Transcript: Sen. Kelly Ayotte’s Q&A w/ DOD & VA officials on the handling of military sexual assault, PTSD & suicides

Partial transcript of Sen. Kelly Ayotte’s (R-New Hampshire) Q&A on the Department of Defense and Department of Veterans Affairs handling of post traumatic stress disorders and suicides of service members who suffered military sexual assault. The hearing before the Senate Armed Services Subcommittee on Personnel was held on Feb. 26, 2014:

Sen. Kelly Ayotte (R-New Hampshire):
Thank you very much. I want to thank the witnesses for being here. I wanted to follow up, Dr. McCutcheon, just to clarify one point that I think it’s important for people listening at home to understand is that in terms of sheer numbers, there are actually more male victim in the military of sexual assault than female victims, isn’t that right? Just in terms of sheer numbers.

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
Senator, that was correct maybe about three or four years ago, but what we’re seeing right now is there is actually more women who’s screened positive for military sexual trauma who choose to come to the VA who are part of our VA health care system. So the numbers are pretty close.

Sen. Kelly Ayotte (R-New Hampshire):
So we now have more women victims with the recent numbers that have come forward?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
So in our last fiscal year, ma’am, we have within our system about a little over 77,000 women who have screened positive for military sexual trauma, and for the men it’s over 57,000.

Sen. Kelly Ayotte (R-New Hampshire):
Because one point I wanted to make is that this isn’t a male or a female victim situation. And so as this issue has come up in our committee and people talk about it, they make it an issue of this is an issue of women. And certainly women – there are fewer women in the military, and thankfully they’re taking on greater roles, which is a wonderful thing. But I just want people to understand that are home right now that there are a lot of men who are victims as well and who are watching this, because this isn’t a male or a female crime. This is a crime committed against anyone could be the victim of this in the military. So I think that’s important because people need to understand that as we get at this issue that it needs to be addressed for everyone.

And one of the questions that I wanted to follow up with you – how long on average does it take for once the referral is entered for someone actually to see a mental health provider?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
I’m sorry, ma’am. I don’t have that data with me as far as from screen to treatment, so I’ll have to take that for the record.

Sen. Kelly Ayotte (R-New Hampshire):
I would appreciate that because I think that’s an important question because immediacy is really important, that people are waiting too long to see mental health providers. I hear this from people at home and I can only imagine that this could be even exacerbated for someone who is a victim of sexual assault. And what I’d also love for you to take for the record is that period getting shorter or longer?

And I think the other challenge that we face is what’s the situation in terms of providers? Are we facing a shortage of providers? …One of the things that I was certainly glad to hear glad to hear the report of is that more people are coming forward. That’s what we wanted. We wanted to feel that people would be able to come forward and we want more to come forward, and so that also will mean that we’ll need to make sure we have the providers to give treatment and to give support. So I want to get your answer on that one too – what’s our situation on having enough providers in the mental health area? Because my experience has been that even at my state, for example, taking it outside the military context, we have a shortage of mental health providers within our state. So I’d imagine that you may have similar challenges. Wanted to get your thoughts of whether we need to put more of an emphasis on that.

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
Senator, we are required to produce a report on capacity to provide MST-related mental health care and virtually all medical centers within the VA system do have that capacity. So that is something that we do track.

Sen. Kelly Ayotte (R-New Hampshire):
Okay, on the follow up if you can let me know just sort of how long does an average person wait once the referral’s made and also just if you can answer to me what you think the provider challenges are in terms of going forward as we’re going to have more people report to make sure that we have adequacy of the support system there, I would appreciate an answer to that as well.

And Dr. Galbreath, I wanted to follow up on this issue of where we are with regard to the reports and the increase that we’ve seen in the reports. What do you think that that says in terms of – you’ve talked, I think, fairly positively about that as an indicator that we’re certainly glad that more people are feeling that they can come forward. What do you think in terms of the role of the commander? One of the pieces of legislation that we’re going to be looking at is how do we within the system – who keeps the decision in terms of whether the charge will go forward. And also, you know, the proposal for example that Sen. McCaskill and I have is one that would go if there’s a difference of opinion between the JAG lawyer and the commander, it would go up all the way to the civilian secretary in instances where the decision is to not bring a case. And in instances where both are in line that a case should not be brought, then it still goes up to another level of review. So, if we were to – what effect do you see or what role do you believe the commander should have in terms of involvement in addressing this issue? If you have thoughts on this.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
I will offer – ma’am, I’m a clinical psychologist, and clearly my perspective would come from treating victims. So I know that –

Sen. Kelly Ayotte (R-New Hampshire):
Well, yeah. I’m only asking you from your own background and perspective.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
You bet. I would offer to you that we believe that commanders really do need to be more involved, not less involved in this process because we know that they are going to be critical to setting that climate of dignity and respect in the unit. And that’s a kind of unit environment where we know that victims can heal and flourish. And every single victim who comes forward is – they’re experiencing influences other victims that are deciding whether or not to report. Until we get this right and we make sure that commanders are held appropriately accountable to set that climate of dignity and respect and have those tools with them that would allow them to enforce that climate, we really believe that that’s going to allow us to move forward on this and increase even more reports of sexual assault every year.

Sen. Kelly Ayotte (R-New Hampshire):
Thank you. I appreciate that. Can you also give us an update – my time is almost gone here – we’ve talked a lot about the Special Victims Counsel today, and I think all of us are very supportive of this. This has been legislation that I’ve worked on with Sen. Murray, who was the chair of the veterans committee, now the chair of the budget committee, very involved in these issues. How are things going? I know this is a very important undertaking and large undertaking. And so just as an initial report of what your thoughts are of implementing this important initiative that is going to give every victim a counsel that is…there to advocate for them and no one else?

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Yes, ma’am. Very briefly. All the services were supposed to have initial operating capability last October. They all stood up their full capability in January.

The Air Force as you know has the greatest number of the – has had this program going for about a year now.

Sen. Kelly Ayotte (R-New Hampshire):
They started it as a pilot. We extended it.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Absolutely, yes ma’am. And the information that we’ve gotten back from the survivors that have used the special counsel is overwhelmingly favorable. I do believe that this is a deal changer for victims of sexual assault in the military. Having that person to represent you increases their confidence, it allows them to kind of understand what their options are even more from a legal perspective. And although it is a small number, I would offer to you that what we’ve heard is of the restricted reporters that have engaged a special victims counsel, they’re conversion rate from restricted to unrestricted cases that would then bring them into the justice system and participate in a prosecution, their conversion rate is at about 50%. On average, across the DOD, we’re about 14% to 15% conversion rate. But once again, small numbers and initial data but we do think that this is very promising. And from a psychologist’s perspective, I think it’s great because it builds victims’ confidence and it boosts their abilities and gives them greater understanding of the legal system.

Sen. Kelly Ayotte (R-New Hampshire):
Thank you. And I think one of the things we’ll be watching carefully is just making sure we’re being updated on how it’s being implemented so that every victim can have access to a special victims counsel.

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