UPDATE: The U.S. Senate passed the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 by unanimous consent on June 24, and President Joe Biden signed it into law on June 30. Original post follows.
From the earliest Memorial Day observances organized by freed slaves following the Civil War, this holiday has focused on remembering military service members who died in wars. More than 26,700 Iowans have died in wartime service, with the Civil War accounting for nearly half of the fatalities.
Far too many Americans with military backgrounds die by their own hands. Hundreds of active-duty troops and more than 6,000 veterans take their own lives every year. That death toll exceeds the total U.S. military fatalities in Iraq from 2003 to 2020.
Iowa's members of Congress have tried again this spring to improve mental health services for veterans. Unlike in previous years, legislation named after Sergeant Brandon Ketchum made it through the U.S. House and now awaits action in the Senate.
Ketchum did two tours in Iraq as a Marine and later deployed to Afghanistan with the Iowa National Guard. He was discharged for medical reasons in 2013 and struggled with post-traumatic stress disorder, a traumatic brain injury, and substance abuse. While living in Davenport in July 2016, he sought inpatient psychiatric care at the Veterans Administration Medical Center in Iowa City. Inpatient detox rooms were full, so Ketchum was sent home and advised to continue outpatient care, even though his case file showed he had already made two suicide attempts. He took his own life the next morning.
U.S. Representative Dave Loebsack (IA-02), whose district included Davenport and Iowa City, introduced the "Sgt. Brandon Ketchum Never Again Act" in 2017. The bill would have required "the Department of Veterans Affairs (VA), upon the request of a veteran who is enrolled in the VA health care system and entitled to in-patient psychiatric care, to furnish such veteran with in-patient psychiatric care at: (1) the VA facility that is closest to where the veteran resides and that has the capacity and capability to provide such care, or (2) at a non-VA facility if the VA facility lacks such capacity or capability." Loebsack's bill did not advance in the Republican-controlled House, despite having some GOP cosponsors (none from Iowa).
Axne led the Iowa's whole House delegation in introducing a new bill in April. I've enclosed their joint statement below. The Congressional website summarizes the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 as follows:
This bill requires the Department of Veterans Affairs (VA), during FY2022, to establish and maintain three new centers of the Rural Access Network for Growth Enhancement (RANGE) Program in areas with interest from personnel and a need for additional mental health care for rural veterans. The RANGE Program serves veterans in rural areas who are experiencing mental illness.
The bill requires the Government Accountability Office to conduct a study and report on whether the VA has sufficient resources to serve rural veterans who need mental health care that is more intensive than traditional outpatient therapy.
Tony Leys reported for the Des Moines Register last month, "The program is described as being for rural vets, who under federal rules would include those living in much of Iowa." The Congressional Budget Office estimated the expansion would cost $3 million over the three-year implementation period.
Loebsack's bills never got a committee hearing, but a House Veterans Affairs subcommittee quickly took up this bill. It advanced from committee and was brought to the floor on May 18, along with more than a dozen other bills. Some of those bills also related to support for veterans and were introduced by Republican Representative Mariannette Miller-Meeks, who now represents IA-02.
House members suspended the rules and passed the package by 350 votes to 75. All four Iowans were part of that large bipartisan majority.
The bill now moves to the Senate, where it should garner bipartisan support. Senators Chuck Grassley and Joni Ernst demanded an investigation of Ketchum's case in 2016.
Final note: A special crisis line is available for veterans or military service members considering suicide: (800) 273-8255, then press 1.
Free, confidential support is available 24/7 for people who have considered taking their own lives. Anyone can call the National Suicide Prevention Lifeline at (800) 273-8255 or contact the Crisis Text Line by texting TALK to 741741. Iowa operates its own free crisis hotlines at all hours and every day of the year, for those seeking help with any mental health issues (including thoughts of suicide) as well as gambling or substance abuse problems. Visit YourLifeIowa.org online, call (855) 581-8111, or text (855) 895-8398.
If a loved one is showing warning signs of suicide, try not to leave the person alone. Try to remove weapons, drugs, or objects that could be used to take one’s own life, take the person to an emergency room, or call the National Suicide Prevention Lifeline at (800) 273-8255.
April 13 joint news release:
Axne, Iowa Delegation Honor Iowa Veteran Brandon Ketchum with Bipartisan Legislation to Improve Rural Veteran Mental Health Care
The Sgt. Ketchum Rural Veterans’ Mental Health Act expands VA rural mental health programs and supports additional research
Today, Rep. Cindy Axne (IA-03) led the entire Iowa House delegation in honoring the memory and service of Sergeant Brandon Ketchum of Iowa with the introduction of bipartisan legislation named in his honor that would expand access to mental health care for rural veterans.
In 2016, Sgt. Brandon Ketchum of Davenport died by suicide after he was denied access to mental health services related to his battle with post-traumatic stress disorder at a Department of Veterans Affairs (VA) facility in Iowa.
The Sgt. Ketchum Rural Veterans’ Mental Health Act establishes new Rural Access Network for Growth Enhancement (RANGE) programs through the VA and supports additional research on rural veteran mental health care needs.
“Veterans like Sgt. Ketchum put their lives on the line and serve our nation with honor. When they come home, they should be able to receive the care they need regardless of their zip code.” said Rep. Axne. “We need to improve mental health care for veterans to ensure any veteran requesting treatment has the proper resources are available to them. Turning veterans away shouldn’t be an option. I’m proud to introduce this commonsense legislation to establish more mental health programs and examine some of the barriers our rural veterans might face when seeking mental health care.”
“The case of Sgt. Ketchum is tragic and shows us that we must do more to serve our veterans,” said Rep. Mariannettee Miller-Meeks (IA-02). “Expanding healthcare services in rural America and among our veterans are two of my top priorities in Congress, so I am proud to join the entire Iowa delegation in this effort. We simply have to do better for our veterans, there is no other option.”
“Our veterans deserve the best care and attention, including when it comes to treating unseen wounds. That is why I am honored to be a part of this effort to expand mental health services to veterans in rural areas. After Sgt. Ketchum’s heartbreaking death, it is clear the lack of reliable mental health services for our veterans needs to be addressed. Our legislation will help prevent tragedies like this moving forward,” said Rep. Randy Feenstra (IA-04).
“Sergeant Ketchum’s tragic story is too common among veterans, especially those in rural areas who may have a harder time accessing mental health services. This legislation, introduced in his honor, will help increase access to mental health services for veterans and ensure those who served our country have the support they need and deserve once they return home,” said Rep. Ashley Hinson (IA-01).
According to the VA, at least one in five veterans return from combat with at least one serious mental health condition, yet 85% of rural residents live in a Mental Health Care Health Professional Shortage Area (HPSA).
To address this, the VA developed RANGE programs, which provide a small team of specialists to meet the needs of rural veterans with serious mental health and daily living issues.
These programs are designed to support veterans who often are at high risk for housing insecurity and extensive inpatient hospitalization by integrating community, family, and financial resources in support of independent living.
In addition to establishing three new veteran mental health programs, the new legislation bill will direct the Government Accountability Office (GAO) to study how the VA can improve mental health care for rural veterans to enable better response in the future for veterans like Sgt. Ketchum who request treatment.
The bill was introduced with Reps. Ashley Hinson (IA-01), Mariannette Miller-Meeks (IA-02), Randy Feenstra (IA-04), Tim Ryan (OH-13), and Ed Case (HI-01).
The House Veterans’ Affairs Subcommittee on Health is scheduled to hold a hearing on the legislation Thursday at 10:00 a.m. ET. More information on those proceedings can be found here.
The legislation has been endorsed by The American Legion, Veterans of Foreign Wars (VFW), Disabled American Veterans (DAV), Wounded Warrior Project, Military Veterans Advocacy, Paralyzed Veterans of America (PVA), Minority Veterans of America, Iraq and Afghanistan Veterans of America (IAVA), Nurses Organization of Veterans Affairs (NOVA), The Eating Disorders Coalition for Research, Policy & Action.
"The Sgt. Ketchum Rural Veterans Mental Health Care Act of 2021 would aid rural veterans in obtaining and receiving the mental health care they need and deserve,” said Kenneth Lloyd, Chapter President of the Iowa Paralyzed Veterans of America. “Iowa PVA thanks Representative Axne for leading the effort to diminish barriers to mental health care for rural veterans."
“Improving mental health services must be a key goal for the Department of Veterans Affairs,” said Commander J. B. Wells U. S. Navy (Retired), Chairman of the Board and Director of Litigation at Military-Veterans Advocacy, Inc. “Mental health, specifically Post Traumatic Stress, is often at the root of the suicide epidemic plaguing the veteran's communities. Urban areas have such services available but rural areas and tribal lands do not. This bill is a first step to alleviating this problem. Military-Veterans Advocacy thanks Rep. Axne for introducing this bill."
Top image by photographee.eu, via Shutterstock.