February 04, 2022

Hirono, Colleagues Raise Concerns About Lack of Oversight to Prevent Veteran Suicide

(Washington, D.C.) — Senator Hirono joined six colleagues in a letter to U.S. Secretary of Defense Lloyd Austin and U.S. Department of Veterans Affairs (VA) Secretary Denis McDonough to voice concerns about a Department of Defense (DoD) Inspector General report highlighting failures within DoD to screen for and prevent suicide amongst transitioning servicemembers from DoD to VA. As a member of the Senate Armed Services and Veterans’ Affairs Committees, Senator Hirono remains dedicated to advocating on behalf of veterans and servicemembers in Hawaii and across the country.

The Inspector General report, titled Evaluation of the Department of Defense’s Implementation of Suicide Prevention Resources for Transitioning Uniformed Service Members (DODIG-2022-030), found DoD did not screen for suicide risk or provide uninterrupted mental health care to transitioning servicemembers as required by Federal and DoD guidance. Specifically, DoD did not establish and implement oversight of the Mental Health Assessment (MHA) and lacked proper suicide risk screening procedures for transitioning servicemembers.

“Veterans and servicemembers have devoted their lives to defending our country and keeping us safe,” Senator Hirono said. “When they make the transition to civilian life, we must ensure that the DoD and VA will provide comprehensive care, including services that support holistic health and wellbeing.”

Senator Hirono has collaborated with colleagues in the House and Senate to introduce and pass bills that support servicemembers, veterans, and military families on various fronts. In 2021, she secured final approval for the construction of a long-awaited VA outpatient health clinic on the island of Oahu.

Hirono also introduced the Veterans and Family Information Act which required the VA to make information more accessible for non-English language speakers, enabling veterans and their families to better understand the benefits, programs, and resources available to them. Additionally, in light of the growing diversity of servicemembers and veterans, Senator Hirono also introduced the Every Veteran Counts Act directing the VA to establish and regularly update a database of veterans’ demographic data. This would allow for better understanding and accommodation of the needs of veterans from every race, ethnicity, gender identity, and sexual orientation.

Hirono was joined on the letter to DoD and VA by U.S. Senators Sherrod Brown (D-OH), Richard Blumenthal (D-CT), Maggie Hassan (D-NH), Patty Murray (D-WA), Bernie Sanders (I-VT), and Cory Booker (D-NJ).

The senators’ full letter is available HERE and below:

Dear Secretary Austin and Secretary McDonough:

We write to express our/my disappointment following the release of the U.S. Department of Defense’s (DoD) Office of Inspector General (OIG) report titled Evaluation of the Department of Defense’s Implementation of Suicide Prevention Resources for Transitioning Uniformed Service Members (DODIG-2022-030). The report highlighted DoD’s failure to take steps to screen for and prevent suicide amongst servicemembers during the transition period from DoD to the Department of Veterans Affairs (VA).

The report required by Presidential Executive Order 13822, Supporting Our Veterans During Their Transition from Uniformed Service to Civilian Life, highlighted multiple DoD failures during the transition process for all servicemembers with planned or pending separation from military service. The DoD OIG found that DoD did not screen for suicide risk or provide uninterrupted mental health care to transitioning servicemembers as required by Federal and DoD guidance. Specifically, DoD did not establish and implement oversight of the Mental Health Assessment (MHA) and lacked proper suicide risk screening procedures for transitioning servicemembers. DoD failed to provide continuity of mental health care by an insufficient definition of a warm handoff between the Departments, deficient provider training protocols, lack of standardized documentation methods, and unsatisfactory oversight procedures to ensure compliance of DoD Instruction (DoDI) 6490.10, Continuity of Behavioral Health Care for Transferring and Transitioning Service Members.

The report highlighted that the Defense Health Agency (DHA) and military services did not prioritize the MHA as part of the Separation History and Physical Exam (SHPE). Additionally, DoD and the services relied on expired policy to govern suicide risk screening and referral processes.[1] DoD did not implement a “warm handoff approach,” as required by DoDI 6490.10, to create continuous mental health care during the transition from the MHS to the Veterans Health Administration (VHA).[2]

We know that the first-year post separation is critical for servicemembers, veterans, and their families. These suicide prevention screening deficiencies could affect patient care at an important point in a veteran’s life. DoD and VA must do more to continue assisting servicemembers as they transition from uniform to civilian life. We strongly support the report’s recommendations, and urge your Departments to fully implement them in order to enhance the transition from military service and save lives. The report recommends that the Assistant Secretary of Defense for Health Affairs, in coordination with the DHA Director, and the Surgeon General of each Armed Service, establish consistent policies and procedures to manage suicide risk screening and referrals as part of the medical process for transitioning servicemembers.

The report also recommends that the DHA Director, in collaboration with the Director of the DoD and Veterans Affairs Collaboration Office, identify gaps in continuous mental health care for servicemembers who are transitioning from the Military Health System to the Veteran Health Administration, and ensure servicemembers have continuous healthcare for the duration of their transition. I/We further ask to provide support, time, and budget resources to initiatives intended to improve the quality of the warm handoff of care.[3]

We respectfully request answers to the following questions by January 30, 2022, and stand ready to work with you to combat servicemember and veteran suicide.

  • What steps are DoD and VA taking to ensure that all of the recommendations in the Evaluation of the Department of Defense’s Implementation of Suicide Prevention Resources for Transitioning Uniformed Service Members (DODIG-2022-030) are implemented?
  • What actions are DoD and VA taking to establish consistent policies and procedures to manage suicide risk screening and referrals as part of the medical process for transitioning servicemembers? When do you expect to have the policies and procedures in place?
  • Where are the gaps in continuous mental health care and what is DoD and VA doing to ensure that these gaps are fixed?
  • The report stated that there are no clear guidelines exist to help inform what dictates a warm handoff and there was no warm handoff from DoD to VA. What is DoD and VA doing together to establish what a warm handoff is and ensure a warm handoff takes place? 

We appreciate your service, and ask that you keep us informed as you develop and execute the policies and procedures that will help save lives during the transition process.  Thank you for your time and attention to this important matter.

Sincerely,

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[1] https://www.dodig.mil/reports.html/Article/2841764/evaluation-of-the-department-of-defenses-implementation-of-suicide-prevention-r/

[2] https://www.dodig.mil/reports.html/Article/2841764/evaluation-of-the-department-of-defenses-implementation-of-suicide-prevention-r/

[3] https://www.dodig.mil/reports.html/Article/2841764/evaluation-of-the-department-of-defenses-implementation-of-suicide-prevention-r/