Veteran Suicide Prevention: Innovative Research and Expanded Public Health Efforts

Statement of

Tammy Barlet, Deputy Director
National Legislative Service
Veterans of Foreign Wars of the United States

Before the

United States House Of Representatives
Committee on Veterans’ Affairs

With Respect to 
“Veteran Suicide Prevention:

Innovative Research and Expanded Public Health Efforts”

Washington, D.C.  

Chairman Takano, Ranking Member Bost, and members of the committee, on behalf of the men and women of the Veterans of Foreign Wars of the United States (VFW) and its Auxiliary, thank you for the opportunity to present how the VFW is spreading awareness for suicide prevention.

Veteran suicide prevention requires a multi-faceted approach. An upstream perspective can examine root causes and support protective factors before mental health reaches a breaking point. This social-ecological model brings together the individuals, family and friends, and communities to create connectedness, strengthen life and coping skills, empower a purpose, and address social determinants of health to improve outcomes and reduce the risk of suicide.

VFW Programs, Outreach, and Service

One of the VFW’s most prominent resolutions is to end veteran suicide. The VFW has used multiple programs and outreach opportunities to engage our membership and communities in suicide prevention awareness including Give an Hour’s Campaign to Change Direction, Accessing Telehealth through Local Area Stations (ATLAS), Green Alert system, #StillServing campaign, health surveys, VFW Unmet Needs, and donations from VFW Posts for suicide prevention innovation.

The VFW collaborates with Give an Hour, a national network of mental health professionals that provides free mental health counseling for veterans and their families. This past May, VFW Past National Commander-in-Chief Hal Roesch was a panelist on Give an Hour's "Collective Impact: Communities Collaborating to Improve Mental Health" webinar to discuss military and veteran culture and mental health. Give an Hour's Campaign to Change Direction provides information such as the Five Signs of Emotional Suffering, which empowers people to recognize the signs and guides them to reach out for help. The VFW assisted in this outreach by distributing  awareness cards, educating veteran service officers, highlighting in the VFW Magazine, and on the VFW's website. More than 200 VFW Posts and 13,000 volunteers reached 25,000 people through the inaugural event.

Connectivity remains a critical issue for rural and underserved veterans and their mental health care providers. Department of Veterans Affairs (VA) health care professionals are able to practice across state lines utilizing telehealth as a result of the VA MISSION Act of 2018. For many veterans in rural and urban settings, access to strong broadband technology remains an issue. Through ATLAS, the VFW has worked with VA and Philips to leverage VA's anywhere-to-anywhere authority to expand telehealth options for veterans. More than 20 VFW Posts have been identified as possible ATLAS locations. VFW Posts in Eureka, Linesville, Los Banos, Athens, and Gowanda are currently operational, bridging that gap between veterans and their VA health care providers.

Several VFW state departments led the charge to create a veteran alert system. Like the Amber and Silver Alerts, the Green Alert system notifies the public through billboards or text messages of missing at-risk veterans, and active duty, National Guard or Reserve members. In 2018, the VFW Department of Wisconsin was on hand in the governor's office to witness the signing into law of SB 473, Corey Adams Searchlight Act. Wisconsin Act 175 is the law that created the Green Alert system. The inspiration for Act 175 was from the disappearance and death of U.S. Air Force Reserve Sergeant Corey Adams, who suffered from PTSD. Currently, Wisconsin, New Hampshire, and Iowa all use the Green Alert system. Since the implementation of the Green Alert system in Wisconsin, two dozen alerts have been issued; all but two veterans have been found and returned safely. That is a 92 percent success rate in that state. The VFW urges Congress to pass H.R. 2797, National Green Alert Act of 2021, to establish a commission to recommend Green Alert implementation in all the remaining states.

The new generation of VFW members are moving forward with the century-long foundation of service. In February 2020, the VFW launched the #StillServing campaign to spread the word, bring attention, and honor veterans continuing their commitment and sacrifice. Since then, the website has had nearly 1.7 million people engaged with the campaign, 813 personal stories shared, 26,421 requested #StillServing decals, and 2,623 shared web content on social media.

Stories shared on the #StillServing campaign bring hope to inspire others to do the same. An Army Combat Engineer, Scott Hyder, founded Hidden Battles, which is an activity-based, non-profit organization in Massachusetts and New Hampshire that connects with veterans and first responders to improve mental health and raise suicide prevention awareness. In 2019, Hidden Battles hosted 52 events, including meditation, equine therapy, rucking, yoga, and family movie nights at no cost to the veterans, first responders, and their families. In 2018, two members from VFW Post 3103 in Fredericksburg, Virginia, Army veterans Steve Hotz and Dave Seitz, opened Black Horse Forge, which uses blacksmithing as a unique way for veterans and first responders to work through mental health concerns.

Whether it was in response to a worldwide pandemic or a natural disaster, VFW Posts were still serving their communities by opening contactless drive-thru food pantries, doing buddy checks, using technology to connect, or rallying with other veteran organizations for a common cause. In partnership with Comeback Yoga, VFW Post 1 in Denver, Colorado, known for its in-person yoga sessions, continued in a virtual format. VFW Post 4641 in Dickson, Tennessee, became the physical footprint in the community to assist Team Rubicon with donations following floodwaters at the end of August 2021.

As the world watched the U.S. troops withdraw from Afghanistan, the collapse of the Afghan government, and the return of Taliban rule, some veterans questioned the worth of the work they had done during deployments. Several VFW Posts channeled their energy and took action to check in with each other and find ways to help those who helped them in the past. VFW Post 2702 in Huntsville, Alabama, holds group support meetings every Tuesday to talk openly, share space, and actively listen to each other.

Engaging in something bigger than oneself builds a sense of purpose. VFW Post 9274 in Falls Church, Virginia, collected over 5,000 items of clothing, shoes, various hygiene products, and much more to fill an entire 18-wheeler container and raised over $7,000 to donate to local non-profit organizations assisting Afghan refugees arriving in Northern Virginia. The Post also collaborated with Georgetown University Student Veterans Association, VA, and Afghanistan Youth Relief Foundation on September 11, Patriot Day and National Day of Service and Remembrance, to sort and organize donations.

The COVID-19 pandemic forced us all to shelter in place and increased the likelihood of loneliness, depression, anxiety, and other mental health illnesses. A few weeks into the declared national emergency in March 2020, participants in a VFW COVID-19 health survey reported that 68 percent (6,205 of 7,154) had five or fewer days of poor mental health. In a 2021 VFW COVID-19 health survey, around 50 percent (1,836 of 2,243) of respondents stated they had five or fewer days of poor mental health. The VFW prides itself on moving forward through the pandemic by engaging within the organization and our communities, processing benefit claims, and conducting organizational business, including elections and swearing-in of new officers. One of the reasons respondents were experiencing good mental health days was that the VFW represented a beacon of hope and growth for the future beyond the pandemic.

Financial stress can lead to hopelessness. The basis of the VFW's Unmet Needs program is to help veterans, service members, and military families who may face financial difficulties. A grant of financial assistance of up to $1,500 is given to those who meet the eligibility criteria. Since 2004, the VFW's Unmet Needs program assisted almost 11,000 families with $5.4 million financial aid grant funds.

From the national level to the Post level, the VFW continues to do more for veterans, including supporting innovation in suicide prevention. Many Posts donate funds to organizations that are making a positive difference in this battle. VFW Post 11453 in Cheyenne, Wyoming, raises funds through Buddy Poppy donations and then presents that money to Grace for 2 Brothers, a local non-profit providing suicide prevention education to purchase and distribute gun locks.

2021 National Veteran Suicide Prevention Annual Report

Earlier this month, VA published its 2021 National Veteran Suicide Prevention Annual Report. The report acknowledged progress, identifying areas where the most recent picture of veteran suicide demonstrated statistical improvement. Though this should be lauded as a positive step, the VFW remains concerned that we do not have the complete picture of how this change occurred. The report, which has been issued by VA since 2014, continues to only contemplate the trends among veterans who either engaged with the Veterans Health Administration (VHA) within the past year or veterans who did not, which in our opinion seemingly presents veteran suicide as simply a crisis of health care and specifically a crisis of mental health.

For years, the VFW has insisted that VA must stop viewing suicide simply as a mental health crisis and instead seek to better understand the underlying causes. While VA has done some research in this regard, the annual report continues to ignore the full scope of engagement that a veteran may have with VA, which includes every program under the purview of the Veterans Benefits Administration (VBA) as well.

The report in its current form does not capture social determinants of health, which VA's own research indicates are often better predictors of suicide or suicidal ideation. Many VBA programs like disability compensation, GI Bill, or home loan guaranty are facets of critical social determinants of health such as steady income, workforce skill attainment, and stable housing. The VFW believes that VBA has significant data regarding recipients of these benefit programs, and that VA should easily be able to cross-reference this data as it already has with VHA and now the National Cemetery Administration to produce the annual suicide prevention report.

The VFW explained this shortcoming in recent conversations with VA. While we believe that community-centered engagements have changed the discourse in the veterans' community on mental wellness, like the VFW's work with our partner Give an Hour on the Campaign to Change Direction, we are only speculating at this point that this works.

However, we believe VBA has access to information that really can inform our decision-making on VA programming that affects social determinants of health. The VFW has asked these questions for years, but VA has either chosen not to evaluate it or does not want to share it. If VA is serious about understanding and preventing suicide, then we must demand a more thorough evaluation of all VA programs. This is why the VFW calls on Congress to direct VA to include relevant VBA data in the annual report on all VA programs and their impact on veteran suicide. 

Moving Forward with Legislation

The VFW would like to thank the committee for its leadership and perseverance in the past twelve months. Even during a global pandemic, Congress passed significant mental health and suicide prevention legislation. The VFW urges Congress to maintain vigilant oversight of the implementation of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, the Veterans COMPACT Act of 2020, and the Sgt. Ketchum Rural Veterans Mental Health Act of 2021.

Breaking barriers and expanding access to high-quality mental health care professionals and services while maintaining a continuum of care within VA and the Veterans Community Care Program (VCCP) is essential to a veteran's mental health treatment. Before the COVID-19 pandemic, VHA had roughly 45,000 unfilled vacancies, which included more than 700 psychologists. According to the VA MISSION Act of 2018 Section 505(b) 2021 Annual Report, VHA mental health workforce onboarding increased by almost 900 employees, including 160 psychologists. The VFW urges VA to expedite staff hiring and onboarding to fill the remaining vacancies and establish a succession plan to ensure adequate mental health staffing. VA must also continue to train mental health VCCP providers to maintain or exceed VA's highest level of quality care.

Continuum of care creates and cultivates trust between the veterans and mental health care professionals. Recently, some VFW members expressed their concern with VA's postponement of VCCP provider reauthorization, which delayed, terminated, or altered the veterans’ treatment plans, thereby weakening the trust and placing veterans at risk by disconnecting them from their mental health providers. The VFW urges VA to reauthorize VCCP referrals in a quicker and proactive process that considers the best treatment path for the veterans.

In 2007, VA established the Veterans Crisis Line (VCL). This hotline provides 24/7 confidential call, text, or chat crisis intervention and suicide prevention for veterans, service members, National Guard and Reserve members, and their families. The VFW urges Congress to extend the safety planning pilot program, fund research for improvements, and oversee VCL staffing, training, and processes. The VFW looks forward to working with Congress and VA to roll out the upcoming national 3-digit suicide and mental health crisis hotline––988.

Vet Centers are VA's most unheralded program that has been around for 42 years. Over 300 centers, 83 mobile units, and several outstations and community access points serve eligible veterans and their families. Vet Centers offer various services from individual and family counseling, benefits explanation, substance abuse assessment and referral, and many others. Vet Centers operate without a proper staffing model to provide service for an increasingly eligible group of veterans and families. The VFW urges Congress to expand eligibility to Vet Centers to include certain veterans using educational assistance benefits and require VA to assess Vet Centers, specifically Title V therapists who can be grandfathered into Hybrid Title-38 position. As Vet Center eligibility and usage has increased, we must also provide an increase in resources for these vital programs.

Eliminating suicide among our nation's veterans will continue to be a top priority for the VFW. Although the data recently released from VA shows a slight decline in veteran suicides from 2018, the number must be reduced to zero and remain there. There is movement in the right direction, but more needs to be done. Veteran suicide prevention awareness is not just a VA, congressional, or veteran organization issue, it is an everyone issue.

Information Required by Rule XI2(g)(4) of the House of Representatives

Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has not received any federal grants in Fiscal Year 2021, nor has it received any federal grants in the two previous Fiscal Years. 

The VFW has not received payments or contracts from any foreign governments in the current year or preceding two calendar years.