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                                                       Calendar No. 279
110th Congress                                                   Report
                                 SENATE
 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 
                               following

                              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.

                              INTRODUCTION

    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. 
479.
    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.

                           COMMITTEE MEETING

    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 
below.
    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 
illness.
    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 
health assessment.
    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 
facility.
    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 
programs.
    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 
services.
    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 
family,

          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 
so.
    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 
        licensed professional.

    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 
health assessment.
    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 
next steps.

    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 
section 3(b)(11).

                      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 
governments.
    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.

                             AGENCY REPORT

    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 
CDC).
    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 
these efforts.
    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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