tv House Appropriations Subcommittee Hearing on Female Veterans CSPAN March 6, 2019 12:01am-1:08am EST
>> i would like to call the meeting to order. this morning we welcome doctor haze -- and doctor susan mccutcheon. the topic of our hearing today which i am really glad we have an opportunity and time to take there are some byproduct benefits of a government shutdown and it is that we have the opportunity to slow down for a minute and take a step back and be able to have some really important discussions about the issues that we need to consider before we start writing our bills and access to health care for women is really critical and one that we think is important to try to turn the
spotlight on. women have been serving in the military at various capacities since world war ii. the number of women in the military continues to increase over the years. women have face challenges in gaining access to combat roles and it was not until 2016 that all combat positions were finally open to women. 20 [ inaudible ] just like in the battle states women face unique challenges seeking access to healthcare through the va. just like men who make up the largest population in the military the va is dominated by gender specific care programs for men. while the va has taken great strides to increase access to care for women more needs to be done. women and men serve with equal commitment to the military when it comes to access and gender specific care options at the va. funding for gender specific healthcare for women has remained stagnant at around $500 billion over the past two years. they are the fastest growing group and are estimated to make
up 50% by 2035 of the veteran population. more resources need to be invested to increase women's veteran access to care. they should be able to walk into any va facility and receive a basic standard of care and that is not possible now. having women doctors and gender specific care programs at every facility is the absolute least we can do and we are not currently providing it. on the bright side healthcare programs have expanded access to care primarily in remote areas and in places where the service is remote but the location where the veteran is is in. the aj provides standard pacificare through telehealth services but the va cannot rely only on those services to maintain care for women veterans. women deserve up close and personal care as well. like everyone around this table
the mental health of all veterans demands the proper top priority for me. women are more than likely to commit suicide and the suicide rate among women veterans is climbing much faster with a 45% increase from 2005 through 2016. there they are. thank you. i have really bad allergies. sorry about that. women who have experienced trauma are also more likely to commit suicide and we must do better to protect veterans who experience. while the va has made it is we need to dramatically reduce the number of veteran suicide rates and start seeing effective results of the va mental health program. dr. hayes thank you again for being here today and i look forward to your testimony and discussing these important issues with you. >> thank you madam chairman. i am pleased to have you here
today. i know this committee [ indiscernible - low volume ] has the greatest number of veterans and many of these veterans [ indiscernible - low volume ] more and more women are serving in the military and when they leave the service they become eligible for benefits and the appropriate programs need to be available to them. as i said in our hearing tuesday we have no excuse of not giving our veterans the very best. thank you for your work to honor and support our female veterans. welcome to our subcommittee and i am looking forward to your testimony. thank you.
>> thank you judge carter. now i would like to record nice the committee chairwoman. >> thank you for holding this important hearing. i am very pleased to welcome both doctors before the subcommittee. this subcommittee must address the challenges facing the department of veterans affairs in delivering care and benefits to the men and women who have faithfully served our nation. as the number of women veterans increases and with service academies reporting record numbers of female cadets and large numbers of women entering ground combat and special forces roles the development up specific and more diverse healthcare needs are critical. it is imperative that we focus on the women veterans of today
and tomorrow ensuring equitable access continues throughout every state stage of life. i am encouraged by some of the steps the department has taken which are important to this subcommittee. improving access [ inaudible ] improving access to and fertility treatments, maternity, newborn care, access to emergency contraception, women tailored prosthetics, these are just some of the improvements. these are encouraging and i am concerned there are systemic challenges at the va that may divert attention from these and future efforts. the va recently had almost 43,000 job vacancies across the
healthcare system. as of december 2018 this represents a 14,000 increase from 2017 and the demands on the va only increased and the shortages are a troublesome trend. systemwide strain will likely effective services that our women veterans rely on from primary to reproductive and mental health and long-term care. shortages of this magnitude may stall progress and lead to reductions in accidents which delay preparations for a large number of aging women and veterans and we west must maintain focuses on women's health needs. i appreciate you appearing here today and i look forward to
your testimony and thank you for your commitment to our nation's veterans. thank you. >> thank you madam chair. we will proceed with the standard five minutes rounds alternating sides. i would ask as always to be mindful of asking her questions leaving enough time for the witnesses to answer. i haven't seen the majority leader so i am not quite sure what time we will be called but knowing it is a getaway day whoever is comfortable doing one round and we can pick up a session for the record and hopefully [ indiscernible - low volume ]. i will begin, i have a lot of questions and actually, i'm sorry i have so many questions i eager to ask before you give your testimony. forgive me i am suffering from lack of sleep. >> [ inaudible ] good morning.
i appreciate the opportunity to discuss the high-quality care and support that the va is providing to our women veterans. i am accompanied today by the national mental health director for family services women's mental health and military sexual trauma and i am the director of healthcare delivery for the va. the number of women's veterans enrolling in va healthcare is increasing with increased demands on the healthcare system. women make up 16.2% of today's active-duty military forces and 90% of the reserves. in all service branches the expected number of women's veterans healthcare will continue to rise rapidly and the complexity of injuries of returning troops is likely to increase. more women are choosing va for their healthcare than ever
before. the number of women veterans using va services have tripled since 2001 growing from under 160,000 per year to 500,000 a year today. to address the growing number of women veterans eligible for va healthcare we are strategically enhancing services and access for women veterans. every vha healthcare system has a full-time women veterans program manager tasked with advocating for the healthcare needs of women veterans using that facility. any residencies use components which have been disseminated to improve efficiency and since 20 oh 8/5800 healthcare providers have been trained in our national program. we have enhanced by focusing on the goal of making sure we have women's health permit care providers at every site of care. the va has at least two women
helps providers health providers and in addition 90% of the community-based outpatient clinics [ inaudible ] . the va has implemented delivery models that inshore women receive equitable, timely, high-quality primary healthcare from a single provider and team thereby decreasing fragmentation and improving quality of care. the va boasts a wide range of services to women's veterans including comprehensive primary care, gynecology care, maternity care, specialty care and mental health services. additionally recent legislation authorizes in vitro fertilization and other in fertility testing and treatment for married veterans who have a disability that results in in fertility. the va has witnessed a 154% increase over the past decade [ inaudible ] number of women's veterans access to va mental health care. over 40% of our women veterans who use va have been diagnosed
with at least one mental health condition, many also struggle with multiple medical and psychological challenges including trauma related difficulties. to ensure providers have the skills and expertise to meet women women's needs they have developed innovative clinical trainings to strengthen access to services such as the new women's mental health residency. unfortunately some women experience sexual assault during their military service and may experience trouble with his aftereffects years later. the va provides free care including outpatient, residential for any mail till mental and eligibility is expansive. veterans do not need to have reported their experiences at the time or have any documentation that they occurred and they may be able
to receive free related care even if they are not eligible for other va care. in addition every va healthcare system has a dedicated coordinator to help them access services and programs. since 2007 there has been a 297% increase in the number of women veterans receiving related outpatient care indicating the positive impact of these efforts. the va is proud of its high- quality healthcare for women veterans and ongoing measures show women are more likely to receive less cancers than women in private sector healthcare. va analyzes quality and performance measures by gender, this has been key in the reduction and elimination of gender disparity and important out aspects of chronic disease management. since 2014 we have tracked access by gender and identified small but persistent disparities in access for women
veterans who overall are waiting longer for appointments than male veterans. the va has identified the longest wait times for women's veterans as working directly with those sites on initiatives to improve access that includes designating more women veteran health providers to provide training and improve provider efficiency. in addition to these delivered we have delivered telehealth to women in rural areas and in geographical areas. women's health services has also worked to ensure the inclusion of women pharmacists to expand the availability [ inaudible ] the va continues to make significant strides in enhancing the language, practice and culture of the department to be more inclusive of female veterans. these would not have been possible without consistent congressional commitment. it is critical we continue to move forward with the current momentum and preserve what we
have gained so far. or support is essential to providing high-quality care for the veterans and their families and this concludes my testimony. >> thank you. we appreciate your service and your testimony. we do have an increasing number of women veterans yes. we need to access va care as it increases. according to the number of women veterans that access to be a care was about 230,000 and i just want to say that number increased. i would like to know how the va is evolving to support the ever-growing number of women in the veteran population, particularly because the funding has been flat and stagnant and to me
that cries out for an increased amount of resources. how can the va's properly support the increases without providing additional resources? >> you are right. we have continued to experience what i call a tsunami wave of women veterans over the last 10 years and the numbers we are talking a lot of women that are staying longer and longer. what we have done that has been most to address it has to do been to develop a primary care model. there will be a designated women's healthcare provider we would have at least two at every medical center and unfortunately we are still at only 90%. we have been working on it and working on it. this year one of the ways we
have addressed it specifically is we are taking the training in a mobile way to the. we take the team out there. >> i'm glad there are creative ways that you are trying to make sure you reach more women but i am specifically asking are you receiving, do you need additional resources? i don't know how you don't given the explosion of women and the fact that we aren't even reaching all of the women we should. >> i must clarify the money we get goes into the medical services and it goes out at every site so it is distributed based on the number of women who [ indiscernible - low volume ] at that site and that model is when you are familiar with. in that sense the more women that are there presumably be fewer dollars we go there to meet that increased demand. specifically for the area of things that come to my level it has also been fairly stable and we are challenged to offer all of these trainings and do the
things we need to do for the demand. >> maybe the system isn't working properly in terms of the way dollars are distributed because if we are having trouble getting women access to gender specific care and we are at flat funding distributive based on the number of women at a particular facility then perhaps we are not allocating the funding in the right way. i would love for you to think about that and follow up with that. i have a lot of questions and most of them will have to be stricken from the record because of the schedule but i want to focus on women veterans suicide rates. we just had a 45% increase since 2005 through 2015 , any loss of life is horrific but whatever it is they the va is doing to research the cause of
women given the suicide rate is far more dramatic than men and how you cater your [ inaudible ] based on their previous gender specific traumatic experiences compared with other women for example that did not experience that. >> that his doctor mccutcheon's expertise. >> i cannot speak to what the causes are but i would like to talk about our clinical program. >> can you answer that question for the record? >> [ indiscernible - low volume ] >> you will help us get that information? >> absolutely. >> we have special programming that targets trouble with ptsd, addiction, msd which there is a known suicide risk. we also have a universal screening program. [ inaudible ] universally screened and so we have that
early indications so we can refer to services. we offer evidence based practice services at everyday medical centers across the country and such evidence based practices like cognitive therapy are the gold standards for ptsd treatment and they also show readers or of impacting suicide risks. in mental health services we have recently developed an innovative portfolio of services. we now provide training and collaboration with women's health services [ indiscernible - low volume ] and there is a link between eating disorders and suicide. what we have now done is we have trained teams including the physician, a therapist and a dietitian to address our veterans risks. even though this is gender- neutral we
new training we have and one of the things we find is individuals have problems with personal relationships and emotional regulation. this is something that is something we can provide for our trauma folks and some that come in aren't ready for this but still trainings help them. >> i'm sorry i am past my own
time having expired. i appreciate your input. what i would like to do because we are only going one round today i think it would be really important for the va to come and speak at the women's conference particularly about the range of issues that are important to women accessing care at the va and then we can drill down into some of these issues like suicide prevention. we can do that beyond just the appropriations committee. >> okay. >> thank you. judge carter. >> i too have a lot of questions [ indiscernible - low volume ] i think the question was asked and maybe wasn't answered completely, if we just had a magic money wand that we can waive over the issue of women's health what could you be specific as to what your needs are? where we should target extra
money? if you don't [ indiscernible - low volume ] we are all serious about the new wave of the military and we got to get it right. i know you've got a shortage of primary care doctors, is that part of the issue female primary care doctors? you try to put women with women doctors? that is one of the things i would like to ask. i just went through with my daughter and daughter-in-law's fertility treatment and i can tell you that is a very specific and skilled area and if you do it right [
indiscernible - low volume ] are you going to contract with that kind of treatment? [ indiscernible - low volume ] the guys that are good are really good. finally we just made a move in and you may be familiar with it . the number one reason for that being was that to get to their facility they had to walk [ indiscernible - low volume ] and it caused them not to come in most of our ptsd and other issues relative to ptsd [ inaudible ] before fort hood and was swapped out [ indiscernible - low volume ]
are you aware of that? >> to address your questions properly in order i would like to get back to you about some of the areas in which we have gaps and we can describe that in writing. it is multi-determined the need for primary care providers in women's health is critical and retaining the ones we have and i think you heard some yesterday about retention with the pay, there are issues that we have difficulty with retaining women's healthcare providers when we get them in place. we know is about recruitment. those issues and then there are issues about just the entire program and have enough of the right kind of support surrounding the women's program. i will be responding to that. in regard to fertility treatments yes it is contracted
out through the choice or mission act of the contracts we have because it is very special and a complex procedure. i am very aware of what you have done in support of the and it brings up an issue about making sure that the culture of the va changes to be better for women. we can't always move a site or the kind of program we want, we have to improve the work we are doing with veterans and staff to make sure the culture is safe, respectful and civil and that women do feel secure. we are doing major efforts on veterans by veterans in order to address this issue of what the culture is like in the va hospital. both answers are there and we can sometimes make [ indiscernible - low volume ] -- >> we are making specialized services that female veterans don't want to have a separate
place. they want to be in a place where they are welcomed and liked and every veteran should be welcomed and that they feel secure and comfortable [ inaudible ] on that. >> [ indiscernible - low volume ] >> that should not be when you come to your medical appointment. >> it should not. [ indiscernible - low volume ] waco has got more availability then does. >> just to add we have connected the waco with our national support team so they are making sure they get the proper training and education to make sure that treatment program is of the same caliber as it was. >> [ indiscernible - low volume ] that is what we are looking at. >> i hear that there is a lot of enthusiasm in waco and that
the construction is nice and people are excited. >> good. thank you. >> thank you judge carter. >> thank you and thank you for coming here today. a few years ago and was turned away because they had never seen a pregnant veteran there before. she was sent away without the necessary referral. i don't know what she was doing the first two trimesters and there is a piece of literature that says that your local va facility has a full-time women's veteran program manager ready to assist you in getting timely access to the healthcare you need. to the va facilities do the va
facilities have a women's medical program manager and if not is there someone trained to assist veterans for referring them to the appropriate care so what happened in my district frankly never happens again? have you heard of that before? >> madam chair i am always [ indiscernible - low volume ] improper care has been delivered or not delivered in this case. we do have someone at every site so while there is a main program manager at the hospital every site has a women's liaison and is trained with often a nurse there or other assistance that is there and we make sure they are trained up in these things. we have rapidly expanded our maternity services and our maternity care. we have a maternity care coordinator so if someone comes into the va regardless of their time that is pregnant, we know
about 50% of pregnancies are unintended so that could mean people are a little surprised and end up delaying care. they come into the va and we make sure they get all of the testing and get started on things like the vitamins they will need and assign them to a care coordinator. something like that would be an urgent appointment and then we follow them through their pregnancy and they get called every month or more often and we get them lactation help and anything they might need to have a successful pregnancy. women should want to come back to the va after the an postpartum care. >> that sounds good to me. >> we have had some improvement. i was not aware of that particular one but that things happen sometimes when people are not trained up correctly. >> thank you madam chair.
>> we have consistency and awareness of the way we should be dealing with women veterans. >> thank you madam chair and thank you for being here this morning. doctor haze well excuse me -- dr. patricia hayes you mentioned the 154% increase in women veterans accessing va mental health care in the last decade and i noticed there is also a 290 for 7% increase 297% increase in msd. is there a study linking those two together [ inaudible ] how much of the mental health treatment as a result of the msd? >> [ indiscernible - low volume ] i got so excited to answer this. we have a universal screening program when every veteran comes in and it has two
questions, while you were in the military were you sexually assaulted or were you harassed in a threatening nature. if you answer yes to one or both questions then you are automatically told you can receive free mental health [ indiscernible - low volume ]. since we have been screening this last fiscal year 29% of the women who have been screened have indicated yes that this did occur. the numbers have been slowly creeping up. at one time we were saying 1 in 5 , now it is at 29.1. one of the good news stories out of that though is we are seeing an increase of those individuals who then say yes i want treatment for this experience and last year for women it was 80.8% of our women and that number has been increasing. i think women are getting the
good news that there are quality treatments available in mental health. you are right, so many of our women we see have mental health disorders, sexual trauma itself is not a diagnosis but there are many diagnoses associated with it so the majority of our women do suffer from ptsd or depression or things like that. >> the outreach must be and the education piece must be pretty effective because they don't have to show up at the va for any other healthcare issue to be seen for mental health as well correct? >> right. if they just want msd related treatment that is yes. certainly we find many of our have other medical and mental health issues so we have a lot of coordination of care and that is one of the good aspects
of having the va. >> good job. there are 24 of the va facilities that don't have gynecology care on site. is it because of where these facilities are at? can you talk about that? >> certainly. we have gynecology on site at the majority of our facilities. those that do not are the class of facility that generally doesn't even have surgery on site. gynecology is a surgery profession so you need a surgical service to have a clinic and to be able to perform procedures on site. those women who are at those sites are seen by and because these tend to be fairly rural sites widespread veteran
locality that is better for the women to find a gala colleges close to where she lives so she will be traveling a long distance to a facility and that would make sense. we need to give it to her where she lives in those cases. >> so it is not really as much related to a lack of ob/gyn doctors as it is location? >> the location frequently is one in which we have to -- some will do office work and we would love to have them come in and do some of the care at those sites but then it could be a small town where you have one person and they are working at a community hospital. the option is to send the veteran into the community and the coordination is critical. >> last year the service women's action network called the establishment and social groups for all women and veterans, how have we done on
bringing that together? >> veterans have a number of different counselors and women veterans are also counselors there. i would have to get back to you about whether the implemented that. there could also be confusion over peer counselors which was part of a legislative request. we may need to clarify your question in terms of what exactly -- >> they were trying to establish peer support groups in each facility and i guess that is part of the positions you spoke about four. >> [ indiscernible - low volume ] [ inaudible ] >> sorry. >> my time is up. >> mr. bishop. >> thank you very much madam chairman and thank you dr. patricia hayes and dr. susan
mccutcheon for your work and thank you for both appearing before us this morning. you have touched on a lot of the issues already that i had an interest in but let me go to a little different here. i believe gilman wrote a book called the hazards of war the untold story of a team of women soldiers in special operations on the battlefield. it is about a team of servicewomen who were recruited by special ops to serve on combat missions in afghanistan. she paints a picture that while a record number of women [ indiscernible - low volume ] war stories haven't caught up with the pop-culture and that pop-culture phase is a huge part have may change in america is listening to their stories. we often think of special ops as a male based operation but i
know that now i know that is not always the case in this is an example. i was enlightened on the number of fellows that said -- platoon leader they sought out the female soldiers to go on missions with them to conduct searches of local females of various operations. i am going to ask you whether or not veterans affairs has any special programs that work with female veterans who may have endured those kinds of stressful deployed circumstances . my second question is to put it all together. in your written testimony you
state that the va is aware of the challenges that are faced by veterans with children with regards of access to their medical appointments and medical care counseling services. of course that is stressful for a veteran who is a single parent and dealing with ptsd. do you have facilities at the va clinics to accommodate children that may have to accompany the single-parent to the medical appointment while they wait for their care? of course do you have also special programs to deal with the high stress of female veterans that have been exposed to that combat exposure? >> i would like to address that question second actually because childcare is more straightforward.
childcare is not let me back up, the va is not authorized to provide child care to veterans because it is not medical care. the council opinion in 2009 and with public law we have carried out the pilot in childcare and those are limited and -- >> can congress count on that? >> i think congress passed a bill last week so i will defer to your wisdom on that. we can answer any questions. the other question about experiences in the military and combat and things i think both physical and emotional experiences related to combat are things we are addressing and we could go into details about more ptsd programs to have combat components or combat sequences where these are women's programs that they can go to in terms of combat
experience. >> i appreciate that answer to know that you do have those programs but getting back to the childcare, it seems to me [ inaudible ] an added stress for a single female veteran, a single parent a female veteran to have to go to a medical appointment with a child or children and have to keep up and manage that trial child while they are waiting to get care. if you are limited in terms of what you can do with regard to providing childcare for female veterans for that matter any veteran that has to come get treatment and bring children we in congress do have the authority to give you the
ability to do that. we need to know it is needed. >> thank you. >> [ indiscernible - low volume ] >> thank you madam chair. i am the rookie on this committee just to be clear can you use more money? >> i have gotten myself completely boxed in. this is a discussion -- >> let me rephrase the question, if you have increased your people coming into your facility by a factor of three since 2001 could you let this committee know of a factor increase in your budget and what it would look like? the question is not for the secretary of the va but for you. >> i understand. >> texas has more female veterans than any other state with 820,000 and my second question is on nontraditional
therapies. i have an entity in my district called pink berets and they do cooking therapy and gender specific group therapy, how can nontraditional care like that be better integrated into what the va does? >> we are always hearing about these wonderful community resources and so hopefully every va medical center has a women's mental health champion and it will be their responsibility to do outreach into the community to find such programs like what they offer because temporary offers are programming not available in the va. some of these special resources -- >> is that a function due to choice program where they get connected to the va and
ultimately seen by there coach with provider or is it more like a? what is the specific style of program for those to be a tool that the women can use? >> the pink beret is a nonprofit that our women veterans can go there for free. it would be a choice of whether the va is paying for services but [ inaudible ] complement what is going on in the va or perhaps if they are interested in therapy at this point a support group would be important [ inaudible ] >> every va should be connected with these types of programs because we can't do it all by ourselves. >> i am sure you are opening to me following up and having more
specific questions? >> absolutely. >> i am glad we are having this interaction but we are not there yet and in the absence of getting there we should not allow and as judge carter alluded to if women are not coming to care because they are uncomfortable with the code gender, coed group sessions then we need to address that and we need to make sure that we are able to provide them the care they need and what are we doing in the interim until we have achieved this utopian state where this doesn't happen? what are we doing to make sure they feel comfortable to get those resources? >> we are working really hard and i appreciate your point. this is not there yet. >> this is concern i hear from female veterans in my district. >> i have met directly with several directors and we are
holding everyone accountable about this gender and sexual harassment. we have a major effort going on and we will tell you more about what we are doing but i also appreciate what you're saying that women only groups would be the ideal and i think that would be important for dr. susan mccutcheon to have a comment on that. >> some women do prefer women only groups for various reasons but some of our women do prefer gender mixed gender groups and the va does not put one over another. women eventually have to do out go out into their communities where there are men and they have that opportunity to interact with men in a therapeutic and protected environment which could be part of some treatment plan. we don't want to reduce all of the mixed gender programs. sometimes we will work with a
woman individually and build up her skills so she may want to enter in. >> i appreciate all of that and we do recognize that i am not a doctor, i am not a clinical physician, i don't understand these things but if women are uncomfortable even getting that first step of treatment and that is why they are not coming i hope you recognize that. yes we are trying to get them back into society if you will but we have to address the problem of front which is the gap of why our female veterans aren't getting the help they need. >> guess there is definitely a difference. >> thank you. i agree and it should be the veterans choice. >> [ indiscernible - low volume ] >> first of all i am walking along the same path as the ranking chair and everyone else which is that this is us asking you what you need and to me looking at it into the future
this is completely predictable. you have 10% of veterans now that our women and 16% are increasing numbers going into the armed services, is there a long-term plan? let's say long-term is 10 years, do you know today within reason what you think the number of veterans will be in 10 years? what percentage of the veterans they will be what percentage of veterans they are going to be, and what services they are going to need so that you can start today to build up your treatment services and to request funding over a period of time that is a funding mix over a little bit more to emphasize the needs of a growing disproportion of population as compared to now? we can see where this is going, and i don't know where i am
going to be in 10 years, somebody will be sitting in the chair in 10 years and say why didn't you do this 10 years ago? are you starting down this path? >> i started on this path 11 years ago and somebody show me a speech i made earlier in my career and by the time i retired about women would be 20% of the population. i have been running and wrapping up for quite some time and they ba has very good projections on enrollment and by zip code, and we know what we need. >> how far out do those predictions go? >> the ones that go with the exact numbers are 30 years and then there is 50 years. we work with local facilities on those projections. the real issue, and there's many other issues, but the one that you spoke to is about shifting resources and unfortunately, the world war ii veterans are passing on and korean war veterans are just behind him.
the issues as we replace those positions and other staff, that is part of the projection as well, moving the resources from some of the other programs and making sure that people are trained up, and we train up so many providers. men are uncomfortable with prescribing things like birth control, so we trained him to do this and to do exams and inspections and women and things like that. part of it is not just more money, but making sure that we are getting the right force in their so that we have people that are designated as health providers taking care of the women. that is a program that is going on now and we have been doing it really hard. we have many more than we had a few years ago, but there is turnover and more women coming in the door. as you say, are we doing it for tomorrow and six months from now when your side might have 1000 more women than they have today.
that is the in the weeds part of it that it is hard to implement. >> that is really good to know. one quick question. do women utilize the healthcare more than men generally or less? >> women need more visits than men do. my question is are they in the va healthcare system disproportionate to man? >> no, they underutilize, about 10 points lower than men in terms of those that are eligible to come back him. >> why is that? >> we have actually grown from a greater gap than that, and more women are coming and staying. the reason they don't come and the number 1 reason is that women do not know they are eligible and don't identify with the word veteran and don't know the va benefits for them, and the second reason is they think the va doesn't have women's health services. >> that would be for a woman directed outreach. >> we do so, and we have a call
center that calls women who do not use the va, and we actually make calls to about 1.2 million and have reached about 600,000 in the last five years. we are doing outreach as well as part of the effort to increase the number of women that utilize the va. >> thank you very much. >> thank you. >> mister cartwright. >> thank you madam chair. thank you both for being here, and since the passage of the women's veteran health program act of 1992, we have obviously been playing catch-up to provide women veterans with gender specific healthcare services from the va. here is my question. is there a way of quantifying in any way the closing of the care gap when it comes to women's health, and candy vha give us more than just a general report on the gap closing that still needs to be
achieved? >> i think we can give you numbers on how many providers are for each site and how many we need. you cannot always say that the reason for that gap and we have that very detailed gap analysis, and i am not sure exactly what else we can describe for you sir that would be helpful in this case. >> i am a numbers guy, and i would like to see a chart that will show are we closing that gap and how rapidly and are we doing a good job? >> we do produce these reports on where we are, the status today, and where we have been is much more important than the need going forward. in terms, we can show you the enrollment projections and utilization projections and where we are with the providers to meet that.
>> i am going to get back in touch with you. >> i am very happy to brief you on that because the numbers help to drive us to do the right care and fill in the gaps more comfortably. >> thank you, and that is all i had. >> thank you mister cartwright. >> thank you very much and thank you so much for the work that you do for our women veterans. i will try to be specific and you guys talked a lot about mst and it is uncomfortable with the amount of women that experience that and i am happy to have the expert here with us today, so thank you for that. let me just read through this so i get it right. please recognize that mst is a valid claim for claiming disability and in 2002, this does not generally end up in service records and you mentioned that. it is written that the relaxed standard is only available to those diagnosed with ptsd and not diagnosed with other mental health disorders. this is something i'm putting a
lot of focus on the benefits side. i know on the mental health professional side, i would like you to speak a little bit to the range of mental health disorders that sexual trauma can cause include using major trauma disorders as defined by the american psychological association. i think what i am looking for in your professional opinion you believe it will be appropriate for congress and the va to provide uniform standards so that all veterans that are diagnosed with a mental health disorder for sexual trauma during their time of service are eligible for claims and benefits. i hope i have made that clear. you cannot qualify for benefits unless you exhibit ptsd and we know and i'm sure you know there are other things that people might exhibit. i realize you are not in charge of them and may not even want to be quoted on this.
>> you are absolutely right. although ptsd is the most prevalent disorder, we see as you mentioned depression, addiction, anxiety, and we are doing a lot with eating disorders. >> you mentioned that. >> being a long time va employer i am taught to stay in my lane. it seems like that is more of a vba issue but it certainly has been well recognized, and it is not just ptsd with a sex base. i think we have come a long way in understanding what goes on with our men and women with this experience and i think people will or will recognize that it is more. if you have any more comments to that, that is something that i think is well-established, and i would have to talk with the
va. >> i am working very hard on the benefits side, and i fully understand it is not your lane, but i do appreciate if for no other reason that you are validating my concerns and only ptsd, and everything else, sorry, go on with your life and good luck. thank you for that. >> as you know for your self, and men and women experience, the actions of the individual, and we respect that and i applaud you for what you are doing. >> thank you so much for the work you are doing and we appreciate it. i will get back. >> batting cleanup mister ryan. >> thank you i will be brief because i know we have to hustle up. i want to say thank you for your leadership all of these years and it is much appreciated
and to have two dynamic women here from the committee and before the congress is very important. i feel like we can really move the needle on this so thank you for that. i am going to throw a couple of things out submitted for the record, i want to follow up on summons heard question about the outside treatment and outside groups that can help with some of this as they do a lot of work around mindfulness stress reduction, and a lot of work around adverse childhood experiences, and i think it would be smart for us on the defense side even before they become veterans to start to understand some of the trauma that happened before they get into the military. we end up handling and dealing with a lot of that. i want to figure out how we can get a more coordinated effort around childhood experiences as
we are learning more more every day and that long-term impact, and the sooner we can figure this out for each individual, i think the better off we are going to be. so again, thank you for that, and if there is anything that we can do on the side to work and help coordinate that, it would be terrific. >> just a brief comment because i know you are in the area, and what we find in that area is that you actually have a hallmark of behavioral therapy offered, and i wish we could, and this is something that we hope to do in the future. >> i'm sorry, can you say that again. >> i appreciate that.
>> that is a physician, and that is not a paid position where there is a woman's veteran position, but a funded position. a person has to do coordination around the mental health at that time. the coordinator and the women's mental health champion are vital positions, and they do that probably on their lunch hour and whenever they can. >> we have an issue. that's all right. i would just say quickly i went out, and yoga and mindfulness, and these are not operative everywhere. i went to the, and with a just
started it, a lot of vietnam veterans was there, and i wish they would've found these treatments or techniques or whatever you want to call them 40 years ago as we could've healed them and healed the relationship and their health would've improved. i went back a few years later and the veterans cannot get into the classes because they became in high demand. they don't want to go on medication. they want to get some technique they can take outside of the va, and work with themselves. i think maybe we found the opportunity here, so thank you. >> when we write this bill we have a lot of opportunities here, and that is why we have been focusing on these hearings where we can shine a little bit of a brighter spotlight on the issues that we don't normally get to spend some time on. thank you mister ryan and thank you both for your dedication to
our women veterans, and i understand that restrictions of your ability to communicate and not be advocates here in front of the committee today. that is our job, so continue to follow up and we will have discussions with you on how we can best meet the needs of our women veterans and it will be ongoing. that concludes the hearing this morning and i want to remind members that i next hearing will be on wednesday march 6, and that hearing will be at 10:00 a.m.. the committee stands adjourned.
news and policy issues that impact you. coming up wednesday morning president of the institute for free speech will discuss a bill by house democrats to reform campaign finance laws. mike thompson will talk about gun violence prevention legislation in congress. in the latest report on all timers in the united states including the prevalence and cost of care with chief program officer of the all timers associated -- association. sure to watch the c-span washington journal. joined the discussion. >> in the morning here on c- span 3, homeland security secretary krista nielsen has to capitol hill to testify on motor security and other issues. that is live at to the clock a.m. eastern. then a hearing on sexual assault in the military focused on response and prevention.
also, on c-span 3, and the free c-span radio app. >> a senate homeland some committee own investigations is looking into the impact of the chinese government on the u.s. education system. the chinese government has invested in more than 100 confucius institutes located on campuses across the u.s. witnesses from the state and education department testify at this hearing.