Twenty-two U.S. veterans die by their own hands every day.

Susan Selke is the mother of one of those vets -- Marine Cpl. Clay Hunt, who committed suicide in 2011.

Selke went to Washington Wednesday to again tell her son's story -- this time before a Senate committee that is grappling with the myriad problems of the Veterans Administration.

Frustration and Delay

Selke said the VA lost her son's medical records for months, shuffled him from department to department, and forced him to wait a long time for care.

Finally, when Hunt visited the Houston VA center to see a psychiatrist he found it too stressful and did not want to go back. Two weeks later he committed suicide.

After his death, Selke went to the Houston Veterans Affairs center in search of her son's medical records.

"There were large crowds. No one was at the information desk and I had to flag down a nurse to ask for directions to the medical records area. I cannot imagine how anyone dealing with mental injuries like PTSD could successfully access care in such a stressful setting without exacerbating their symptoms."

Now the Senate is considering a bill called the Clay Hunt Suicide Prevention for American Veterans Act known as the Clay Hunt SAV Act.

Sen. Richard Burr, (R-N.C.) a ranking member on the Committee of Veterans Affairs, Sen. John McCain (R-Ariz.), and Sen. Richard Blumenthal, (D-Conn.) think this bill offers a solution.

Modeled after previous legislation introduced by Sen. Timothy Walz, (D-Minn.) in July, it would require the VA to review its mental health and suicide prevention programs, weeding out those that are ineffective. It would also direct the VA to focus on transitioning veterans returning from the battlefield to civilian life and attempt to entice more psychiatrists to work at the VA.

One More Hearing

On Wednesday, the Committee on Veterans Affairs questioned directors of mental health and suicide prevention services at the VA about efforts to improve the quality and timeliness of mental health care.

During the hearing, senators criticized the VA for long wait times, limited access to mental health resources, and poor tracking of returning soldiers, particularly those diagnosed with a mental health condition.

Burr said VA officials had earlier told the Senate of its efforts to provide evidence-based care, but Burr said a review of VA outcomes raised serious questions about the validity of such care.

He cited an American Legion survey of around 3,100 veterans, the majority of whom felt that their symptoms were either not improving or worsening after psychotherapy or medication that was prescribe by the VA.

"If more than half of our nation's veterans don't think they're getting better, I believe the focus on whether evidence-based treatment is provided might be misguided."

Burr asked what the VA is doing to track the improvement of veterans who are receiving mental health care and wanted to know whether that care is tailored to meet their individual needs.

The VA may have to look outside its ranks for help said Sen. John Boozman (R-Ark.), who urged the agency to integrate other mental health care providers besides psychiatrists into its services including marriage and family counselors, social workers, and other licensed therapists.

"A veteran who is having suicidal thoughts should never be turned away because of bureaucratic red tape."

Waiting, Waiting

Sen. Dean Heller (R-Nev.) said the average wait time in Nevada for new veteran patients seeking mental health care is 23 days in Reno and twice that in other cities in the state. At one Las Vegas clinic new patients wait an average of 64 days.

"Veterans in need of mental health treatment absolutely cannot be waiting more than 2 months to be seen," he said.

The chief consultant for Mental Health Services for the Veterans Health Administration at the Department of Veterans Affairs Harold Kudler, MD, said the VA planned to expand "entry points" to care beyond its 150 medical centers to include 820 community-based outpatient clinics, 300 veteran centers providing readjustment counseling, and 70 mobile veteran centers as well as a national veterans's crisis line.

"With assistance from state partners, the VA is now better able to assess the effectiveness of it suicide prevention programs, and we can identify at-risk veterans earlier and apply specific interventions tailored to their needs," Kudler said.

Elspeth Cameron Ritchie, MD, a retired colonel and chief clinical officer at the District of Columbia's Department of Mental Health summarized a report from the Institutes of Medicine charting the VA's efforts and offering its recommendations.

Ritchie said, "There's a lot of good people trying really hard to provide care and the results are mixed."

Because the results aren't well measured, it is difficult to see who is getting better and why. "The VA does not know enough about who is suiciding," she said.

Ritchie recommended more resources be channeled to exploring patterns of suicide and to screening members for the types of deployment they were on.

Ritchie also suggested screening for exposure to Agent Orange, and drugs like mefloquine, which can have severe side effects including psychosis. Lastly, Ritchie recommended the VA conduct more studies on alternative therapies such as acupuncture, yoga, and canine therapy.

"We need to have more research to see what works and who it works for."

More Problems Than Solutions

Kudler described a joint suicide data repository developed by the VA and the Department of Defense to track patterns of suicide among veterans and service members. He said that data could be used to identify and replicate the most effective suicide prevention programs.

Ritchie added, "If you come from working at Abu Ghraib or Guantanamo Bay or the detainment facilities in Bagram you don't necessarily get a whole lot of pats on the back, and we need to recognize that type of service as well."

Vincent Vanata, a retired master sergeant with the U.S. Marine Corps and Combat Stress Recover Program participant with the Wounded Warrior Project from Cody, Wyo., said the VA's problem is a lack of outreach. "From my perspective the VA is not engaging with these returning veterans and letting them know what's available," he said.