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Calendar No. 279
110th Congress Report
1st Session 110-132
JOSHUA OMVIG VETERANS SUICIDE PREVENTION ACT
July 23, 2007.--Ordered to be printed
Mr. Akaka, from the Committee on Veterans' Affairs, submitted the
R E P O R T
[To accompany S. 479]
The Committee on Veterans' Affairs, to which was referred
the bill (S. 479), to reduce the incidence of suicide among
veterans, having considered the same, reports favorably
thereon, and recommends that the bill do pass.
On February 1, 2007, Senator Tom Harkin introduced S. 479,
the proposed ``Joshua Omvig Veterans Suicide Prevention Act,''
which is named for an Iowa veteran who committed suicide after
returning from Iraq.
On April 25, 2007, the Committee held a hearing on
veterans' mental health issues at which Joshua Omvig's father,
Randall, appearing with his wife Ellen, spoke in favor of S.
On May 23, 2007, the Committee held a hearing on pending
veterans' health legislation at which testimony on S. 479,
among other bills, was offered by: Gerald M. Cross, MD, FAAFP,
the Department of Veterans Affairs' Acting Principal Deputy
Under Secretary for Health; Carl Blake, National Legislative
Director, Paralyzed Veterans of America; Dennis M. Cullinan,
Director, National Legislative Service, Veterans of Foreign
Wars; Joy J. Ilem, Assistant National Legislative Director,
Disabled American Veterans; Shannon Middleton, Deputy Director
for Health, Veterans Affairs and Rehabilitation Commission, The
American Legion; Bernard Edelman, Deputy Director for Policy
and Government Affairs, Vietnam Veterans of America; and Jerry
Reed, Executive Director, Suicide Prevention Action Network USA
(SPAN USA). All of the witnesses from the veterans'
organizations and SPAN USA supported S. 479. The Department of
Veterans Affairs did not support the legislation, expressing
the view that the bill's provisions are duplicative of existing
programs and initiatives.
After carefully reviewing the testimony from the foregoing
hearings, the Committee met in open session on June 27, 2007,
to consider, among other legislation, S. 479. The Committee
voted by voice vote to report favorably S. 479 to the Senate.
SUMMARY OF S. 479 AS REPORTED
S. 479, as reported (hereinafter, ``the Committee bill''),
would convey the sense of Congress that suicide among veterans
suffering from post-traumatic stress disorder (PTSD) is a
serious problem, and direct the Secretary of Veterans Affairs
(hereinafter, ``the Secretary'') to take the measures described
Section 3(a) would require that the Secretary develop and
implement a comprehensive program for reducing the incidence of
suicide among veterans, consisting of the following elements:
Section 3(b)(1) would require that the program include a
nationwide campaign to increase awareness in the veteran
community that mental health is essential to overall health and
that there are treatments that can promote recovery from mental
Section 3(b)(2) would require that the program include
mandatory suicide prevention training for all medical personnel
who interact with veterans.
Section 3(b)(3) would require that the program include a
mental health education and outreach effort, with special
emphasis on veterans of Operations Enduring Freedom and Iraqi
Freedom and their families.
Section 3(b)(4) would require that the program include a
peer support program under which veterans would be permitted to
serve as peer counselors on mental health matters.
Section 3(b)(5) would require that the program encourage
all applicants for veterans' benefits to undergo a mental
Section 3(b)(6) would require that the program provide for
referrals for all veterans who show signs of mental health
problems to appropriate counseling and treatment programs.
Section 3(b)(7) would require that the program include
designation of a suicide prevention counselor at each
Department of Veterans Affairs (hereinafter, ``VA'') medical
Section 3(b)(8) would require that the program include
research on best practices for suicide prevention among
veterans, and establish a committee to advise on such research.
Section 3(b)(9) would require that the program provide for
referrals for all veterans who show signs or symptoms of
substance abuse to appropriate counseling and treatment
Section 3(b)(10) would require that the program include
mechanisms to ensure 24-hour mental health care services
availability to veterans.
Section 3(b)(11) would provide that the program may include
a 24-hour, toll-free telephone number, staffed by personnel
with appropriate mental health training, through which veterans
might receive information on and referral to mental health
Section 3(b)(12) would provide that the program may include
such other activities and programs to reduce the incidence of
veteran suicide as the Secretary considers appropriate.
Section 4 would require the Secretary to report within 90
days on VA programs to reduce the incidence of suicide among
veterans, and to present a plan for additional programs to this
effect. This plan would be required to be formulated in
consultation with the National Institute of Mental Health, the
Substance Abuse and Mental Health Services Administration, and
the Centers for Disease Control and Prevention.
BACKGROUND AND DISCUSSION
At the Committee's April 25, 2007, hearing on veterans'
mental health issues, Randall Omvig stated on behalf of his
We would like to voice our strong support of the
Joshua Omvig Veterans Suicide Prevention Act, S. 479,
reintroduced by Senator Harkin and Senator Grassley.
Mr. Omvig addressed the need for expanded mental health
outreach and education for returning servicemembers, new
veterans, and their families, as well as for a more aggressive
and preventative approach to mental health treatment by VA and
the Department of Defense. A number of provisions of S. 479,
contained in section 3 of the Committee bill, directly address
these concerns and are discussed below.
De-stigmatizing Mental Health [Section 3(b)(1)]: As
documented by numerous media sources, mental health issues are
viewed by some members of the armed forces as a sign of
weakness and an obstacle to career advancement. This stigma
carries over to reservists and new veterans, some of whom
choose to avoid counseling or treatment. Such was the case with
Joshua Omvig, as conveyed in his father's testimony. This
section would direct the Secretary to take steps to address the
stigma and to convey a message of hope and recovery to the
veteran community. While the section suggests a number of
potential steps in this direction, it would allow the Secretary
to determine the best approach.
Training of Employees and Other Personnel [Section
3(b)(2)]: Under this section, the Secretary would arrange for
suicide prevention training for all mental health and social
work professionals who interact with veterans. The Secretary
would be left to determine the format of this training. The
Committee notes that long-term employees with extensive
experience in counseling veterans with PTSD, depression, or
suicidal thoughts could be considered as having completed the
requirements of the training.
Family Education and Outreach [Section 3(b)(3)]: Upon his
return from Iraq and disposition to reserve status, Joshua
Omvig did not seek help from the military or VA for his mental
health problems. This section would direct the Secretary to
reach out to individuals such as Joshua, and their families, in
order to educate them on readjustment issues and on the
symptoms of mental health problems, and to encourage them to
seek assistance if needed. These programs would necessarily be
geared towards individuals who have not applied for VA health
care services, including those still on active duty. The
Committee recognizes that certain initiatives of recent years,
such as VA briefings for units returning from Iraq or
Afghanistan, as well as expanded family eligibility for
counseling at Veterans' Centers, fall within the spirit of this
section. The Secretary would be directed to develop additional
programs in this vein, and would be given broad latitude to do
Peer Support Program [Section 3(b)(4)]: At the Committee's
May 23, 2007, hearing on pending veterans' health legislation,
two witnesses spoke in support of the peer counseling provision
of S. 479. Referring to peer support received during his
recovery from a spinal injury, Carl Blake of the Paralyzed
Veterans of America stated:
I know firsthand that being able to talk to someone
who has experienced what you have experienced and has
dealt with the same problems you are dealing with can
help you overcome bouts of depression, sadness, and
anger as you first come to grips with your condition.
The peer counselor serves as a motivator to get you
moving in the right direction.
Jerry Reed of SPAN USA testified:
I support the provisions in S. 479 that encourage
peer support programs. While there is no substitute for
licensed mental health professionals with respect to
diagnosis and treatment of PTSD, depression, and
anxiety, it is often fellow veterans who provide the
support needed to convince a veteran to visit a
Peer support, as envisioned under S. 479, is not a
formalized, top-down, nationwide program that requires
additional resources, but rather a resource in itself, whereby
local managers can recruit volunteers to provide advice based
on personal experience to other veterans who are willing to
accept it, or to their families. The peer counselor training
called for under the section is not intended as a formal,
classroom process. Rather, it could be provided on a one-on-one
basis whenever a clinician makes arrangements to pair a peer
counselor with his or her assigned veteran.
Health Assessments of Veterans [Section 3(b)(5)]: In the
interests of suicide prevention and general well-being,
veterans should be fully informed of their opportunities to
receive timely mental health screening. The Committee notes
that under this section, veterans applying for VA health
benefits in particular would be encouraged to undergo a mental
Counseling and Treatment of Veterans [Section 3(b)(6)]: The
Committee recognizes that veterans enrolled in the VA health
system who report symptoms of mental illness are generally
referred for appropriate counseling and treatment. This section
would broadly direct the Secretary to be more aggressive in
identifying at-risk veterans who exhibit symptoms of mental
illness, but do not ask for help.
Suicide Prevention Counselors [Section 3(b)(7)]: Under this
section, a suicide prevention counselor would be designated at
each VA medical facility. The Committee notes that some VA
Medical Centers have already met the requirements of this
section by assigning suicide prevention counselor functions to
existing staff, or else by hiring new staff for this purpose.
Either of these two approaches would bring a VA medical
facility into compliance with the requirements of this section.
Research on Best Practices [Section 3(b)(8)]: The research
called for under this section would encompass relevant studies
currently in progress in addition to any new initiatives that
VA clinicians or researchers may propose. The Secretary would
be encouraged to look favorably on new research proposals in
the field of suicide and suicide prevention.
Substance Abuse Treatment [Section 3(b)(9)]: The Committee
recognizes that veterans enrolled in the VA health system who
report a substance abuse problem are generally referred for
appropriate counseling and treatment. This section would
broadly direct the Secretary to be more aggressive in
identifying veterans who exhibit symptoms of substance abuse,
but do not ask for help.
24-Hour Mental Health Care [Section 3(b)(10)]: Under this
section, the program mandated under section 3(a) would be
required to include mechanisms to ensure the availability of
mental health care services for veterans on a 24-hour basis.
The Secretary would be left to determine how best to comply
with this requirement. The Committee notes that a continuously
operational mental health telephone hotline for veterans, as
described under section 3(b)(11), could, if established and
maintained in an effective manner, fulfill a significant
element of the requirements of this section.
Telephone Hotline [Section 3(b)(11)]: The Committee
recognizes that the language of this section, referring to a
potential mental health telephone hotline for veterans, is not
obligatory. However, as noted above, the Committee believes
that implementation of such a hotline could be a significant
element in meeting the requirements of section 3(b)(10).
At the Committee's May 23, 2007, hearing, Mr. Reed of SPAN
USA spoke of the benefits of a crisis hotline for at-risk
veterans. According to Reed,
For most individuals in a suicidal crisis, what is most
important when utilizing a hotline is simply knowing that
someone is listening and that they are not alone. A caller
needs a competent counselor at the other end of the line who
can conduct a lethality assessment and provide direction on
Should the Secretary choose to utilize a telephone hotline,
the Committee notes the possibility of utilizing an existing
capacity rather than building from scratch. In his testimony,
Mr. Reed recommended the existing, federally funded National
Suicide Prevention Lifeline (NSPL) and its 1-800-273-TALK
(8255) number, for this purpose:
I think we should build upon what Congress has
already funded and let 1-800-273-TALK be the door all
callers in crisis, including veterans, enter. Once a
caller dials the number, an option can be provided to
be transferred to a VA call center if the individual
wants the services and support of the VHA.
The Committee views this as a sensible and cost-effective
approach. However, it would remain up to the Secretary to
determine how best to fulfill the requirements of section
3(b)(10), and whether to implement the option described in
COMMITTEE BILL COST ESTIMATE
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the CBO, estimates that enactment of
the Committee bill would, relative to current law, incur
little, if any, cost. Enactment of the Committee bill would not
affect direct spending or receipts, and would not affect the
budget of State, local or tribal governments.
The cost estimate provided by CBO follows:
S. 479--Joshua Omvig Veterans Suicide Prevention Act
S. 479 would require the Secretary of Veterans Affairs (VA)
to develop and implement a comprehensive program to reduce the
incidence of suicide among veterans. This bill would require
that the program have specific components, including training
for all staff who interact with veterans, a suicide prevention
counselor at each medical facility, outreach and education for
veterans and their families, and a national campaign aimed at
reducing the stigma of mental illness among veterans.
According to VA, most of those requirements are already in
place or will be implemented before the end of the year. For
example, training seminars have recently begun for all
employees and peer-support groups are a regular facet of
veterans' rehabilitation centers. Annual screenings for suicide
risk factors such as depression and alcohol abuse are routinely
performed by primary care physicians. Two medical centers are
focused on research and education about suicide and its
prevention. In addition, VA works with other medical providers
in the community to reach veterans who may not use the VA
health care system. VA also plans to hire suicide-prevention
professionals at each of its hospitals. The bill would
authorize VA to create a toll-free hotline staffed by mental
health personnel, and the agency plans to have such a hotline
in operation by the end of August 2007.
CBO estimates, therefore, that implementing this bill would
have little, if any, cost because VA already has or soon will
implement all the specific requirements of the bill. Enacting
the bill would not affect direct spending or receipts.
S. 479 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
On March 19, 2007, CBO transmitted a cost estimate for H.R.
327, the Joshua Omvig Veterans Suicide Prevention Act, as
ordered reported by the House Committee on Veterans' Affairs on
March 15, 2007. The two versions of the legislation are
similar, and their estimated costs are identical.
The CBO staff contact for this estimate is Michelle S.
Patterson. This estimate was approved by Peter H. Fontaine,
Deputy Assistant Director for Budget Analysis.
REGULATORY IMPACT STATEMENT
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans'
Affairs has made an evaluation of the regulatory impact that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses or result in any impact
on the personal privacy of any individuals and that the
paperwork resulting from enactment would be minimal.
TABULATION OF VOTES CAST IN COMMITTEE
In compliance with paragraph 7 of rule XXVI of the Standing
Rules of the Senate, the following is a tabulation of votes
cast in person or by proxy by members of the Committee on
Veterans' Affairs at its June 27, 2007 meeting.
On that date, the Committee, by voice vote, ordered S. 479
reported favorably to the Senate.
On May 23, 2007, Gerald M. Cross, MD, FAAFP, VA's Acting
Principal Deputy Under Secretary for Health, appeared before
the Committee and submitted testimony on, among other things, a
draft version of the Joshua Omvig Veterans Suicide Prevention
Act. Excerpts from this statement are reprinted below:
Statement of the Views of the Administration
Good Morning Mr. Chairman and Members of the Committee:
Thank you for inviting me here today to present the
Administration's views on several bills that would affect
Department of Veterans Affairs (VA) programs that provide
veterans benefits and services. With me today is Walter A.
Hall, Assistant General Counsel. I am pleased to provide the
Department's views on 15 of the 20 bills under consideration by
the Committee. I will briefly describe each bill, provide VA's
comments on each measure and estimates of costs (to the extent
cost information is available), and answer any questions you
and the Committee members may have.
s. 479 joshua omvig veterans suicide prevention act
S. 479 would require the Secretary to develop and implement
a comprehensive program (comprised of 10 specific elements) for
reducing the incidence of suicide among veterans. First, the
program would include a national mental health campaign to
increase awareness in the veteran community that mental health
is essential to overall health and that effective modern
treatment can promote recovery from mental illness. Second, it
would call for mandatory training on suicide prevention for
appropriate employees and contract personnel (including all
medical personnel) who interact with veterans. This training
would require the provision of information on the recognition
of risk factors for suicide, protocols for responding to crisis
situations involving veterans who may be at high risk for
suicide, and best practices for suicide prevention. Third, the
comprehensive program would include outreach programs and
educational programs for veterans and their families, in
particular OEF/OIF veterans and their families. The educational
programs would serve to help: eliminate or overcome stigmas
associated with mental illness; further understanding of
veterans' readjustment issues; identify signs and symptoms of
mental health problems; and encourage veterans to seek
assistance for these types of problems.
Fourth, the program would include a peer counseling program
in which veterans are trained as peer-counselors to assist
other veterans suffering from mental health issues. (Training
of these veterans would have to include specific education on
suicide prevention). The peer-counselors would also be
responsible for conducting outreach on mental health matters to
veterans and their families. The legislation would require the
Secretary to make this peer-program available in addition to
other mental health services already offered by VA (including
those that would be established by this Act).
Fifth, the Secretary would be directed, as part of the
comprehensive program, to encourage all veterans applying for
VA benefits to undergo a mental health assessment at a VA
medical facility or Vet Center.
Sixth, the program would include the provision of
referrals, as appropriate, to veterans who show signs or
symptoms of mental health problems.
Seventh, the Secretary would need to designate a suicide
prevention counselor at each VA medical facility (other than a
Vet Center). These counselors would work with a variety of
local non-VA entities to engage in outreach to veterans about
available VA mental health services. They would also be
responsible for improving the coordination of mental health
care furnished to veterans at the local level.
Eighth, VA's program would have to include research on best
practices for suicide prevention among veterans. Moreover, the
Secretary would need to establish a steering committee to
advise on such research. Such committee would be comprised of
representatives from the National Institute of Mental Health
(NIMH), Substance Abuse and Mental Health Services
Administration (SAMHSA), and the Centers for Disease Control
and Prevention (CDC).
Ninth, the Secretary would have to ensure the availability
of VA mental health services on a 24-hour basis.
Finally, the Secretary would be authorized to establish a
continuously operational, toll-free telephone number that
veterans could call for information on, and referrals to,
appropriate mental health services.
This legislation would permit the Secretary to include any
other activities in the comprehensive program that the
Secretary deems appropriate. It would also require the
Secretary to submit, not later than 90 days after the date of
enactment, a detailed report to Congress on all of the
Department's suicide prevention programs and activities. (Any
suicide prevention programs VA establishes afterwards would
have to be developed in consultation with NIMH, SAMHSA, and
We appreciate the purpose of this legislation; however, we
do not support this bill. It is unnecessary because it
duplicates many efforts already underway by the Department.
Indeed, many of the bill's requirements are already being
addressed and implemented through VA's current Mental Health
Strategic Plan. (As you will recall, this Strategic Plan was
designed to both ensure that our Department continues as a
leader in the area of mental health and to implement the goals
of the President's New Freedom Commission on Mental Health). We
therefore ask that the Committee forbear in its consideration
of S. 479. In the meantime, we will be happy to brief the
Committee on the myriad initiatives we have right now and
explore with you additional measures that could supplement
Should the Committee proceed to act on this measure, we
note our objection to the bill's requirement to train and use
veterans as peer counselors for other veterans with mental
health issues. The use of adult veterans as peer-counselors in
caring for other veterans who suffer from mental health issues
is simply not advisable. Data on the efficacy of these types of
programs do not reflect favorable results. Although well-
intended, we believe such an approach to clinical care lacks
scientific support. We strongly believe that VA mental health
care services, including counseling, should continue to be
provided by our capable, experienced, and appropriately-trained
cadre of mental health care professionals.
In addition, we do not think the bill's requirement that we
encourage every veteran seeking any type of VA benefit to
obtain a mental health assessment is justified, and it may
cause veterans to believe they have been stigmatized.
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