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

Partial transcript of Sen. Tim Kaine’s (D-Virginia) 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. Tim Kaine (D-Virginia):
…Thank you all for the work that you do on this important area. I want to start with a concern that was raised by Corporal Arbogast and directing it to the VA, and that was the concerned that he raised about as a man being told, “Well, we don’t really have a group for men” and feeling like the services weren’t maybe at the same level.

And I was just curious, Dr. McCutcheon, as I was looking at your title. You’re the National Mental Health Director and it says “Family Services, Women’s Mental Health, and Military Sexual Trauma.” Is that the name of like a department or division or program – “Family Services, Women’s Mental Health, and Military Sexual Trauma”?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
Senator, that’s a good question. It’s actually three areas of our responsibilities that I hold in my position.

Sen. Tim Kaine (D-Virginia):
I see.

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
I have a colleague who is the National Director for Evidence-Based Treatment and Psychogeriatrics. It just happened to be that those were their special areas. But my title in no way implies that we see MST as a women’s issue. We have worked very hard to show it as a gender-neutral disorder, and actually the primary responsibility for military sexual trauma was removed from women’s health services to be placed in mental health services in 2006.

Sen. Tim Kaine (D-Virginia):
Good. That’s helpful.

Let me ask your reactions each from the VA and DOD sides about the discussions in both of our earlier witnesses, their concerns about this over-medication phenomenon. What could you tell me about that?

Dr. Susan J. McCutcheon, National Mental Health Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Department of Veterans Affairs:
Senator, I’ll start from the VA. I really can’t speak to that because I have no first-hand knowledge of what the VA is doing as far as analyzing the use of medications. So I would need to take that for the record. I’m sorry.

Dr. Karen S. Guice, Principal Deputy Assistant Secretary of Defense for Health Affairs:
I don’t know what the degree of specificity, I think, really you need to have for this answer, so we would like to take it for the record too.

Sen. Tim Kaine (D-Virginia):
Okay, then what I’ll do is we’ll try to submit a precise question in writing rather than you have to have to kind of guess what we mean, and that might be a little bit easier. And we’ll just take that one under advisement.

One concern – just to share a concern that I’ve heard and I don’t know if it’s regional or more general is in the suicide prevention area. I think you guys do a good job of trying to publicize to active duty and veteran suicide prevention hotlines within DOD and VA. I had an experience in the last year in the Hampton Roads area in Virginia where there are a lot of veterans of somebody saying they’re doing a great job of putting out – there’s a suicide prevention hotline and there will always be somebody there to take your question and deal with you, and he said “But they didn’t deal with me right away.” I said, “Why not?” He said, “I contact them.” We dug into it and this was an individual who would email the email address. And it turned out that the hotline really was a 24-hour hotline if you called on the phone. But if you emailed, it was kind of a cold line. And he made the point to me that if you’re in an extreme in the mental health area, it might – even the act of talking to someone can be a little bit tough, and it can be a little easier just to write an email and send it “I need help.” And he felt like his cry for help was kind of ignored…Turned out it was maybe treated differently because it was an email. I would just recommend that to your attention. That might be fixed. Might have been just an aberration. It might have just been one VA hospital. But I can see why somebody who’s in an extreme situation might feel more comfortable reaching out via an email than a phone call.

Ms. Jacqueline Garrick, Director of Department of Defense Suicide Prevention Office:
Senator, you raised a good point in that we know suicide is complex and so we’d like to think that the way in which we deal with suicide also take a multi-faceted approach so that when somebody reaches out for help that there are options in how they even initiate that contact. And what the Department of Veterans Affairs has is a veterans crisis line. The DOD uses it as well, and we brand it as the military crisis line. It’s the same crisis line.

We also have a Vets for Warriors program that we have funded in the Department of Defense that’s a peer-support program so it gives you an option of if you just want to talk to a peer and do some problem solving, get a referral. And the peers also provide what we call resilience case management so that they can track and stay with you over the course of your military career.

The goal, though, is to make sure that regardless of whether you do a phone call, an email, a text, a chat, that when you look for help, there are different options and ways for you to find that help.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
And sir, I would offer that at DOD safe helpline as well you can click, call, or text 24/7 and there’s somebody there live to answer any kind of reach out from the individual.

Sen. Tim Kaine (D-Virginia):
Finally, I’d like to go back to Ms. Kenyon’s testimony. When I asked you that question about her analogy between incest and military sexual assault because of the betrayal factor, I was curious. In some full hearings before the Armed Services Committee, we’ve tackled to some degree the issue of suicide of active duty and veterans. Sen. Donnelly in our committee has been really focused on this. And I recall some testimony about sort of while it’s a complex phenomenon, a number of military witnesses in the past talking about and sort of enlightening me about it, that it’s less people have come back and seen horrible things and the horrible things are weighing on them and driving them to suicide and more that people are involved in such a close support network and came back and that network – that band of brothers and sisters – kind of was no more and even if they had networks of people around and they didn’t understand what they’ve been through. And that experience of going from a close support network of colleagues to a feeling of disconnection that that has been a factor in testimony earlier in the full committee that’s kind of been suggested that there’s some research that really ties that into this problem of military suicide. Am I remembering or basically describing it correctly? I mean, is that one of the factors?

Ms. Jacqueline Garrick, Director of Department of Defense Suicide Prevention Office:
The causes and the associated factors with suicides do tend to be very complex. And we know that the primary factors associated with suicide are relationship issues, financial issues, and legal issues. So when we look at relationship issues, I think what you’re describing is a loss of a relationship issue. We tend to think about that as an intimate relationship issue but that does certainly extend beyond, and we know that on the active duty side, this is mostly young white male who have died by or attempted suicide. So that when they come and go from active duty or changed units, we have seen the majority of our suicides are among those that in their first year of enlistment and who have never deployed and have not been in combat. 89% have not seen combat. So there is some serious issues that we feel we try to look at and that’s why again the peer support and providing community-based care is so important is because we really see that those relationship issues are such a driving factor in relationship to suicide and self-harm.

Sen. Tim Kaine (D-Virginia):
Madam Chair, just to close the loop with one last question. That would then loop back to Ms. Kenyon’s point about the betrayal phenomenon. In a sexual assault in the military, if there’s a close connection between colleagues, your superior, a sexual assault in your unit is the sundering of a relationship that you had an expectation that was a relationship based on trust. And that suggests a little bit of the connection between sexual trauma in the military and this risk of suicide.

Ms. Jacqueline Garrick, Director of Department of Defense Suicide Prevention Office:
And the Defense Suicide Prevention and Dr. Galbreath’s office, we are working on a study right now looking at some of those intersections between suicide prevention and sexual assault response so that we can get a better understanding of how we can move forward on providing support and services to this population.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
I was just going to say I couldn’t agree with Ms. Kenyon more. I mean, it really is tantamount to an incest-type of situation. I think that’s a very adequate description.

Sen. Kirsten Gillibrand (D-New York):
And to follow on, isn’t the betrayal also that they have to tell their “dad” – the decision maker? It’s not just the betrayal that you’re being raped by your brother. It’s that second betrayal that makes it intense.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
Depending on who the perpetrator is, ma’am, yeah.

Sen. Kirsten Gillibrand (D-New York):
No, what I’m saying is the second thing about reporting and that the decision maker is – I’ve just heard one victim say “It’s like being raped by your brother and your father decides the case.” So the reference to incest goes beyond who the rapist is; it’s also that it’s decided as a family matter, and the person deciding has to decide between two children that they both deeply love. And so that lack of objectivity to just look at the facts, look at the record, knowing the victim, knowing the perpetrator, according to this one victim, that was the second betrayal. It’s not just one betrayal.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
So it’s so important now to have so many different ways to report so we can get it outside of that system, that you can report to a –

Sen. Kirsten Gillibrand (D-New York):
No, we’re just talking about the decision maker. Your dad decides. No question. I was just clarifying what I understood the testimony to be based on other conversations I’ve had with survivors and how they perceived it, that the incestuous reference is not just about who rapes you; it’s also about who decides your future, your fate.

Dr. Nathan W. Galbreath, Senior Executive Advisor of Department of Defense Sexual Assault Prevention and Response Office [SAPRO]:
That’s not one that I’ve heard from my victims, but I understand what she said.

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