IAVA, and anyone serious about understanding the current state of veteran suicide, are frustrated that the Joint Suicide Data repository has not been fully utilized. That data can be critical in understanding and preventing suicide and there is no reason to not share it with the researchers and scientists outside the VA who can bring additional resources to analyzing it. Similarly, we want to see the VA’s Coming Home study finally launched. Data from this study will help us to understand the transition home and define what is unique to military service from a health outcomes perspective.
A greater understanding of the unique challenges facing subgroups of vets is why IAVA supports the House-passed Female Veterans Suicide Prevention Act (H.R. 2915/S. 2487). This legislation will be critical in identifying the mental health and suicide prevention programs and services that work for women veterans. We have called on the Senate to take immediate action on the bill.
Supporting Those Most at Risk
Finally, as a community we must provide care for those most at risk. Veterans with bad paper have a higher risk of suicide and homelessness and yet often do not have access to care. A recent report estimated there are 125,000 post-9/11 veterans with bad paper. It is likely that for some, their discharge status was a result of symptoms experienced from an undiagnosed mental health injury. The current system does not make it easy to identify these individuals and get them into care. This must change. IAVA urges passage of the Fairness for Veterans Act (S.1567/H.R.4683) as part of the solution, but we also recognize that there must be a broader solution identified through a collaborative effort between the VSO/MSO community, Congress, DoD, and VA. Suicide prevention efforts are most effective when we can identify an at risk population and provide targeted solutions to support this population. We’ve identified one of these populations and we know what they need. It’s negligent not to take action.
In some cases, the answer might lie within the Vet Centers. This resource continues to be highly praised among IAVA’s member population. We recommend a comprehensive assessment of the role the Vet Centers play in supporting veteran and family mental health. This is a critical resource and fills a specific need, particularly for veterans who may less inclined to seek services at the VA health centers, are seeking care with their family or are not eligible for VA care. We want to ensure that it is being fully utilized.
All veterans deserve the very best our nation can offer. We look forward working with you and the Administration to address these very real challenges with informed solutions.