Answering the Call: Examining VA’s Mental Health Policies

House Veterans' Affairs Subcommittee on Oversight and Investigations

2025-04-30

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Summary

This subcommittee hearing focused on a deeper examination of the VA's mental health policies, processes, and the quality of care provided to veterans, particularly in light of the ongoing mental health crisis and alarmingly high suicide rates among veterans. The discussion highlighted concerns regarding delayed access to care and the effectiveness of current interventions, with witnesses from the VA and the Office of Inspector General (OIG) presenting insights into existing programs, identified deficiencies, and planned improvements to address these critical issues[ 00:09:05-00:09:14 ] [ 00:24:51-00:25:02 ]

Themes

Veteran Mental Health Crisis and Suicide Prevention

Despite significant investments by the VA, the veteran suicide rate remains a grave concern, with 17 veterans dying by suicide daily and an additional 20 by self-injury mortality, such as overdose[ 00:09:54-00:10:48 ]

. Key issues include long wait times for mental health appointments and the need for more timely access to care[ 00:09:27 ] [ 00:09:41 ] . The VA offers a broad range of mental health services, including crisis intervention, same-day urgent care, inpatient and outpatient services, and the Veterans Crisis Line. The VA’s National Strategy for Preventing Veteran Suicide emphasizes a public health approach, combining community prevention and clinical interventions, and continuously updates clinical guidelines and staff training. However, OIG reports have found deficiencies in the VA's mental health intake process and a 55% annual adherence rate for suicide risk screening, leading to tragic outcomes in some cases. The importance of providing wraparound services for known suicide risk factors like anxiety, depression, substance use disorder, and PTSD was also stressed.

VA Policy, Oversight, and Bureaucracy

Concerns were raised about the VA's bureaucracy and the need for improved oversight of processes and policies governing veteran mental health care[ 00:12:57-00:12:59 ]

. There is notable variation in how VA's mental health policies are interpreted and adhered to across different facilities and Veterans Integrated Service Networks (VISNs)[ 00:27:07 ] [ 00:27:31 ] . The OIG specifically highlighted a lack of clarity in the role and authority of VISN chief mental health officers, hindering their ability to effectively address staff non-compliance and intervene in facility-level issues. The VA is actively working to clarify policy language, provide consistent training, and improve communication channels between central office, VISNs, and facilities to ensure standardization. Additionally, challenges were noted in the seamless sharing of information and continuity of care between VA and community healthcare providers, particularly for mental health records and prescription information.

Staffing and Workforce Issues

The discussion included significant concerns about personnel cuts, resource limitations, and their impact on the VA's ability to deliver mental health care. Ranking Member Ramirez questioned the administrative burden on clinician supervisors tasked with justifying employee retention, and the practicality of assessing a provider's value in just one to two sentences. Reports of VA clinicians conducting telehealth sessions in compromised, non-private settings (such as closets or showers) due to return-to-office orders raised serious privacy concerns for veterans[ 00:54:35 ]

. The OIG identified psychiatrists, psychologists, and medical support assistants as among the top severe occupational staffing shortages[ 00:37:48 ] . While there was reassurance that frontline mental health providers are exempt from hiring freezes and that hiring is ongoing, a request was made for data on the number of employees onboarded since January to verify actual staffing levels[ 00:56:09 ] [ 00:56:50 ] .

Alternative Mental Health Treatments and Funding

The VA is expanding its use of somatic treatments for mental health, including electroconvulsive therapy (ECT), transcranial magnetic stimulation, ketamine infusions, and intranasal S-ketamine. Ongoing research within the VA includes studies on psychedelics, stellate ganglion block, and other emerging therapies, with a commitment to evidence-based approaches. Concerns were raised about potential cuts to Narcan funding and its impact on veteran overdose deaths, with the VA acknowledging Narcan's life-saving role and the success of its naloxone distribution program[ 00:48:12-00:48:12 ]

. Questions were also posed regarding the partnership between the Substance Abuse and Mental Health Service Administration (SAMHSA) and the VA, and how potential cuts to SAMHSA might affect the VA's ability to provide essential services for substance use disorder and mental health.

Tone of the Meeting

The meeting had a serious and urgent tone, driven by deep concerns over the veteran suicide crisis and systemic deficiencies in mental health care provision[ 00:09:14 ]

[ 00:10:13 ] . While initially framed as a bipartisan issue focused on improving veteran care, political tension emerged through critiques of the "Trump administration's" policies regarding workforce reductions and their perceived negative impact on veterans' mental health and access to care[ 00:13:09-00:13:11 ] . Despite these undercurrents, VA witnesses expressed a committed and responsive attitude, acknowledging OIG findings and outlining ongoing efforts to clarify policies, expand services, and ensure accountability. The overall sentiment conveyed a shared commitment to improving the well-being of veterans, despite differing views on the causes of current challenges and the best path forward[ 00:14:42 ] [ 00:58:35 ] .

Participants

Transcript

Jennifer Ann Kiggans

Good morning, everyone. The subcommittee will come to order. I would like to welcome our witnesses, my fellow members, and the audience to this hearing of the Subcommittee on Oversight and Investigations. Today, we will dig deeper into VA's mental health policies to gain insight into the processes and quality of care decisions regarding veterans' mental health care. From speaking with veterans in my district, it's clear that we have a lot of ground to cover to fix the mental health crisis in the veteran community. Of the concerns I hear most from veterans is how long it takes to schedule their appointments for mental health treatments. Delayed mental health care in the age of telehealth is well within our ability to address. Veterans deserve timely care. Despite the VA investing billions into PTSD treatment, suicide prevention, and alternative approaches to mental health, We continue to lose too many veterans to suicide. One veteran's suicide is too many. In 2022, 6,407 veterans died by suicide. That is 17 veterans a day. Unfortunately, it does not stop there. An additional 20 veterans die by self-injury mortality, which generally means overdose. I've heard horror stories from constituents who have been prescribed pain medication and told to take more when they feel bad and less when they feel better. As a provider, I would not feel comfortable prescribing two medications that might interact with one another without first consulting a psychiatrist. This is unacceptable. It's impossible to cover every detail of every case, but we know that we are losing veterans. Despite a seemingly endless amount of resources spent, these numbers have failed to substantially decline. One veteran's suicide, again, is too many. These men and women volunteered to serve their country in a variety of roles throughout our armed services. They have answered the call to serve, and as a veteran and a nurse practitioner, it's alarming that we have allowed the VA to fail to move the needle for this long. We must do better. We've tried to throw more money at the problem. The VA's budget has risen 479% since 2001.

Jennifer Ann Kiggans

And yet, despite a shrinking veteran population, the veteran suicide rate has remained virtually stagnant. Unfortunately, the VA's own numbers have only shown that they are doing less with more. This is not a question of spending more taxpayer dollars, but getting veterans what they need when they need it. Making progress means that we must take a closer look into the VA's bureaucracy and improve our oversight of the processes and policies that determine the quality of veteran mental health care. Suicide prevention and veteran mental health are bipartisan issues. Losing these veterans impacts red states and blue states. I hope this hearing will yield results to important questions about VA mental health care. How are these policies developed? What steps has the VA taken to adjust its approach? How does the VA use science and data to improve veteran care? And most importantly, how can the VA better serve the veteran? The answers that we hear today will inform our next steps to address these urgent issues. Veterans should not have to wait for mental health care, and it is our bipartisan responsibility to ensure the VA has up-to-date policies and is enforcing these policies to ensure no veteran slips through the cracks. Again, this is a bipartisan issue, and we cannot let politics stand in the way of making progress. There was spirited conversation during our last full committee hearing on the VA's workforce reform efforts, the impact the VA's workforce reform efforts would have on delivering mental health care to veterans. The Secretary has addressed this misinformation, and let me reiterate, no mission-critical employees, including those at the Veterans Crisis Line, have been terminated from the VA. I am committed to ensuring that the VA works for veterans and their caregivers with a functioning, quality workforce. That being said, I look forward to hearing from our witnesses, and I now recognize our ranking member, Ramirez, for her opening comments.

Delia Catalina Ramirez

Thank you, Chair Kiggins. For many years, I worked at a homeless shelter where I saw a case of veterans confronting alone without anyone to turn to mental health challenges. After wearing the uniform and serving our nation, these veterans were dealing in silence with the pain of PTSD, depression, substance abuse, and the risk of self-harm. So I'm really glad that today we're having this hearing to truly discuss the necessity of adequate mental health and suicide prevention screening for veterans. The topic of today's hearing really gets to the crux of why VA and this committee specifically exist.

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