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“Bridging the Gap: Enhancing Outreach to Support Veterans’ Mental Health”

Senate Veterans Affairs Committee Hearing

April 29, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked) (Panel One):

• Thomas O’Toole, MD: Acting Assistant Undersecretary for Health for Clinical Services and Deputy Chief Medical Officer, Veterans’ Health Administration, U.S. Department of Veterans Affairs

• Michael Fisher: Chief Officer, Readjustment Counseling Service, Veterans Health Administration

Witnesses & Written Testimony (linked) (Panel Two):

• Jim Lorraine: President & CEO, America’s Warrior Partnership

• Gilly Cantor: MPA, Director of Evaluation and Capacity Building, D’Aniello Institute for Veterans & Military Families (IVMF), Syracuse University

• Steffen Crow: SSG Parker Gordon Fox Grant Program Manager, Oklahoma Veterans United

• Heather Barr: U.S. Marine Corps Veteran

• Austin Lambright: U.S. Marine Corps Veteran

• Lindsay Church: Executive Director & Co-Founder, Minority Veterans of America

Keywords mentioned:

• Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, collaboration, community outreach, mental health workforce, Veterans Crisis Line, telehealth, veteran engagement

IN THEIR WORDS

OPENING STATEMENTS FROM THE COMMITTEE & OTHER MEMBERS

• Chairman Jerry Moran recalled that nearly five years ago, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act was signed into law, which he introduced with support from advocates and former Senator Jon Tester. The legislation promoted collaboration between the VA and the Department of Defense (DoD), expanded the VA's mental health workforce, and authorized the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. He explained that the hearing would review the effectiveness of the grant program and gather feedback on four related bills aimed at improving veteran suicide prevention and mental health engagement.

• Ranking Member Richard Blumenthal praised the Fox Grant Program as a transformative initiative that supports veterans through community-based, non-clinical services. He condemned recent cuts to VA mental health services, including firings and canceled support contracts, calling them reckless and harmful to veterans in need. Ranking Member Blumenthal also criticized a VA memo undermining patient privacy and warned that eliminating outreach workers could cripple suicide prevention efforts, calling for bipartisan action and robust oversight.

• Sen. Mark Warner expressed gratitude for the Committee’s work and stressed that supporting veterans’ mental health is a national obligation, not charity. He described the Fox Grant Program as an essential tool in reducing veteran suicide and noted its success in providing outreach through local organizations, including in Virginia. Sen. Warner shared that he and Senator John Boozman introduced the initial legislation in 2019, which evolved into the current grant program. He advocated for its permanent reauthorization, pledging his continued support and cooperation to advance the legislation quickly.

SUMMARY OF KEY POINTS (PANEL ONE)

• Dr. Thomas O'Toole thanked the Committee for the opportunity to speak on several bills affecting VA services, particularly the Fox Grant Program. He explained that the grant program funds community-based efforts that blend outreach and evidence-based strategies to prevent veteran suicide. Since its launch in September 2022, the VA has awarded $157.5 million to 95 organizations, with early results showing improved mental health, well-being, and reduced suicide risk among participants. He strongly supported the program’s reauthorization and urged the Committee to avoid any disruptions to its operations as legislative changes are considered.

• Chairman Moran asked what the VA had learned from grantee performance and outcome data under the Fox Grant Program and how the department was addressing internal staff awareness issues. Dr. O'Toole responded that early findings highlighted the importance of improving outreach and ensuring that grantees had the necessary tools and skills to serve veterans effectively. He pointed to the need for sufficient capacity and clear pathways to providing mental health care, including raising awareness of the grant among VA employees.

• The Chairman followed up, asking how the VA was positioned more broadly to reduce veteran suicide. Dr. O'Toole described the VA’s tiered mental health care system, from screening and primary care to specialized inpatient services, and illustrated a whole health approach that includes social and economic factors.

• The Chairman then asked what additional improvements could be made beyond outreach. Dr. O'Toole noted the importance of sustaining the Veteran Crisis Line (VCL), ensuring access to treatment, improving support during the military-to-veteran transition, and addressing broader social drivers of suicide.

• Ranking Member Blumenthal confirmed with Dr. O'Toole that human-driven outreach was essential to suicide prevention and questioned the rationale behind recent staffing cuts. Dr. O'Toole replied that the VCL had actually increased staffing and noted that those positions were exempt from hiring freezes.

• The Ranking Member pressed on broader staffing concerns, mentioning open positions and potential firings and calling them a deterrent to recruitment and retention. Dr. O'Toole responded that the 300,000 direct care positions were exempt and that efforts to retain staff were ongoing, though challenges persisted.

• Sen. Kevin Cramer expressed frustration that North Dakota had received no grant funding despite a strong application and asked why the VA opposed his amendment to prioritize states that had not previously received funding. Dr. O'Toole responded that he could not speak to that specific application but underlined the importance of maintaining high and universal standards.

• Sen. Cramer explained that his amendment was intended as a one-time prioritization fix for underserved states like North Dakota. Dr. O'Toole agreed to work with the Committee to find a path forward and acknowledged that more resources would help.

• Sen. Patty Murray criticized the VA for refusing to participate in her women veterans roundtable and asked why joint discussions between VA staff and veterans are important. Dr. O'Toole affirmed their importance. Sen. Murray then asked whether the directive to bar elected officials from VA facilities originated within VHA or VA leadership, to which Dr. O'Toole deferred to higher leadership.

• Sen. Murray raised concerns about suicide among women veterans with histories of military sexual trauma (MST) and staffing cuts under the Trump administration. Dr. O'Toole noted that outreach was ongoing, and Mr. Michael Fisher added that Vet Centers had continued outreach efforts and saw high trust ratings among women veterans.

• Sen. Marsha Blackburn asked about gaps in mental health service access and how the VA was addressing inconsistencies. Dr. O'Toole reiterated that the Fox Grants helped reach disconnected veterans and supported community-based care tailored to veterans' needs. When pressed on how the VA could simplify access to care, he pointed to the importance of outreach, universal suicide risk screening, and a responsive VCL. Sen. Blackburn voiced concern about veterans transitioning from the VA to the DoD and noted that she would follow up with questions for the record.

• Sen. Mazie Hirono challenged Dr. O'Toole on the logic of workforce cuts given persistent VA staffing shortages. Dr. O'Toole clarified that 300,000 direct care positions were exempt from hiring freezes but did not provide a total number of unfilled positions. Sen. Hirono expressed concern that the VA lacked information on which veterans had lost federal jobs—an identified suicide risk factor—and criticized the department for being unprepared.

• Sen. Hirono further questioned the economic impact of tariffs on veterans, which Dr. O'Toole could not address. She warned that widespread instability across agencies would raise suicide risk factors among veterans.

• Sen. John Boozman asked how increased funding for the Fox Grant Program would improve outcomes. Dr. O'Toole responded that additional funding would allow the VA to expand the number of grantees, target high-need areas, and reach underserved veteran populations.

• Sen. Boozman then asked what aspects made the program successful. Dr. O'Toole pointed to the involvement of trusted, community-based organizations and a holistic, wraparound care model. On metrics, he spoke about measuring not only veteran participation but also the quality of care, outcomes, and successful connections to VA or community-based services.

• Sen. Maggie Hassan asked whether Dr. O'Toole had been asked to analyze the impact of firing 80,000 VA employees. Dr. O'Toole said that he had not been asked nor conducted such an analysis. Sen. Hassan cited severe shortages of psychologists and psychiatrists across VA facilities, and Dr. O'Toole agreed that they are essential to meeting complex needs.

• Sen. Hassan followed up about the benefits of holistic, wraparound care. Dr. O’Toole said that this type of care helps meet veterans' needs on their terms and reflects the VA’s commitment to stability and individualized support.

• Sen. Angus King raised concerns about burdensome intake procedures under the Fox Grant Program, saying veterans in Maine were dropping out due to intrusive questioning. Dr. O'Toole acknowledged the issue and explained that the program was still in its learning phase. He agreed that balancing effective screening with rapport-building was crucial.

• Sen. King suggested modifying intake procedures during reauthorization and described the importance of outreach, especially for veterans not connected to the VA. He also promoted a bill he co-sponsored to provide free gun lockboxes to veterans, which Dr. O'Toole supported as a means of creating distance between suicidal ideation and action.

• Sen. Tammy Duckworth criticized staffing cuts and attacks on underserved communities, asking what the VA was doing to ensure the Fox Grant Program could be administered with sufficient staffing. Dr. O'Toole replied that the Fox Grant Program reported to him and was prioritized in staffing discussions.

• Sen. Duckworth asked about rehiring mental health personnel, and Dr. O'Toole repeated that VCL staff were exempt from cuts and staffing levels had increased. He also committed to advocating for privacy, resource access, and the protection of mission-critical staff from adverse actions.

• Sen. Ruben Gallego asked whether Dr. O'Toole was aware of therapists working in inappropriate environments due to return-to-office mandates. Dr. O'Toole replied that he had heard of such cases secondhand but stressed that the VA had procedures to resolve them.

• Sen. Gallego then asked whether either witness had received directives related to the planned 83,000 job cuts. Both witnesses said that they had not received such guidance, and Mr. Fisher confirmed that Vet Centers remained focused on hiring staff, using all available tools to do so.

• Ranking Member Blumenthal discussed suicide rates among older veterans in Connecticut and asked whether that trend was national. Dr. O'Toole said that suicide had a bimodal pattern, with high rates among both young and older veterans, but he would need to provide the specific data later. The Ranking Member asked for an analysis of geographic disparities and requested that the VA reassess its opposition to the BRAVE Act.

• Sen. Elissa Slotkin criticized ongoing threats to VA staffing, particularly in mental health roles, and expressed disbelief that massive cuts could improve care. She asked Dr. O'Toole what he planned to do to safeguard veterans’ access to care. Dr. O'Toole recommitted to maintaining direct care, acknowledged broader workforce challenges, and affirmed that care should not be compromised. Sen. Slotkin urged him to advocate for veterans above politics and claimed that outreach needed to increase, not decrease, especially given data showing most veteran suicides involved individuals not connected to the VA.

• Before the end of the first panel, Chairman Moran made a note of the connection between mental health care and community care access. Dr. O’Toole agreed that both community care and mental health support are critical.

SUMMARY OF KEY POINTS (PANEL TWO)

• Mr. Jim Lorraine described America’s Warrior Partnership (AWP) and the organization’s purpose to improve veterans’ quality of life. He mentioned that the Fox Grant Program is effective in proactively helping AWP reach veterans before they become suicidal. He spoke on the importance of early intervention and the grant program’s role in connecting veterans to local resources. Mr. Lorraine recommended reestablishing outreach channels, reducing redundancies and burdens in intake processes, and increasing transparency between community identification and the VA.

• Ms. Gilly Cantor discussed the D’Aniello Institute for Veterans & Military Families’ (IVMF) goal of coordinating clinical and nonclinical care organizations to address veterans’ mental health. She then reviewed recent data suggesting that non-clinical stressors often play a large role in negative mental health outcomes among veterans. She claimed that veterans often see significant improvements when community organizations and the VA work together, such as through the Fox Grant Program. Of IVMF’s recommendations, Ms. Cantor specifically pointed to holding the VA accountable for its role in ensuring the program’s success through awareness and compliance.

• Mr. Steffen Crow, a retired Marine gunnery sergeant, testified about how Oklahoma Veterans United has leveraged the Fox Grant Program to build a statewide veteran support network. He described their outreach to over 5,000 veterans and highlighted major barriers such as the misuse of the Columbia screening tool, inconsistent VA referral processes, and restrictions on funding effective therapies like gym memberships. Mr. Crow emphasized that rural veterans were particularly underserved and advocated for grantees to hire licensed mental health providers to fill care gaps. He urged the Committee to implement tangible reforms to rebuild veterans’ trust and save lives.

• Ms. Heather Barr, a former Marine sergeant, shared her personal story of struggling after military transition and finding critical support through a Fox Grant-funded program at Upstate Warrior Solution. She recounted how the program connected her to therapy, employment, and a supportive veteran community, helping her regain purpose and stability. Ms. Barr stressed that her positive outcome was not typical, as many veterans lack strong family support systems. She expressed deep gratitude for the program and echoed its life-saving potential for veterans facing mental health and transition challenges.

• Mr. Austin Lambright, also a Marine veteran, testified about his difficult post-service transition marked by arrests, depression, and suicidal thoughts. He credited the birth of his son and his eventual connection with Upstate Warrior Solution and the Fox Grant Program for saving his life. Through peer support, mental health counseling, and community engagement, he rebuilt his life and found purpose. Mr. Lambright urged the continuation and expansion of the Fox Grant Program, stating that asking for help should be seen as a strength, not a weakness.

• Lindsay Church mentioned how historically underserved veterans—such as LGBTQ veterans, veterans of color, and women—face systemic barriers that increase suicide risk. They detailed recent policy rollbacks at the VA that erased protections for marginalized veterans and criticized decisions that reduced data collection and visibility. Church underscored that equity must be embedded in every step of suicide prevention efforts, including grant funding, cultural competency training, and data-driven accountability. They called for bold, urgent action to build trust and save lives, warning that visibility without real change amounts to betrayal.

• Sen. Tommy Tuberville asked whether there was enough oversight over the Fox Grant Program and how to better prevent misuse. Mr. Lorraine responded that oversight existed but lacked transparency, and he suggested more audits with clear outcome-based standards. Sen. Tuberville also asked about improving data use, to which Ms. Cantor replied that better tracking from outreach through successful treatment was needed, but current transparency was lacking.

• Sen. Tuberville asked whether grant recipients showing better outcomes should receive more funding, and Ms. Cantor agreed, saying performance-based funding was crucial. Sen. Tuberville then asked the witnesses if they had any suggestions for additional suicide prevention methods. Mr. Lambright shared that psychedelics like DMT had helped him personally, though not provided by the VA. He also highlighted issues with inflated VA billing compared to private insurance.

• Ranking Member Blumenthal asked why Ms. Barr and Mr. Lambright sought help from Upstate Warrior Solutions instead of the VA. Ms. Barr explained that she initially contacted the VA but encountered outdated contacts and poor outreach, eventually being guided to Upstate Warrior Solutions by a Vet Center. Mr. Lambright testified that although he went to the VA first, the care he received was inadequate and left him in a worse mental state, leading him to seek better support through community organizations.

• The Ranking Member asked whether witnesses had seen evidence of staffing cuts or anxiety about cuts within the VA. Mr. Lorraine said that no direct impacts had been seen yet, but Mr. Crow mentioned hearing growing concerns from VA staff and veterans about possible layoffs. Church added that VA employees were already experiencing delays in services, support staff reductions, and extreme anxiety, noting that many veteran employees faced mental health challenges due to instability within the VA itself.

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