[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
[H.A.S.C. No. 113-23]
UPDATE ON MILITARY SUICIDE PREVENTION PROGRAMS
__________
HEARING
BEFORE THE
SUBCOMMITTEE ON MILITARY PERSONNEL
OF THE
COMMITTEE ON ARMED SERVICES
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD
MARCH 21, 2013
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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U.S. GOVERNMENT PRINTING OFFICE
80-193 PDF WASHINGTON : 2013
SUBCOMMITTEE ON MILITARY PERSONNEL
JOE WILSON, South Carolina, Chairman
WALTER B. JONES, North Carolina SUSAN A. DAVIS, California
JOSEPH J. HECK, Nevada ROBERT A. BRADY, Pennsylvania
AUSTIN SCOTT, Georgia MADELEINE Z. BORDALLO, Guam
BRAD R. WENSTRUP, Ohio DAVID LOEBSACK, Iowa
JACKIE WALORSKI, Indiana NIKI TSONGAS, Massachusetts
CHRISTOPHER P. GIBSON, New York CAROL SHEA-PORTER, New Hampshire
KRISTI L. NOEM, South Dakota
Jeanette James, Professional Staff Member
Debra Wada, Professional Staff Member
Colin Bosse, Staff Assistant
C O N T E N T S
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CHRONOLOGICAL LIST OF HEARINGS
2013
Page
Hearing:
Thursday, March 21, 2013, Update on Military Suicide Prevention
Programs....................................................... 1
Appendix:
Thursday, March 21, 2013......................................... 33
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THURSDAY, MARCH 21, 2013
UPDATE ON MILITARY SUICIDE PREVENTION PROGRAMS
STATEMENTS PRESENTED BY MEMBERS OF CONGRESS
Davis, Hon. Susan A., a Representative from California, Ranking
Member, Subcommittee on Military Personnel..................... 2
Wilson, Hon. Joe, a Representative from South Carolina, Chairman,
Subcommittee on Military Personnel............................. 1
WITNESSES
Bromberg, LTG Howard B., USA, Deputy Chief of Staff, G-1, U.S.
Army........................................................... 5
Garrick, Jacqueline, Acting Director, Defense Suicide Prevention
Office......................................................... 3
Hedelund, BGen Robert F., USMC, Director, Marine and Family
Programs, U.S. Marine Corps.................................... 8
Jones, Lt Gen Darrell D., USAF, Deputy Chief of Staff for
Manpower and Personnel, U.S. Air Force......................... 7
Reed, Dr. Jerry, Ph.D., MSW, Vice President and Director, Center
for the Study and Prevention of Injury, Violence and Suicide,
Suicide Prevention Resource Center............................. 9
Van Buskirk, VADM Scott R., USN, Deputy Chief of Naval
Operations, Manpower, Personnel, Training, and Education, U.S.
Navy........................................................... 7
APPENDIX
Prepared Statements:
Bromberg, LTG Howard B....................................... 55
Davis, Hon. Susan A.......................................... 38
Garrick, Jacqueline.......................................... 41
Hedelund, BGen Robert F...................................... 88
Holt, Hon. Rush, a Representative from New Jersey............ 39
Jones, Lt Gen Darrell D...................................... 79
Reed, Dr. Jerry.............................................. 98
Van Buskirk, VADM Scott R.................................... 67
Wilson, Hon. Joe............................................. 37
Documents Submitted for the Record:
[There were no Documents submitted.]
Witness Responses to Questions Asked During the Hearing:
Mrs. Davis................................................... 111
Dr. Heck..................................................... 111
Mrs. Noem.................................................... 111
Mr. Scott.................................................... 111
Questions Submitted by Members Post Hearing:
Ms. Shea-Porter.............................................. 115
UPDATE ON MILITARY SUICIDE PREVENTION PROGRAMS
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House of Representatives,
Committee on Armed Services,
Subcommittee on Military Personnel,
Washington, DC, Thursday, March 21, 2013.
The subcommittee met, pursuant to call, at 10:02 a.m., in
room 2118, Rayburn House Office Building, Hon. Joe Wilson
(chairman of the subcommittee) presiding.
OPENING STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM
SOUTH CAROLINA, CHAIRMAN, SUBCOMMITTEE ON MILITARY PERSONNEL
Mr. Wilson. I would like to welcome everyone to a meeting
of the Military Personnel Subcommittee on the very important
issue of military suicide prevention programs. Today the
subcommittee meets to hear testimony on the efforts by the
Department of Defense and the military services to prevent
suicide by service members, military families, and civilian
employees.
I want to preface my statement by recognizing the
tremendous work the Department of Defense and the service
leadership has done to respond to the disturbing trend of
suicide in our Armed Forces. This has not been an easy task and
I thank you for your hard work.
Suicide by members of our Armed Forces is particularly
distressing to me because I consider military service an
opportunity for a person to achieve their highest ability of
fulfilling life. I also consider military service as a family,
where we want the best for each other and we care about each
other.
I want service members to know they are talented people who
are important and appreciated by the American people. They can
overcome challenges.
Suicide is a difficult topic to discuss. Last year 350
service members took their own lives. Each one of them is a
tragedy.
Every one of them has a deeply personal story. We cannot
rest until we have created every opportunity to change such an
awful statistic.
Suicide is a multifaceted phenomenon that is not unique to
the military. Unfortunately, in addition to the hardships of
military service, our service members are subject to the same
pressures that challenge the rest of society. They are exposed
to the same stressors that may lead to suicide by their
civilian counterparts.
I am deeply concerned about the uncertainty of
sequestration and the coming budget challenges, how that will
affect our service members and their families. Each of the
military services in the Department of Defense has adopted
strategies to reduce suicide by our troops.
I would like to hear from our witnesses whether those
strategies are working. How do you determine whether your
programs incorporate the latest research and information on
suicide prevention?
I am also interested to know how Congress can further help
and support your efforts. Lastly, I am interested in learning
how our civilian experts are tackling the problems across the
Nation and how private organizations, like Hidden Wounds of
Columbia, are assisting and making a difference.
With that, I want to welcome our witnesses and I look
forward to your testimony.
Before I introduce our panel, let me offer Congresswoman
Susan Davis from San Diego an opportunity as ranking member to
make her opening remarks
[The prepared statement of Mr. Wilson can be found in the
Appendix on page 37.]
STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE FROM
CALIFORNIA, RANKING MEMBER, SUBCOMMITTEE ON MILITARY PERSONNEL
Mrs. Davis. Thank you, Mr. Chairman.
And welcome to all of you. Thank you so much for being here
and sharing your expertise with us.
I am pleased that the subcommittee is continuing its
attention on suicides in the military. It has been nearly a
year and a half since our last hearing, and during this time we
have only seen increased numbers of service members taking
their own lives. And behind each statistic we know there are
families with shattered lives.
While Congress has pushed forward a number of initiatives
to support the Services and the Department of Defense in their
efforts to develop policies and programs to reduce and prevent
suicides in the force, we know that these numbers continue to
grow.
And yet, we also know that military service members are not
alone. Over 38,000 individuals die by suicide every year.
In 2010, suicide was the 10th leading cause of death in the
United States and the fourth leading cause of death for adults
between the ages of 18 and 65. While suicide among young
individuals from 15 to 25 years continues to be a concern, the
rate of suicide among older Americans is even higher.
It is important that we share what we learn in the military
and what is learned by others in our country if we are to be
successful in addressing this societal issue. The establishment
of the Department of Defense Task Force on the Prevention of
Suicide by Members of the Armed Forces in the Duncan Hunter
National Defense Authorization Act of Fiscal Year 2009 was a
start, only a start.
The task force made 76 recommendations, and I am interested
in where the Department and the Services are in implementing
these recommendations. Have we walked back all the cases that
we are aware of and understanding the dynamics involved in all
of those?
Have we completed all of these recommendations? And if so,
what metrics are being used to track success? What other
efforts can be undertaken to address suicide in the military?
I welcome all of you, our witnesses, and look forward to
hearing from you about what has been done, what is being done,
and where do we go from here in our efforts.
Thank you, Mr. Chairman.
[The prepared statement of Mrs. Davis can be found in the
Appendix on page 38.]
Mr. Wilson. Thank you, Mrs. Davis.
I ask unanimous consent to include into the record a
statement from Congressman Rush Holt of New Jersey.
[The prepared statement of Mr. Holt can be found in the
Appendix on page 39.]
Mr. Wilson. Without objection, so ordered.
We are joined today by an outstanding panel. Given the size
of our panel and the desire to give each witness the
opportunity to present his or her testimony and each member an
opportunity to question the witnesses, I would respectfully
remind the witnesses to summarize, to the greatest extent
possible, the high points of your written testimony in 3
minutes. I assure you that your written comments and statements
will be made part of the record.
Let me welcome our panel: Jacqueline Garrick, Acting
Director, Defense Suicide Prevention Office; Lieutenant General
Howard B. Bromberg, U.S. Army, Deputy Chief of Staff, G-1, U.S.
Army; Vice Admiral Scott R. Van Buskirk, Director, Military
Personnel, Plans and Policy, U.S. Navy; Lieutenant General
Darrell D. Jones, Deputy Chief of Staff for Manpower and
Personnel, U.S. Air Force; Brigadier General Robert F.
Hedelund, Director, Marine and Family Programs, U.S. Marine
Corps.
And, General, thank you for being here today. This is your
first appearance before this committee.
Jerry Reed, Ph.D., Vice President and Director, Center for
the Study and Prevention of Injury, Violence and Suicide, the
Suicide Prevention Resource Center.
We will proceed, beginning with Ms. Garrick, with opening
statements, and it is imminent that we will be having votes. We
will, at a prudent time, suspend and then return.
And, Ms. Garrick.
STATEMENT OF JACQUELINE GARRICK, ACTING DIRECTOR, DEFENSE
SUICIDE PREVENTION OFFICE
Ms. Garrick. Thank you, sir. Of concern for DOD [Department
of Defense] is the rate of suicide among its forces, which rose
in the past decade from 10.3 to 18.3 per 100,000.
While we saw leveling in 2010 and 2011, the suicide rate
for 2012 is expected to increase. DOD has closely tracked every
suicide and attempt published in the DODSER [Department of
Defense Suicide Event Report] since 2008.
Therefore, we know the majority of our suicides were
completed by Caucasian males below 29, enlisted, and high-
school educated. In some cases, relationship, legal or
financial issues were present.
Service members primarily used firearms and died at home.
They did not communicate their intent, nor did they have known
behavioral health histories. Less than half had deployed and
few were involved in combat.
Nonfatal suicide attempters were similar to those who died.
However, those used primarily drugs and had at least one
documented behavioral health disorder.
A DOD task force report made 76 recommendations, with the
first establishing the Defense Suicide Prevention Office to
oversee all strategic development, implementation,
standardization, and evaluation of DOD's suicide and resilience
activities.
NDAA 13 [National Defense Authorization Act for Fiscal Year
2013] codified this office, which enhances its authority to
implement the remainder of the legislation.
A general officer steering committee established priority
groups on data, stigma, lethal means, investigations, research,
and evaluations, and the Department has made significant
strides.
The Defense Suicide Prevention Program Directive will set
policy and assign responsibilities. DOD and V.A. [U.S.
Department of Veterans Affairs], along with CDC [Centers for
Disease Control and Prevention], created a suicide repository
going back to 1979, so that now the DOD can affirm military
service for the CDC, enhancing its ability to track Guard and
Reserve and service member deaths overseas. This will enhance
our research, longitudinal studies, and population health
surveillance.
DSPO [Defense Suicide Prevention Office] program evaluation
approach tracks requirements, funding, and will unite
efficiency measures with effectiveness for continuous process
improvement reporting on shortfalls and duplications. We are
evaluating training to develop core competencies for peer,
command, clinical, and pastoral requirements.
A critical aspect of preventing suicide is eliminating
stigma that prevents service members or families from seeking
help. DOD and V.A. are implementing President Obama's executive
order and have a 12-month help-seeking ``Stand By Them''
campaign to encourage service members, veterans, and their
families to contact the military crisis line by phone or
online.
We are expanding it in Europe and we are expanding it to
Japan and Korea. It is at larger bases in Afghanistan, and
where it is not available we have trained medics to initiate a
peer support call line, similar to the Guard's Vets4Warriors
program.
Since service members often believe that seeking care is
career-ending, training is key. In reality, denials and
revocations involving mental health are less than 1 percent.
Therefore, service members must understand that seeking help is
a sign of strength and it does not jeopardize their clearances.
Postvention has implications for prevention and reducing
suicide contagion. A postvention guide was published for
Reserve Component commanders, and we do a debriefing with TAPS
[Tragedy Assistance Program for Survivors] on factors leading
up to a service member's death, as reported by the families.
And this dialogue builds a frame of reference that the DODSER
alone does not provide.
DOD is clarifying the NDAA 13, which authorizes mental
health professionals and commanders to inquire about privately
owned firearms, ammunition, and other weapons, and we have
developed a family safety curriculum with Yellow Ribbon and the
Uniformed Services University, and have distributed over 75,000
gun locks.
Since we know suicide and attempts are associated with
prescriptions, DOD started a drug take-back study, allowing
beneficiaries to return unused medications in compliance with
DEA [Drug Enforcement Agency] rules.
We continue to improve access to quality of care, with
behavioral health providers being embedded at the unit level,
and we will continue to evaluate that.
DOD has developed a research plan and created teams to
translate findings from studies into policies and practices. We
have responded to the NDAA 12 by creating a community action
team, partnering with nonprofits, universities, and others to
assess practices and share lessons learned in family and peer
support.
We have expanded Partners in Care, a chaplain program in
which faith-based organizations provide support to the Guard
and Reserve. And we are exploring therapeutic sentencing
techniques for military justice proceedings, as used in
Veterans Treatment Courts.
We have worked with the Action Alliance on the National
Suicide Prevention Strategy, and we have partnered with the
Department of Veterans Affairs on the Veterans Crisis Line,
making sure that material is at preseparation counseling and is
incorporated into transition briefings.
So in closing, DOD fervently believes that every one life
lost to suicide is one too many and prevention is everybody's
responsibility. No stone is being left unturned, and this is a
complex issue. The challenges are great. However, this fight
will take enormous collective action and the implementation of
proven and effective initiatives.
DOD remains optimistic that it will find better solutions
that will save more lives.
Thank you, sir.
[The prepared statement of Ms. Garrick can be found in the
Appendix on page 41.]
Mr. Wilson. And thank you, Ms. Garrick.
And, General Bromberg, we will proceed. And the moment you
get through, the buzzers indicate it is a vote, and so we will
then suspend.
STATEMENT OF LTG HOWARD B. BROMBERG, USA, DEPUTY CHIEF OF
STAFF, G-1, U.S. ARMY
General Bromberg. Yes, sir.
General Wilson, Ranking Member Davis, distinguished members
of the subcommittee, on behalf of our Army, thank you for
continued strong support and demonstrated commitment to our
soldiers, civilians, and families.
As you know, our Nation has been at war for nearly 12
years. Our soldiers, families, and civilians remain the
strength of our Nation and have demonstrated unprecedented
strength, performance, and resilience. And while physical
injuries may be easier to see, there are many invisible wounds,
such as depression, anxiety, post-traumatic stress, that also
take a significant toll on our service members.
Army leaders at all levels are committed to eliminating the
negative stigma associated with seeking help; building
physical, emotional, and psychological resilience in our
soldiers and families and civilians; and ensuring that anyone
who may be struggling gets the help he or she needs.
Tragically, though, the Army has had 324 potential suicides
during 2012, the highest annual total on record. Of those, 183
deaths occurred within the Active Component and Reserve
Component on Active Duty. The Reserve Component not on Active
Duty, a total of 141, is the second highest on record.
While most Army suicides continue to be among junior
enlisted soldiers, the number of suicides by noncommissioned
officers has increased each of the last 3 years. And almost
one-third of our Army suicides have no deployment history and
almost 18 percent have never been mobilized from the Reserve
Component.
By far, most Army suicides are in the 21- to 30-year-old
age range, and that trend has held since 2010.
And, as already mentioned, suicide is not solely a military
problem. It is a rising national issue. And while it is
difficult, we must use extreme caution when directly comparing
the Army population with the general population.
The 2010 national suicide rate is slightly higher than the
Army Active Duty rate for 2010 and 2011. This very general
comparison strongly supports the idea that suicidal behavior is
an urgent national problem that affects all Americans across
all dimensions of society, including those who have chosen to
serve the Nation by serving in the Army.
And we believe we have an historic opportunity to
understand the lessons of the last 12 years and make our force
even stronger. And the Army is now moving forward with our
Ready and Resilient Campaign plan. This campaign is focused on
making resilience a part of our culture and integrates and
synchronizes multiple efforts and programs designed to improve
the readiness and the strength and resilience of the Army team.
I assure the members of this committee there is no greater
priority for myself and other senior leaders of the United
States Army than the safety and well-being of our soldiers.
Suicide does remain a complex issue. It is a hard enemy,
both for the Army and the Nation. The loss of any life is
tragic, and it is imperative that we make a holistic approach
to addressing this complex challenge.
Mr. Chairman, Representative Davis, members of the
committee, thank you and I look forward to your questions.
[The prepared statement of General Bromberg can be found in
the Appendix on page 55.]
Mr. Wilson. General, thank you very much.
And we will suspend and we will begin immediately with
Admiral Van Buskirk.
Thank you.
[Recess.]
Mr. Wilson. The Subcommittee on Military Personnel update
on military suicide prevention programs shall resume.
And, Vice Admiral Van Buskirk.
STATEMENT OF VADM SCOTT R. VAN BUSKIRK, USN, DEPUTY CHIEF OF
NAVAL OPERATIONS, MANPOWER, PERSONNEL, TRAINING, AND EDUCATION,
U.S. NAVY
Admiral Van Buskirk. Chairman Wilson, Ranking Member Davis,
distinguished members of the committee, thank you for holding
this hearing and affording the Navy the opportunity to provide
an update on our suicide prevention and resiliency programs.
Sadly, last year the Navy experienced 65 suicides in our
Active and Reserve forces, an increase of six over the previous
year. We have already suffered the loss of 13 shipmates this
year.
We clearly have more to do. Suicide prevention remains a
top priority of the Navy leadership, and we remain committed to
doing everything possible to save lives.
We continue to vigilantly monitor the health of the force
and investigate every suicide and all suicide-related behavior.
We take what we learn from our investigations and adapt our
education, programs, and prevention strategies.
Operational Stress Control is a centerpiece of our
strategy. It is the way we inculcate our new accessions, the
way we deliver our training to the fleet and to our leaders. It
is a method we use to increase the awareness and strengthen our
resilience.
Our Operational Stress Control Program provides an
integrated structure of health promotion. It focuses on
building resilience, addressing problems early, and promoting a
healthy and supportive command climate. We continue to evaluate
the response to this critical asset.
Our Navy leaders recognize that they are the key to
destigmatizing help-seeking behaviors. The unity of effort at
the deckplates is where we strengthen our sailors.
The deckplates is where we identify and mitigate the signs
of stress and help our sailors cope and acquire necessary
treatment for stress injuries. By teaching sailors better
problem-solving skills and coping mechanism for stress we will
make our force a much more resilient one. We will continue to
do everything possible to support sailors so that they know
their lives are valued and are truly worth living.
Thank you, and I look forward to your questions.
[The prepared statement of Admiral Van Buskirk can be found
in the Appendix on page 67.]
Mr. Wilson. Thank you very much, Admiral.
General Jones.
STATEMENT OF LT GEN DARRELL D. JONES, USAF, DEPUTY CHIEF OF
STAFF FOR MANPOWER AND PERSONNEL, U.S. AIR FORCE
General Jones. Chairman Wilson, Congresswoman Davis, and
distinguished members of the committee, thank you for allowing
me to testify before you today on behalf of the Chief of Staff
of the United States Air Force and all airmen stationed around
the world.
Air Force leaders at all levels are committed to suicide
prevention through our wingman culture. Suicide prevention is
not the purview of the personnel or the medical community. It
belongs to commanders and leaders at all level. This is the
overarching premise on which the Community Action Information
Board was built and the cornerstone of the Air Force Suicide
Prevention Program. Evidence shows this is the necessary
framework for effective intervention across the force.
Suicide prevention is a contact sport. It starts with
leadership involvement, from the chief of staff to the newest
first-line supervisor.
In a wingman culture, airmen look out for their fellow
airmen. We teach them to identify risk factors and warning
signs for suicide and to take appropriate action once these
indicators are identified.
We realize we must continue to reevaluate and enhance our
prevention efforts. And, with this in mind, we have taken on
several initiatives across the Air Force.
We require front-line supervisor training for our most at-
risk career fields and one-on-one training for this program. We
are also increasing our mental health provider staff by 335
people of additional trained professionals through fiscal year
2016. And we are revising our Air Force Guide to Managing
Suicidal Behavior, which has proven to be an effective clinical
tool over the past 10 years.
Within the Air Force, we have not experienced a link
between suicides and deployment. The most significant risk
factors for suicide in the Air Force continue to be problematic
relationships, legal or administrative issues, work-related
problems, or a combination of these factors.
We continue to research how we can better identify those at
risk to achieve the earliest possible intervention. One such
study explores how social media impacts their relationships,
help-seeking behavior, and emotional well-being. We are also
conducting several research projects examining the role of life
events and social stressors in the suicides of our military
members.
We continue to collaborate with the Defense Suicide
Prevention Office, our sister services, and the Department of
Veterans Affairs. Our goal is to leverage our internal
resources, combining our experiences and best practices to
improve suicide prevention across the force.
We need every airman as we face the difficult challenges
ahead. All leaders are responsible for promoting our wingman
culture and removing any barriers to a healthy force.
Thank you for your attention to our efforts and for your
support in these endeavors to keep all of our airmen healthy
and ready. I look forward to answering your questions.
[The prepared statement of General Jones can be found in
the Appendix on page 79.]
Mr. Wilson. Thank you very much, General Jones.
And we now proceed to General Hedelund
STATEMENT OF BGEN ROBERT F. HEDELUND, USMC, DIRECTOR, MARINE
AND FAMILY PROGRAMS, U.S. MARINE CORPS
General Hedelund. Chairman Wilson, Ranking Member Davis,
and distinguished members of the committee, it is my privilege
to appear before you today and I would like to thank you for
allowing me to testify on behalf of Lieutenant General
Milstead.
Like our Commandant, we both are engaged and committed to
tackling the complex problem of suicide amongst our marines. It
is an all-hands effort to us.
As our Commandant has said, one suicide is one too many.
Each suicide has far-reaching impact on families, friends, and
fellow marines.
Regardless of the total number, every single suicide is a
profound tragedy. Whether we have one or many, we will expend
whatever effort is required to gain ground and get ahead of
this problem.
As we all know, discovering, and ultimately understanding,
what leads one to suicide is elusive. It is very difficult to
identify one trend or factor as a key to unlocking the secret
to suicide for our population.
However, through our data, tracking, and research, we have
found that the primary stressors and risk factors associated
with marine suicides and attempts are legal and disciplinary
problems, relationship problems, behavioral health diagnoses,
financial problems, and substance abuse, or a combination
thereof.
Regardless, we are committed to exploring every potential
solution, using every resource we have available, and making
the right investments toward saving marine lives. We deeply
believe that preventing suicide requires engaged leaders who
are alert to those at risk and take action to help marines
before they reach crisis.
We take care of our own. Thus, we are committed to breaking
the stigma that may still exist in pockets around our Corps for
those who seek help. We never leave a marine behind on the
battlefield and we won't leave a marine behind at home.
We thank you for bringing attention to this national
problem, and I look forward to your questions.
Thank you.
[The prepared statement of General Hedelund can be found in
the Appendix on page 88.]
Mr. Wilson. Thank you, General Hedelund.
And we now will conclude testimony with Dr. Jerry Reed
STATEMENT OF DR. JERRY REED, PH.D., MSW, VICE PRESIDENT AND
DIRECTOR, CENTER FOR THE STUDY AND PREVENTION OF INJURY,
VIOLENCE AND SUICIDE, SUICIDE PREVENTION RESOURCE CENTER
Mr. Reed. Good morning, Chairman Wilson, Ranking Member
Davis, and members of the subcommittee.
My name is Jerry Reed and I serve as the director of the
national Suicide Prevention Resource Center and as co-director
of the Injury Control Research Center for Suicide Prevention.
Suicide is not just a challenge for the defense or veteran
communities. It is an American challenge that calls us all to
action. Every suicide is a tragedy.
In the United States, suicide is the 10th leading cause of
death, claiming more than 38,000 lives in 2010. By comparison,
homicide was the 16th leading cause of death, claiming more
than 16,000 lives, or fewer than half the deaths than by
suicide.
There is no single cause for suicide, no single solution,
and no single agency, department, or person can fight this
battle alone. We all have a role to play.
While suicide touches all ages across the lifespan, in the
general population it is the third leading cause of death for
those 15 to 24 years old and the second leading cause of death
for those 25 to 34 years old. Suicide rates generally increase
with age.
A few similarities between the military and the general
population are: more men die by suicide than women, firearms
are used in both populations and the outcome is often lethal,
and substance use is often a factor in both attempts and
completions.
Intuitively, we would expect the military to have lower
rates because service members are screened for mental illness
and drug abuse on entry into Active Duty, they are healthier
than the general population, they are fully employed and fully
insured, they are routinely screened for drug use, and they
have access to mental health care. Yet, rates in the military
have been rising over the past 10 years and this is cause for
concern.
What we don't know is why rates are rising and what can be
done to reverse this trend. We need to more fully understand
the role of combat, deployment, and exposure to traumatic
events on suicide risk. We also need to explore why rates are
higher among junior enlisted personnel, some of whom have not
been exposed to combat, and to better understand the process of
help-seeking in our military.
From what we know nationally, some of what has been shown
to yield positive results include: following a comprehensive
approach, combining several initiatives that target different
behaviors, populations and settings. Examples of this that have
been or are being pursued in DOD are the Air Force Suicide
Prevention Program or the No Preventable Soldier Deaths
Campaign at Fort Bliss.
We know that no one program or intervention by itself will
suffice. We need to ensure a cohesive approach is taken.
The National Registry for Evidence-Based Programs and the
Best Practices Registry include over 100 programs, materials,
and practices that science and experience show can prevent
suicidal behaviors and reduce risk.
Following a public health approach, we need to look at the
data, develop a comprehensive strategy, implement
interventions, measure their effects, and evaluate outcomes.
In my closing comments, I would like to offer the
subcommittee a few recommendations to consider as we move
forward: Follow a battle plan that is comprehensive and
incorporates both public health and mental health perspectives.
We will not simply treat ourselves out of this challenge.
Our current battle plan is the recently released National
Strategy for Suicide Prevention. It is a comprehensive document
and guides our national effort.
We also should take steps to successfully integrate DOD and
the V.A. activities where possible, and efforts with those
going on with the Action Alliance for Suicide Prevention,
chaired by former Senator Gordon Smith and Secretary of the
Army John McHugh.
This public-private partnership, launched in 2010 by
Secretaries Gates and Sebelius, holds great promise for suicide
prevention. The alliance has set a goal to save 20,000 lives
over 5 years, and we are serious about advancing steps that
will move us in this direction.
We should explore ways to ensure that those at risk for
suicide do not have access to lethal means, ensure seamless
care for those transitioning from Active service to veteran
status and from Active service to inactive Guard or Reserve
status, and ensure service members know how and where to
receive help. And we should also build upon success stories and
implement, evaluate, and most importantly, scale up when we see
initiatives that are making a difference.
When we implement a program that works, we need to ensure
it is sustained over time. And we need to think from both an
individual perspective, focused on the service member in need,
and from a systems perspective, ensuring that every door a
service member enters is the right door and that there is
continuity in the care provided between systems.
Finally, we need to change the way we talk about suicide by
including stories of hope and resilience through public
awareness campaigns, such as DOD's Real Warriors and V.A.'s
Make the Connection.
It is important to remember that suicide prevention is a
relatively new field of study. And as we have observed from
working on other public health issues, the effects of
prevention require us to be patient, deliberate, and most
importantly, to stay the course.
Thank you for the opportunity to join you this morning. We
need to approach this battle with the collective attitude of
one team with one fight. It is important to remember that our
military comes from the general community and will someday
return to the general community.
The more we can do together, the better for those we wish
to serve. By working together I am confident that we can and
will save lives.
Thank you.
[The prepared statement of Dr. Reed can be found in the
Appendix on page 98.]
Mr. Wilson. Thank you very much, Dr. Reed.
And we now will proceed to each member of the subcommittee
asking questions for 5 minutes. The time will be determined by
Jeanette James, our professional staff personnel. And she
herself is a retired Army nurse, and she has been so helpful
being a resource to this subcommittee and to the committee at
large.
As we begin, from Ms. Garrick and for our service personnel
who are here, as a 31-year veteran of the Reserves and Guard
myself, as the proud dad of three members of the Army National
Guard, I really appreciate Guard service and Reserve service,
and we have really relied on the Guard and Reserve as never
before, successfully, with overseas operations. But when our
Guard members return they don't have the 24/7 support of
military facilities; equally, they have the stress of military,
but also civilian stress.
Beginning with Ms. Garrick, what programs are there that
could and do apply to Guard members?
Ms. Garrick. We have several programs that we are looking
at with the Guard. The one I mentioned, the Partners in Care
project, leverages the faith-based communities and is a
chaplain program specifically, so that is very helpful in terms
of providing some very specific boots on the ground.
And then, of course, our Yellow Ribbon Reintegration
Programs are very important, very vital to the pre-, during,
and post-deployment phases of the Guard and Reserve
deployments. We also have a postvention guide that we have
worked on for Reserve component commanders, if there is--had
been a death in their unit, that they have the tools and the
techniques that they need to be able to respond to a suicide in
the unit.
We are doing a Safe at Home program, specifically, that
would roll out under Yellow Ribbon. We have distributed about
75,000 gun locks; most of those have been through the Guard.
And I think our Vets4Warriors, the call center that utilizes a
peer support model, has been very helpful.
So those are some of the programs that I have seen that I
think have been working really well with the Guard and Reserve.
Mr. Wilson. Thank you.
General Bromberg.
General Bromberg. Yes, sir. All our programs in the Army,
we are mirroring those at the--trying to mirror those at the
State and local level through both the United States Army
Reserve command and also through the National Guard. The
increased capacity for behavioral health touch points and
services available to our Guards, or it has already mentioned
the Vet4Warriors peer lines is very good.
Additionally, the United States Army Reserve has reached
out to the employer network as well, to link up returning
veterans with employers to solve that challenge, which I think
is very key. Because we have seen, as I looked at eight recent
suicides in the National Guard across the Nation were all
linked--one of the causes was--we think was linked to
unemployment. So how can we employ that employer network back?
Additionally, Health Promotion & Risk Reduction Councils
that we do on the Active side, we are mirroring those at the
State and local level also with additional capacity, so they
can look inside their units.
And as you know, sir, the challenge of connecting to a
guardsman who is not seen every day by a leadership or a chain
of command is something we have asked the Guard and Reserve to
get after as well.
But, again, a complete mirroring of our programs.
Mr. Wilson. Thank you.
Admiral Van Buskirk.
Admiral Van Buskirk. Yes, sir. In addition to all of our
operational stress control programs, which are available to our
reservists, we specifically have a Navy and Marine Force
Reserve Psychological Health Outreach Program that specifically
targets our Reserve Components, both in the Navy and the
Marines.
These are 55 specific individuals that we embed with our
reservists and that are part of a team that have the behavioral
health specialists with them to meet the needs of those
personnel who may need to seek their professional help, and
also for those people to be able to recognize where help is
needed.
In addition to that, we have our Returning Warriors
Program, where our--all of our people who are returning--
mobilized who are returning back to the States from the
deployment go through returning warrior workshops, where
additionally we have health professionals embedded to help our
people cope--not just our personnel, but their families as
well, because it isn't just about the individuals, it is about
the families being able to cope with the stress that our
personnel have endured.
Mr. Wilson. Thank you.
And, General Jones.
General Jones. Sir, I echo the challenges that we have with
Guard and Reserve members as they come home and disperse back
into the community. But we are trying to mirror many of the
same programs we have found success with on the Active Duty
side. The Community Action Information Board in the Guard and
the Reserves followed suit, establishing a wing director of
psychological health to help monitor these programs and just
check on how our airmen are doing when they get back home.
The Guard and Reserve, over the last few years in the--on
the Guard side of the house since 2007, have averaged about
16\1/2\ suicides a year. On the Reserve side it was somewhat
less, about 7\1/2\. But it is positive to report that on the
Reserve side, the numbers significantly dropped between 2011
and 2012. On the Guard side, we saw a slight spike in 2012, but
since 2013, so far this year we have had zero suicides in the
Guard or the Reserve, which we are very excited about that. And
we know that is just a temporary trend but we want to see how
long we can keep that going to help our airmen.
Mr. Wilson. Very encouraging.
Concluding with General Hedelund
General Hedelund. Yes, sir, thank you.
Many of the relationships that have already been mentioned,
the Marine Corps maintains with its Reserve community as well.
And I think that in this current environment where we are
deploying fewer Reserve units in full, but we continue to
deploy Reserves as individuals; we have to ensure that we are
making that transition to services for them in a more
individual way.
We, too, take advantage of the Yellow Ribbon Program, of
course, and we have a Reserve Component that is investing in
additional behavioral health specialists to put in key places
around the country to address needs in the Reserve community.
But every directive, MARADMIN [Marine Administrative
Message], or initiative that goes forward, you will see at the
bottom of it, ``this applies to the total force.'' So every
requirement, all the training, education, et cetera, that
Active Duty marines are required to fulfill, those commanders
and marines that are in the Reserve force are also required to
fulfill. So the same support that we give to our Active Duty we
provide to our reservists, although delivery sometimes varies.
Mr. Wilson. Well, thank you all. And as part of the
military family I particularly want to thank you.
And we now proceed to Congresswoman Susan Davis, the
ranking member.
Mrs. Davis. Thank you. Thank you, Mr. Chairman.
We all know that there are a multitude of programs that
have been in existence for some time and are relatively new. I
wonder if you could talk more about how we are evaluating them.
This is difficult because you can't necessarily evaluate a
nonevent either. If in fact we have people who are not moving
to suicide as a result of programs, which we hope is what
exactly is happening, but we know in many cases it is not.
Could you talk more about that and about the tools that are
being used? And how are really knowing that they are evaluating
what we need to know?
Ms. Garrick. Yes, ma'am. As you recall, the task force
report made some recommendations about doing some program
evaluation, so that is one of the priority areas that we are
concentrating on.
So we have developed what we call a capacity analysis
program evaluation approach, where we have taken actually the
national strategy, the task force recommendations, the NDAA 12
and 13. So we have outlined all the strategies and then we have
looked at the programs and we have started to line up--and we
work very closely with the Services; they are providing us with
the data and the inputs on what their programs are, what they
look like, so that we can start beginning to flesh out what are
the programs, what strategic objective are they supporting, and
then what are some of the costs that bounce up against those
programs.
And then when we look at the strategy we can see, so where
are the gaps and overlaps?
Mrs. Davis. Ms. Garrick, do you have a sense of a timeline,
because we have been with this for a while? Obviously, you can
gather data for a pretty long time and we don't--you don't
always know what is going to happen a few years down the line.
I am just wondering at what point we will have a comfort
level that, in fact, there are some programs that actually
aren't doing what we would like them to do and that we are able
to shift some of those resources or, you know, activities that
are different and that are making a difference.
Ms. Garrick. Correct. So we started this process of just
beginning the--pulling the inventory together about 4 or 5
months ago, and we have made quite a bit of progress in what
that inventory is, and we have developed sort of a rough order
of magnitude on what have we covered down on. And I am hoping
by the end of this fiscal year, all things considered, that we
will actually be able to start reporting out on what we are
seeing in terms of some gaps and overlaps.
And we couple that with an effort we have with the
Department of Veterans Affairs on developing a surveillance
database. That is where we have taken the DOD data from DMDC
[Defense Manpower Data Center], the V.A. data, and the CDC data
and we put surveillance data together so we can start looking
at the--what do we know about suicides, what are some of the
risk factors, how can we do better longitudinal studies, how
can we do better population health surveillance like Mr. Reed
described.
So marrying up some of those initiatives--again, it is a
big-picture perspective.
Mrs. Davis. Yes. It sounds like that in some ways we have
identified some age groups, and also the fact that a firearm
has been used in many of the cases. Is it clear that there are
more firearms used in military or not?
I thought, Dr. Reed, you suggested that that is not
necessarily----
Mr. Reed [continuing]. Population is about 50 percent of
the completed suicides in the civilian population are completed
with a firearm; in the military I think it is closer to 60
percent.
Mrs. Davis. Sixty percent, okay. I thought that I had heard
that it was more than that.
Would that be considered a metric, then? I mean, if we
think about metrics and what we are looking for, what--how do
you describe that for the general public?
General Bromberg. Ma'am, if I could add----
Mrs. Davis. General Bromberg.
General Bromberg [continuing]. One of the things that we
have studied with our Ready and Resilient Campaign plan, one of
our major lines of effort is getting exactly at what you are
talking about. So, we have already peeled out like 122 programs
to start delving into them.
One of the areas we are looking heavily into right now is
does resiliency training or other events like--with our Strong
Bonds campaigns and training that deals with reducing stressors
in relationships--does that training have a direct effect? So
can I take the Strong Bonds training and see if I have a
decrease in domestic abuse or relationship issues. And we are
starting to gather that data now over this course of the year.
Additionally, what we are looking at with the resiliency
training, ma'am, is for those soldiers that have had resiliency
training, is there a reduce in gestures, attempts, and
ideations. We have one unit we have already looked at, and over
the last 18 months we are starting to see a turn.
Mrs. Davis. May I just really quickly turn to General
Hedelund for a second?
At Pendleton I believe they are doing a program and they
have had--actually, they haven't had the suicides in this
particular unit. It is a pilot. Are you aware of that?
General Hedelund. I would have to check and get you more
information on that, ma'am.
[The information referred to can be found in the Appendix
on page 111.]
Mrs. Davis. All right.
General Hedelund. But I would like to echo that it is an
area where we do need to get in and make sure that we have got
the evidence-based approach going.
Mrs. Davis. Thank you.
General Hedelund. Thank you.
Mr. Wilson. Thank you, Mrs. Davis.
And we now proceed by order of appearance to Congressman
Austin Scott, of Georgia.
Mr. Scott. Thank you, Mr. Chairman.
And thank you all for being here. It is certainly an issue
that I think is a big concern not only to the members of the
committee and the military, but to Americans in general.
And I guess two quick questions I have, and then to get to
one more specific.
Ms. Garrick, are there any differences among the trends in
the different branches? And is there a correlation behind the
men and women who are attempting suicide and the V.A. backlog?
Ms. Garrick. I think overall and in general what we see
with--among all the Services are, the big driving forces are
these young white males, junior enlisted, with relationship,
financial, and legal issues. And I think that is why a lot of
the programs I think speak to targeting that. That is why the
resilience piece is so important is to help these young people
adjust to the military.
We have seen about the same amount with deployments versus
nondeployments, combat, noncombat. So we know that there are
other driving forces and factors that come into play.
So we look at those populations, we look at the differences
between some of those issues and try to target programs that
are very specific. The Services have all blended programs that
meet their unique needs as--in their unique environments,
whether it is aboard a ship, or in theater in Afghanistan. We
have seen some programs that we have done there, as well. I
mean, I got to spend some time with the Combat Operational
Stress Control Team in Kandahar and did some training with them
very specific on peer support and crisis-line work.
So we are trying to be very specific in what we are
targeting. And then, in terms of the DES [Disability Evaluation
System] issue, I don't know that we see a higher number of
suicides among those going through a disability process,
although we do know that pain and pain management can be a risk
for those who have died by suicide. So there is some
correlations there.
Mr. Scott. Thank you for that. I would be interested, as
time permits--I know you have a lot of programs--to know,
essentially, what percentage of our men and women that do
commit this are caught up in a V.A. backlog.
[The information referred to can be found in the Appendix
on page 111.]
Ms. Garrick. Yes.
Mr. Scott. Because that can lead to a tremendous amount of
additional stress, as well as the financial conditions that
caused the problems.
And so, Dr. Reed, I think I will focus my next question to
you, as the doctor. And one of the issues that is brought up
again and again is the stigma that is affiliated with the need
for assistance and even seeking treatment. That makes it hard
for people sometimes to actually reach out to others. I know
that we are training people on the warning signs and the
seriousness of the issues, which, I think, is wonderful.
And I guess my question is going to get back to the use of
a specific therapy with regard to animals, whether it be dogs
or some other type of domestic animal that the person is able
to establish a friendship with.
But I want to focus on that area, specifically on
equestrian facilities. I have got one in my area, Hopes and
Dreams Riding Facility. It is in Quitman.
They have a lot of men and women in. They seem to have had
a tremendous amount of success with regard to working with
people.
And my question is, is there ongoing research with regard
to that particular therapy? What are the successes there? And
how do we, if it is working--because it does appear to be
working from what I see, and again, what I see--how do we get
more people involved in those treatment methods that, quite
honestly, are at very little cost to us?
Mr. Reed. When we were asked by Congress to set up the
National Suicide Prevention Resource Center back in 2002 one of
the things we were asked to do specifically was to create a
Best Practices Registry to begin to serve as a clearinghouse
for that which is being done that works.
Today, as I mentioned in my testimony, there are over 100
programs that are listed in the registry. What we need to see
happen--I have been to some of the equestrian programs myself;
I was out in a tribal community and saw just the benefits of
that program for people who might have a difficult time
connecting in other ways.
And I think what we have to accept with suicide prevention
is,as I mentioned, it is a relatively new field--there is not
one solution. It is not necessarily a therapy session in a
therapist's office, but it could be an alternative therapy. It
could be approaching a connectedness issue through animals or
through other kinds of ways to engage a person.
Because part of the challenge is people who struggle with
thoughts of suicide don't feel connected to the larger
community. And if we can enhance that connectedness through
programs such as you have mentioned, and then encourage the
program developer to submit that program to the Best Practices
Registry for review and hopeful inclusion, we then make it a
whole lot more able to be disseminated to the Nation at large
to be able to replicate that program if it has got evidence
behind it that shows effectiveness.
Mr. Scott. Well, thank you for that answer, Dr. Reed. And I
guess the one thing that I would, you know--the review process
and the other things, I think, if we could expedite them I
think that would be a big help.
Thank you, gentlemen, for being here, and ma'am.
Mr. Wilson. Thank you, Congressman Scott.
Now we proceed to Congresswoman Niki Tsongas, of
Massachusetts.
Ms. Tsongas. Thank you, Mr. Chairman.
And thank you all for being here. I commend the work that
you all have done, the really focused effort you are bringing
to this. And, you know, we all hope going forward we are going
to see great progress on this because it is an issue of such
deep concern to all of us here, as well as those across the
country who hear about the great increase in the numbers of
suicides.
But I am concerned that in our current budgetary
constraints, in particular sequestration, that this could
really undermine all your good efforts and exacerbate the--this
particular epidemic. My concern is two-pronged: one, because
the strained resources will inevitably force our men and women
in uniform to take on more responsibility than ever--in other
words, all the pressures of the workplace.
You have looked at, sort of, the legal issues, I mean, that
they tend to have relationship issues, financial issues, legal
issues--but just the demands of the workplace. We have heard
about the multiple deployments, but in reality there are more
suicides taking place in people who are not deployed. So is
there something in the workplace itself and the demands of the
workplace that are exacerbating and causing increased stress?
As one of our witnesses at a recent Oversight and
Investigations Subcommittee hearing on the QDR [Quadrennial
Defense Review] noted, they said, ``You can't, in reality, do
more with less.'' And as we have less, you are asking often
very young people to do quite a bit more.
Second, I am also worried that the budgetary environment
could potentially impede all your prevention efforts from being
researched, because a lot of research is certainly going on or
fully implemented. So I would welcome all of your comments on
just, you know, the stresses in the workplace, how the various
cuts coming about one way or the other may, in fact, exacerbate
those stresses, and whether or not you see any kind of
correlation or are concerned at all as we have to continue to
make these cuts. And then second of all, are you worried that
it will also have an impact on your--all the other efforts you
have put in place?
Ms. Garrick. Well, ma'am, clearly yes. If we furlough our
civilian workforce it means that the military will be picking
up some of that workload, so there will be that stress. That
stress is ongoing already. We are starting to figure out how we
are going to manage that as best we can but it is definitely a
concern for everybody across the spectrum, across the
Department.
There are some recognition that the workplace stress is
certainly a piece of what happens in the nondeployed
environment, that we have been at war for 10 years. There is an
operational tempo that we are all very conscientious about and
that leadership needs to be able to train and mentor junior
officers and bring people on board in such a way that helps
facilitate a resiliency and mentor them through their careers.
And that doesn't always happen when you have the high
operational tempo that we have right now.
So I think your points are well taken and are definitely
issues that we are all grappling with and challenges that we
will have to face and overcome as we move forward through
sequestration, continuing resolutions. I mean, I know you have
had many of our senior leaders here discussing those very
issues, and clearly, I think there will be ripple effects
throughout the Department if sequestration actually goes into
effect.
General Bromberg. Ma'am, with respect to the budget, we are
all concerned. But as far as behavioral health and support
goes, that is one of our primary areas that we will do
everything we can not to furlough in the behavioral health
department. And we are going to ask for those exceptions not to
do that, to keep that workforce steady so we don't lose that
progress.
With respect to the overall workplace stressors, I think
the relationship stressors and those other things you have
heard about, alcohol abuse and other things, are just as
important as the stress in the workplace. And so working
through our Resiliency Campaign, as we continue to train master
resilience trainers to teach people how to deal with the
adversities is really key to what we have to do during this
time period. And that is one of our major focuses.
Ms. Tsongas. So the adversities of the workplace as well as
the adversities of that which you confront outside the
workplace.
General Bromberg. Disappointments in your family
relationships, disappointments if you get in trouble with the
law. How do you work your way through that and not get into
what they call the ``spiral of negative thinking,'' the spiral
of going down, down, down--how you can help pull yourself out
along--and having the leadership engaged with that.
The master resiliency trainers are starting to take effect
as put those across all our formations to include families and
civilians.
Ms. Tsongas. Quickly. I have a few more seconds.
Admiral Van Buskirk. Yes, ma'am.
Just, I was in Norfolk 2 days ago doing all-hands calls,
one for about 1,200 people, one for about 500--and men and
women in uniform, both in the Navy and the Marine Corps. To
answer your question, yes. The pressure of the budgetary
atmosphere that we are in, the stress, it was significant in
terms of the uncertainty that our people are feeling that is
being added to the already environment where OPTEMPO
[Operations Tempo], PERSTEMPO [Personnel Tempo] are part of the
norm in terms of what they are dealing with on a daily basis.
So we have added to that uncertainty with sequestration and
the continuing resolution debate that we have been having here
and the uncertainty that goes with that.
But from a program standpoint, we remain committed to our
programs and we are working to maintain those fully functional.
There will be some areas that have more strain than others, but
for the behavior health programs that we have, to--keep those
fully functional, and we have made those a priority.
Ms. Tsongas. Thank you.
I think I have run out of time, so thank you, though.
Mr. Wilson. Thank you, Ms. Tsongas.
We now proceed to Congresswoman Kristi Noem of South Dakota
Mrs. Noem. Thank you, Mr. Chairman.
And thank all the witnesses for being here.
This is a tough issue for any family that has lost someone
that has taken their own life. And I have a constituent back in
South Dakota that is dealing with this, a loss of a son. And,
you know, it is a grief that no parent should have to go
through.
So I want to thank you for all your work in this area, but
obviously we have a long ways to go.
Some of my questions--and, frankly, I have some concerns,
and I will direct them at Lieutenant General Bromberg because
this young man served in the Army, but after a soldier reaches
out for help, what exactly happens at that point?
General Bromberg. Yes, ma'am.
If the soldier reaches out for help, depends how he reaches
out for help. Does he go to a chaplain, does he go to a peer,
or does he go to behavioral health? So there are multiple
pathways, what we call multiple touch points.
If you start with the unit, training the unit on ask, care,
and escort training that teaches the peers to say--ask
questions, care about the individual, and escort them to
behavioral health. And if they are in the behavioral health
network, of course, they go into seeing the behavioral health
specialist, and they are treated as they are needed to repair
them and get them back to their full capacity. If they go to a
chaplain, they can still be referred to that way.
So there are several pathways that the soldier can go down.
Mrs. Noem. Well, what can happen if the soldier is in
counseling then, yet they are soon to be deployed. How is that
balanced with their mission that they have in front of them?
General Bromberg. There are many avenues. For example, if
they are in counseling there is a decision made is if the
soldier should even deploy. And any soldier that is put on any
type of medication, the psychotropic medication, we
automatically don't deploy them for at least 90 days to see the
effects of the medication.
If the soldier can deal with a mild medication and still
deploy, that is a chain of command and a medical decision to
make. But there is a 90-day period right there.
Mrs. Noem. So if they are deployed then they are under the
supervision of their commanding officer?
General Bromberg. And the medical facilities that are
forward----
Mrs. Noem. Medical facility would be--I have that
information----
General Bromberg. Yes, ma'am.
That is tracked in his medical record and it should go
forward. I am sure we are not absolutely 100 percent perfect
and we have had problems over the past 12 years, but we have
improved that to include putting behavioral health forward. So
we have behavioral health teams with our forward-deployed
organization, which is a step we are doing to standardize that
across the Army out through 2016. Because putting behavioral
health with the units at the point of action is very key. We
have learned that over these last several years.
Mrs. Noem. You know, I understand that after a suicide
occurs that there is an after-action review that it happens
with the family. Is there contact with the family during this
review?
General Bromberg. Yes, ma'am. The first is the unit does an
after-action review as well as we do after-action reviews all
the way up to the Department level. In fact, we meet monthly;
the Vice Chief of Staff of the Army hosts a suicide review
group with all senior commanders where we look at general
trends and cases. And there is also information provided to the
family.
Mrs. Noem. But during that review is the family contacted?
I mean, that is the concern that I have with this individual
situation is this family was not contacted during that
investigation whatsoever.
They were certainly given the advantage of having an after-
action review, but I would think if they were really going to
understand what happened in that individual situation that
there would have to be some kind of communication with the
family during the investigation.
General Bromberg. Yes, ma'am. If you like I can get that
follow-on information. We can, you know, dig into the details
of this case.
Each one is different. We will normally finish our
investigation first. But I will be happy to take that on.
[The information referred to can be found in the Appendix
on page 111.]
Mrs. Noem. Yes, I would really appreciate that, because I
think that is a key missing link. And what I am concerned about
is that while we are very action-oriented in our military in
our national defense, that I don't want us to approach these
situations such as checking the box, that we have completed
what we feel are requirements, that we need to have the
adaptability, the flexibility to care about the individual to
take the action that is necessary, because these are crisis
situations and just checking the box isn't going to get us the
kind of results that we really need and deserve for our service
men and women.
Thank you.
I yield back, Mr. Chairman.
Mr. Wilson. Thank you very much, Mrs. Noem.
And we now proceed to Dr. Brad Wenstrup of Ohio
Dr. Wenstrup. Thank you, Mr. Chairman.
And I applaud all the work that you are doing. I have done
some temporary duty at Fort Lewis dealing with suicide
prevention. I am familiar with the difficulties in trying to
assess and try to prevent and then to try to treat. And I know
that your assignment is difficult.
Of course, we are always looking for numbers; we are always
looking to try and figure out where are the common trends, and
you have identified some of them already, such as legal,
financial, and domestic problems.
I know you compare with the civilian numbers, but do we
compare, say, 30 and under, of the civilian population? As you
mentioned, so many within the military are 29 or younger, so I
was curious if we compared in that way and what kind of results
you have seen there. Is it pretty similar to the general
population?
Ms. Garrick. Yes, sir. I think Dr. Reed addressed some of
that as well. We see a lot of similarities between ourselves
and suicide in the civilian population. It is pretty much a
mirroring demographic, with young white males with these types
of issues and problems. I think there are some studies they
have done with college students that look very similar to our
population.
Dr. Wenstrup. So we can't really conclude that this trend
within the military is military specific, that that may not be
the issue; it may be more societal rather than just military,
right, Dr. Reed?
Mr. Reed. Great point. And I think that is one thing we
really have to tease out. The rate of suicides for 18- to 25-
year-olds in the general population is high. It is the third
leading cause of death.
So the question really is, what percent of the suicides
that are happening in the military in the same demographic are
similar, in terms of their cause, to the general population, or
perhaps unique to the experience of being in the military?
When you look at another group, the same age group--the
college-age student--this population has half the suicide rate
of their peers that don't attend college. So what is it that is
protecting college-age 18- to 25-year-olds that is not
protecting the general population, or perhaps some of those
that are in the military?
These are questions we really have to look at, because it
may not be a military-specific explanation for the 18- to 25-
year-old suicide rate. It may be more of the fact that these
are young people whose brains are still developing. Problem
solving skills, coping skills, impulsivity are factors that
affect all 18- to 25-year-olds. And maybe we need to look from
that perspective as well as we try to address the problem.
Dr. Wenstrup. Thank you. And so it seems, as often is the
case with military research, it tends to benefit the entire
country, and I think that this will be a case of that.
The preventive side is often very difficult, obviously. I
look at like the ACE [Ask, Care, Escort] program with the Army.
Is there any way of measuring how many saves we have had?
General Bromberg. Sir, we are just starting to do that now.
Earlier example, we looked at one infantry division where they
have done now 24 months of resiliency training, and we were
tracking the gestures, attempts, and ideations, and to see how
many peer-to-peer interventions there were.
And the initial results are--is that while the gestures
have remained generally about the same, the number of peer-to-
peer interventions has increased dramatically, and therefore
the number of cases having to go to behavioral health have
really reduced. But we are in the really early stages of doing
that and we are trying to link that training to outcome.
Admiral Van Buskirk. I think I would like--just like to add
on to that, and that is, sir, that we can't exclusively look at
just suicides and suicide-related behavior. I think one of the
good things that is happening as we have all investing in our
behavioral health specialists and embedding those people in our
units. We look at all of the other things that are related to
stress and see how that is being managed. Are incidents of
alcohol abuse going down? Domestic abuse was mentioned earlier.
So there are these other areas that are also related to
stress, to where we see the benefits of when we get the
professionals in there, we reduce the stigma. When it is a
total leadership, down to the deckplate level, we see success
in these areas and start to see the needles move, I think, in
terms of the other behaviors that might be associated with
stress, which might be indicators of a potential suicide-
related behavior later on or an event.
Dr. Wenstrup. I appreciate you taking on this difficult
challenge and thank you for being here today.
And I yield back my time.
Mr. Wilson. Thank you, Dr. Wenstrup.
And we now proceed to Congressman Chris Gibson, of New
York.
Mr. Gibson. Thank you, Chairman.
And I thank the ranking member, as well, for calling this
hearing, and all the panelists for your service commitment to
our country.
I am encouraged, actually, by the dialogue here in this
hearing, and find particularly interesting some of the
responses.
Dr. Reed, the recent one you just gave with my colleague
here, looking at the data, trying to understand it, how
difficult this is that we are just not going to be able to
point to--we are not going to know, you know, by precise
numbers.
But I think the focus on resiliency will come through. And
over time I think we will see a very positive impact on this.
I want to also mention that Mr. Scott, he brought up
equine, and we have a couple of programs going on in our
district in upstate New York with initial very favorable
reviews. So I am encouraged by that and we are going to
continue to work that.
Former commander, 3 years ago a brigade commander in the
82nd--and, you know, can appreciate firsthand how serious our
commanders and sergeant majors, first sergeants, are taking
this issue and all the emphasis that is put in in a period of
enormous stress coming through over a decade of war, the budget
situation, the drawdown. All of these pressures, exogenous and
impacting. And yet we have a leadership very focused on making
a positive difference. Greatly appreciate it.
Ms. Garrick, like you, my wife, Mary Jo, is a licensed
clinical social worker. She is part of a congressional spouse's
group trying to make a difference on this very issue, and they
are partnered with the American Foundation for Suicide
Prevention. And, you know, I think they are doing important
work.
I went to an event recently in Albany where General Graham
and his wife Carol were there. I just can't say enough positive
about this event. It was well attended. It was focused on
education, on warning signs, actions that could be taken.
So to follow up with the Chairman, you know, having
firsthand experience in terms of the Active Component and
seeing how engaged we are, my question really is a followup on
the Reserve Component and veterans side of this, because as
concerning as the data is for our service men and women, we
know the veterans' situation is worse.
And I think you are already making a positive impact on the
work that you are doing in the DOD. And so, you know, coming
away from this event last week, I thought that the American
Foundation for Suicide Prevention is really engaged and making
a difference on this. And so I am interested to know what
partnerships we have with the DOD and what is your review of
that and your intentions going forward?
Ms. Garrick. Yes, we have established a community action
team approach, as described by, actually it was Admiral Mullen
when he wrote the ``Sea of Goodwill.'' So we took that concept
and we have started to have these community action roundtable
discussions where we bring in from the community organizations
like the Tragedy Assistance Program for Survivors, the suicide
association you have just mentioned. Dr. Reed and I talk quite
a bit and I work very closely with the Department of Veterans
Affairs.
Our last roundtable we held we had several university
participation--Harvard, UCLA, the universities in North
Carolina and South Carolina were both on the phone, Penn State.
So we had some really great university dialogue on looking at
peer support and curriculum for peer counselors.
So we are doing a lot of these kinds of outreach efforts.
And my partnership with the Department of Veterans Affairs
truly does allow us to leverage looking at building a joint
data repository across the Department with HHS [Department of
Health and Human Services], the CDC data as well. And I think a
really important step forward is that the DOD will now confirm
for CDC Guard Reserve deaths, so that will really help us
understand the reach into the States and what that looks like
at the local level.
So those kinds of partnerships, they may--it may take us a
while, but those things are certainly the steps that I see that
we needed to take and I think are going to be very helpful in
moving us forward and understanding this from a perspective
that Dr. Reed described.
Mr. Gibson. Well, I appreciate that comment. And just to
put a finer point on the Albany area, it is about 3 hours or so
from Fort Drum, and about 2 hours from West Point. But the
population--about 15 percent of the population, veterans. So
this is why this event was so critically important, because
they were educating the social workers and some of the
volunteers who are at the V.A.--the Stratton V.A.--and also
support some of the Active Duty and the National Guard that are
in the Albany area, whether it be on recruiting, ROTC, or the
42nd Infantry Division right there in New York.
So I am going to be working with the committee and see if
there is maybe more we can do on this partnership, but I
appreciate everything that everyone is doing.
Thank you, and I yield back.
Mr. Wilson. And thank you, Mr. Gibson. And thank you for
your family's commitment and service.
We now proceed to Congresswoman Carol Shea-Porter, of New
Hampshire.
Ms. Shea-Porter. Thank you very much, Mr. Chairman.
And thank you all for being here and the great work that
you are doing.
I have to say, it is frustrating. I wish that we had one
name across the military spectrum. I am reading about all these
various programs, and through the years while I have had the
privilege of serving here there have been different titles--
all, you know, working to serve this purpose and try to help
enlisted men and women and officers as well. But the complexity
of just the titles and the program has to throw a lot of the
intended recipients.
So my first question is, how many people are you aware of,
no matter how hard you try for your outreach, how many victims
or their families have said they didn't know where to turn?
Ms. Garrick.
Ms. Garrick. Yes, I don't know that I have an exact number
of how many, but I have certainly heard that as well. And that
is why, again, part of what we have done, and all of the
Services in their statements noted that we have tried to craft
one message for moving forward, and that is if you need help,
get it. Treatment works.
And when we work with the military crisis line we have an
``It's Your Call'' campaign, and then this year we launched the
``Stand By Them'' campaign, which is a V.A.-DOD single-message,
single point of contact, 1-800 number. And if you type--if you
call the number it is the same number as the SAMHSA [Substance
Abuse and Mental Health Services Administration] suicide
hotline number so that regardless of whether you press one or
don't press one you are getting funneled into the same help
with the same protocols in place, so that our service members
and their families are using the same services that veterans
and their families have available to them so that there is that
pull-through.
And that is why it is so important that at transition we
are going to be able to provide them that information, as well.
So as they move forward, the message never changes. It is the
``It's Your Call,'' the ``Stand By Them'' campaign, and the
same 1-800 number.
Ms. Shea-Porter. But do we keep any statistics? Is the
question asked: Did you know where to turn? Did you know this
service was available? Because my interaction with service men
and women and veterans, and certainly we know this from the
Vietnam era for all the outreach, you know, that somehow or
another there was still a curtain there--were not aware of it.
And I know that our V.A. in Manchester, New Hampshire, has been
reaching out and going to where veterans actually are, trying
to draw them into the system so they can have access to needed
benefits.
So there is still some kind of a curtain there, and is
there any way that we are measuring how effective we are? Are
we asking, did you know where to turn? Did the family know once
they were aware things weren't right? Because I think that is
an important part, to make sure that we are actually reaching
them.
Ms. Garrick. Yes, I think going back to the previous
question from Congressman Gibson, that is why these community
action teams and that approach is so important. Because we
can't do this alone, we really do need our community members
involved and engaged so that that message is getting out there,
that our veterans service organizations know how to facilitate
a rescue, they know how to call the 800 number, how to go
online, how to do the texting, the chatting, so that all that
is out there.
We just did do a study with the Guard and Reserve,
actually, on suicide prevention and resilience. We asked
support professionals and commanders, so what resources are you
aware of? What do you use? What do you like? What don't you
like? So that we could get a better understanding of that exact
issue.
Ms. Shea-Porter. But again, you know, does it actually
arrive through the individual's curtain and do they know that?
And so I have a very simple suggestion. I thought, everybody
has to go to the grocery store. You know, we don't have to go
look for resources to help ourselves or our family members.
Maybe we know to do that; maybe we don't. But everybody has to
go to the grocery store.
Can we put the number on grocery bags? Can we ask various
companies and all of the great corporations and small family
businesses to put this telephone number on grocery bags to--
because there is still some kind of problem there where they
are just not all aware of the resources there.
So for all the great work you are doing, if there are
individuals that are not tied into VSOs [Veterans Service
Organizations], if they are not tied into various
organizations, if they think in their minds that it is better
not to be connected to the military or to the Veterans
Administration for whatever reason, how do we still reach those
who have not reached out and we have not noticed yet?
Ms. Garrick. No, and I think that is a great suggestion.
Ms. Shea-Porter. So I yield back.
Ms. Garrick. We have had some conversation about doing that
with the commissaries.
Ms. Shea-Porter. Right, so I--but past the commissaries,
because a lot of them will not be using commissaries. I think
this is going to call for the effort, and it has already been
developed for a long time, I know, but continuing to make sure
that our business community and our nonprofits as well as those
who are in the military and veterans community can work
together to put this out there.
Because these programs are there, they are wonderful, but
some people still do not access them.
So thank you, and I yield back.
Mr. Wilson. Thank you, Ms. Shea-Porter.
We now proceed to Dr. Joe Heck, of Nevada.
Dr. Heck. Thank you, Mr. Chairman.
Thank you all for what you are doing and for being here. I
am sorry that I missed your testimony. I had another hearing to
attend, but I did read through your written statements prior to
today.
First, I want to thank Ms. Garrick for bringing up the TAPS
program and forging a community partnership with them, not just
for the Services that they provide to the family members but
for looking at the information that they glean from the family
members during their debriefings and how that may help us
identify future risk. I was just at their anniversary dinner a
couple nights ago, so an incredible program and I am glad that
you are involved with them.
I approach the issue, I think, a little bit differently, as
a military health care provider and as a brigade commander who
over the last 2 years has had one successful and two threatened
suicides within my command. So it is a real issue for me that
hits home.
You know, when the Army launched its health promotion, risk
reduction, and suicide prevention campaign in 2009 and it stood
up the task force, the Army Reserve participated and came up
with four pillars that they were going to concentrate their
efforts on, and I want to talk about two of them. One was
reducing the stigma associated with asking for help, which has
been addressed somewhat here today, and the second was
providing resources to geographically dispersed personnel.
I tell you, fortunately, for the two threatened suicides
that we had, it was fortunate that those individuals were
located within the community where the unit was based. Again,
you know, being geographically dispersed in the Reserves can
mean a lot, and in my brigade I have got soldiers that are 3
hours or more away from the unit.
But these individuals made statements to their first-line
leaders. Their first-line leaders then utilized the ACE
mnemonics and went out and asked, took them and escorted them
to care. And both of them were then enrolled in behavioral
counseling services, and I truly believe that that program
saved those two soldiers' lives.
Unfortunately, the completed suicide, although having taken
place in the same town as where the unit was located, had no
previously seen indicators.
And actually, his first-line leader and he were friends and
they happened to be out that night together. And then 2 hours
later, after they departed company, the first-line leader was
called and told that the person he was just with had
successfully committed suicide.
So the issue I bring up about stigma is, as we try to put
more and more of this responsibility on first-line leaders,
especially in the Reserves, we are looking at 25-, 26-year-old
E-5s, and I can tell you that in the successful case, that
first-line leader is still beating himself up over the fact
that not only was he a friend but he was his first-line leader,
and he feels like he failed in recognizing what happened.
And I can tell you that as we talk--about seeing in the
written statement the stigma reduction campaign that is being
developed, I mean, but stigma reduction was identified in 2009.
I identified it when I returned from my deployment in 2008,
because you knew that if you checked the box on your post-
deployment health risk assessment that you had seen a dead body
or anything like that you were not going to be released. You
were going to spend another 2 to 3 days going through
additional counseling, and obviously everybody is waiting to
get home to their families and so they knew not to check the
box--not because they didn't want to ask for care but they knew
it was going to delay their ability to get back to their
families.
So why is it taking until--why are we still developing a
stigma reduction campaign when this had been identified well
before 5, 6 years ago?
General Bromberg. Yes, sir. I just think over all--and I
understand the frustration and the challenges--think this is a
cultural change. I think it is not that we are developing a
campaign or failing to recognize it. I think as I talk to young
men and women, and the numbers are getting better as far as
people that think stigma is improving, but not as fast as we
would like.
This is a huge cultural change for us, whether your
background or how you were raised all the way through your
background in the military. And I think it is the engaged
leadership and the evasive leadership, and then success stories
of where you can seek help and not be penalized for that help.
There is just a recent data I looked at this week, we have
seen very slight improvement this last year, but great
improvement over 4 or 5 years--about 20 percent improvement is
in stigma reduction. We are just going to have to stay at it
and keep leadership engaged.
Dr. Heck. And I just have a couple seconds remaining. I
just want to bring up the issue about help to the
geographically dispersed.
It seems like a lot of the concentration has been on
getting them access to care, but again, if they are remote from
their unit, we have got to identify them. Who are they going to
identify themselves to?
And have we done anything with, you know, our--you know,
units within the same compo [component], whether National Guard
units, sister service units, Active Duty installations, the
V.A., so that if somebody calls their unit and they are 3 hours
away, and they say, ``I am having a problem,'' that we can get
them plugged in with somebody in a uniform who they are going
to be able to relate to much easier than somebody showing up in
civilian clothes on their doorstep. Have we looked at trying to
branch out across Services and compos?
General Bromberg. Yes, sir, we are working at it diligently
right now, and I will provide you some more additional
information on the specifics of how we are getting after that.
[The information referred to can be found in the Appendix
on page 111.]
Dr. Heck. I appreciate it.
Thank you, Mr. Chair, for--and the ranking member for
holding this very important hearing, and I yield back.
Mr. Wilson. And thank you, Dr. Heck.
And indeed, this is an important hearing and it is obvious
the commitment of everyone here. And while we have this
opportunity, we will proceed with additional questions.
And, Dr. Reed, in particular, the Center for Disease
Control has indicated suicide is the third leading cause of
death among 15- to 24-year-olds, and is the second leading
cause of death between 25- to 34-year-olds. And you have
already actually brought up something interesting, and that is
there is a differential between college-age--young people who
are attending college, not attending college, the suicide rate.
Are there practices within the civilian community that could be
adopted to the military?
Mr. Reed. Yes, sir. One of the things that happened in 2005
was after the tragic death of Garrett Smith, the son of Senator
Gordon and Sharon Smith, the Congress passed the Garrett Lee
Smith Memorial Act. It has been in place since 2005. It is
really the first Federal appropriation that has been authorized
and funded to fund States, tribes, and territories, as well as
college campuses, to really aggressively look at early
intervention and prevention in suicide prevention amongst this
age group.
These cohorts have been funded since 2005. It is still
active today, and we gather the cross-site evaluation that is
providing SAMHSA some very valuable information in terms of
what seems to be working. And each grantee has been required to
assess their own performance, and those performances each year
are shared with others who are trying to do the same thing.
So this is a perfect example of where, working with Ms.
Garrick, we can share some of what we are learning in the
civilian community that may have relative value to what is
happening in the military community as well, especially for
those younger military members who may not have taken their
life or thought about taking their life as a result of a combat
experience, but may be more of a developmental issue with
regards to their place and age.
Mr. Wilson. Well, thank you for providing that.
And, Ms. Garrick, I, too, am--was very appreciative of
TAPS. I know firsthand the Yellow Ribbon Campaign. I want to
thank you.
We proceed to Mrs. Davis
Mrs. Davis. Thank you, Mr. Chairman. I appreciate just a
second round quickly to try and mention a few issues that are
out there, I think, that we talk about.
One of them is a guilt factor, that, in fact, people came
home, someone came home and felt that their buddies did not.
And I don't know to what extent you find that that is a large
factor that is being addressed or you think maybe is not
getting the attention that it deserves.
I think the other issue is just the loss of hope, which we
know is probably more than any other thing that people can
express or that family members can express about a loved one,
that they didn't see that coming perhaps, but that was a big
factor. People have talked about the issue of contagion.
And I think, Dr. Reed, you mentioned it is how we speak
about suicide that makes a difference.
I am recalling, Mr. Chairman, that one of the first
hearings that we had here where we had a father talk about his
son, and of course, it was very emotional, and trying to
understand, essentially, the question of, how come nobody--how
come we didn't know, and what services were out there?
So I don't know to what extent you want to address those,
but those are all issues.
But the one that I think you can maybe, you know, get your
head around a little bit is the factor that at least 10
percent, as we know, in the service have perhaps access to guns
at a greater level than in the general population. And the fact
that we have the literature indicating that restricting access
to means--firearms, of course--is an effective strategy for
preventing suicides.
Now, in the military, are we using and thinking about that
and the preventive strategies that are required, knowing that
our service members have access, of course, and perhaps are not
getting to help because, you know, they--it is just too--in
some ways it may be too easy. Can anybody like to talk about
that?
Ms. Garrick. Sure. First of all, the NDAA 13 just gave us
some really good clarifying language on who can, when can you
ask about personally owned firearms, ammunition, and other
weapons, and so we are working on a guidance for that so that
we can get that information out to the Services and make sure
that everybody, that the clinicians as well as the commanders,
are tracking that on what you can do. So, I think, that was an
important step for us.
And I do want to go back and just sort of comment on what
you said about trauma, hope, and contagion, because this is
clearly not just a mental health issue. Suicide is a behavior
and it is a--and I think that is why it is so important that we
have chaplains involved in this process as well as commanders
and mental health providers. This really will take a community
response within the military community and outside of the
military community to address some of those key points.
And I think the research we need to do--and I just met with
General Patton the other day, who heads our Sexual Assault
Program office [Sexual Assault Prevention and Response Office],
I think marrying up, so what are the different issues? What are
the areas of concern? And how can we learn more about trauma
and the--its implications, and hope and resilience and its
implications? I think those are all very key factors.
And then the means restriction is certainly important. I
think the Services can certainly tell you more about what they
are doing in that regard.
Mrs. Davis. And if there is anything more that Congress
could or should be doing to help. In addition, obviously, we
talked about the--just the resource issue, in terms of
assistance.
I think just one other thing to add--I know my time is
running out--is just, how do we determine the quality of care
that is being provided, as well? I mean, I don't doubt that we
have the bulk of our caregivers who are providing that quality
care, but we also sometimes talk to people that don't go
additionally because they don't help them out.
General Bromberg. Yes, ma'am, it is to protect the
weapons--on our installations, of course, that is no issue.
Commanders have the authority to get in what I call almost that
invasive leadership, asking those questions to withdraw those
weapons. And the NDAA did help us significantly by opening up
the aperture for those that live off-post or off the
installation so we can ask the right questions to try to
retrieve those weapons.
The commands are going after that very aggressively. So the
weapons piece, I think, is absolutely essential.
As far as the quality of care, I think, it is the positive,
continuous dialogue in reaching out to those individuals to
find out what else they need, because it may not be just
behavioral health. It may be some other type of relationship
issue or financial issue. Where can we provide that additional
support?
General Jones. Ma'am, in the Air Force, we have had--rather
than going after looking at who carries and has access to
weapons we look at career fields. Three of our most at-risk
career fields are security forces, aircraft maintenance, and
intelligence. Obviously, security forces would have access to
weapons.
We target those career fields with special first-line
supervisor training, must be done one-on-one, must be done in
small groups. And we found a lot of success with that.
The other thing we are trying to do is make our health care
providers more accessible without applying the stigma. Eighty-
three percent of all of our primary care clinics have mental
health providers embedded in the clinic, so if you go in to see
one physician he can take you next door to talk to a mental
health care provider without having to take you down the hall
to the mental health care clinic.
And I think that really gets at some of the stigma. And I
think the stigma is really the metric that shows us that we are
making some headway here. Ninety percent of everybody in the
2012 Air Force climate assessment survey said they believe
leadership was interested in suicide prevention and felt that
was a great thing.
And also in the 2012 survey, 84 percent of the people said
they knew who to talk to. They would talk to their coworkers,
they would talk to their supervisors and their branch chiefs--
not for mental health care but for the first contact to tell
someone that they had trouble--ma'am, much to your question of
where they would take them. And that leads to the ACE care,
where you ask the person--do they have an issue, you care for
them, you escort them over to a real professional.
And in that same survey, 95 percent of the people in the
Air Force said--and this was Active Guard and Reserve--said the
leadership was genuine. Ninety-five percent said the family,
friends, and coworkers would support them if they had mental
health issues and sought help. And 83 percent said that they
would feel comfortable talking about suicide to their coworkers
and to professionals. And we think that is a big plus in our
numbers.
Mrs. Davis. Big improvement. Thank you.
Thank you, Mr. Chairman.
Mr. Wilson. Thank you, Mrs. Davis.
And as we conclude, I want to thank all of you for your
genuine, very thoughtful compassion toward our service members,
military families, and veterans.
At this time we shall be adjourned. Thank you.
[Whereupon, at 12:15 p.m., the subcommittee was adjourned.]
=======================================================================
A P P E N D I X
March 21, 2013
=======================================================================
PREPARED STATEMENTS SUBMITTED FOR THE RECORD
March 21, 2013
=======================================================================
Statement of Hon. Joe Wilson
Chairman, House Subcommittee on Military Personnel
Hearing on
Update on Military Suicide Prevention Programs
March 21, 2013
Today the subcommittee meets to hear testimony on the
efforts by the Department of Defense and the military services
to prevent suicide by service members, family members, and
civilian
employees.
I want to preface my statement by recognizing the
tremendous work the Department of Defense and the service
leadership has done to respond to the disturbing trend of
suicide in our Armed Forces. This has not been an easy task and
I thank you for your hard work. Suicide by members of our Armed
Forces is particularly distressing to me because I consider
military service an opportunity. I want service members to know
they are talented people who are important and appreciated by
the American people. They can overcome challenges.
Suicide is a difficult topic to discuss. Last year 350
service members took their own lives. Every one of them is a
tragedy; every one of them has a deeply personal story. We
cannot rest until we have created every opportunity to change
such an awful statistic.
Suicide is a multifaceted phenomenon that is not unique to
the military. Unfortunately, in addition to the hardships of
military service, our service members are subject to the same
pressures that plague the rest of society today. They are
exposed to the same stressors that may lead to suicide by their
civilian counterparts. I am deeply concerned about how the
uncertainty of sequestration and the coming budget challenges
will affect our service members and their families.
Each of the military services and the Department of Defense
has adopted strategies to reduce suicide by our troops. I would
like to hear from our witnesses whether those strategies are
working. How do you determine whether your programs incorporate
the latest research and information on suicide prevention? I am
also interested to know how Congress can further help and
support your efforts. Lastly, I am interested in learning how
our civilian experts are tackling this problem across the
Nation and how private organizations like Hidden Wounds of
Columbia, South Carolina, are
assisting.
Statement of Hon. Susan A. Davis
Ranking Member, House Subcommittee on Military Personnel
Hearing on
Update on Military Suicide Prevention Programs
March 21, 2013
I am pleased that the subcommittee is continuing its
attention on suicides in the military. It has been nearly a
year and a half since our last hearing on military suicides,
and during this time, we have only seen increased numbers of
service members taking their own lives. While Congress has
pushed forward a number of initiatives to support the Services
and the Department of Defense in their efforts to develop
policies and programs to reduce and prevent suicides in the
force, sadly these numbers continue to grow.
Yet, military service members are not alone. Over 38,000
individuals die by suicide every year. In 2010, suicide was the
10th leading cause of death in the United States, and the
fourth leading cause of death for adults between the ages of 18
and 65. While suicide among young individuals, 15-25 years old,
continues to be a concern, the rate of suicide among older
Americans is even higher. It is important that we share what we
learn in the military and what is learned by others if our
country is to be successful in addressing this societal issue.
The establishment of the Department of Defense Task Force
on the Prevention of Suicide by Members of the Armed Forces in
the Duncan Hunter National Defense Authorization Act of Fiscal
Year 2009 was a start. The task force made 76 recommendations
and I am interested in where the Department and the Services
are in implementing these recommendations. Have they all been
completed, and if so, what metrics are being used to track
success? What other efforts can be undertaken to address
suicide in the military?
I welcome our witnesses, and look forward to hearing from
them on what has been done, what is being done, and where do we
go from here in our efforts.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
=======================================================================
WITNESS RESPONSES TO QUESTIONS ASKED DURING
THE HEARING
March 21, 2013
=======================================================================
RESPONSE TO QUESTION SUBMITTED BY MRS. DAVIS
General Hedelund. Yes, I am aware of the pilot program in
mindfulness training. The goal of the program is to provide Marines
with another tool to combat stress through the use of meditative
techniques. We're expecting the results from the study in the fall of
2013. [See page 15.]
______
RESPONSE TO QUESTION SUBMITTED BY MR. SCOTT
Ms. Garrick. Since the VA claims backlog issue falls under the VA,
we would have to defer to them for the percentage of those who were
waiting for their VA claims.
However, we do know that from the initiation of the Disability
Evaluation System (DES) Pilot (November 2007) through November 2012
(the most recent update from Military Departments, there were 156
deaths reported of Service members enrolled in the DES. Of these, 32
determined to be suicide. During the same time period (2007-2012),
there were approximately 1700 Service members who died by suicide.
Therefore, approximately 1.9 percent (32/1700) of the total Active Duty
and Reserve suicides were in the DES process at the time of their
death. [See page 16.]
______
RESPONSE TO QUESTION SUBMITTED BY MRS. NOEM
General Bromberg. The investigating officer (IO) did not interview
the Soldier's Family because he did not feel it was pertinent to
addressing the lines of inquiry in Army Directive (AD) 2010-01. He
initiated his investigation by looking at the County Sheriff's
Department report, which included depositions from the two individuals
who had found the Soldier after the incident. He then developed a list
of acquaintances and members of the chain of command who knew the
Soldier, and after these interviews the IO believed he was able to
answer each question of each line of inquiry in AD 2010-01.
The policy states that during an investigation, ``any contact or
communications with a Family member of the Soldier should be pursued
only when absolutely essential to the conduct of the investigation.''
AD 2010-01 directs the IO to answer a series of questions which largely
are focused on the Soldier's interactions with his/her peers,
superiors, and subordinates. [See page 21.]
______
RESPONSE TO QUESTION SUBMITTED BY DR. HECK
General Bromberg. The unit chain of command represents the center
of gravity for the health and care of our Soldiers and Families. The
uniqueness of our geographically dispersed population mandates
sustained partnerships with local community leaders and resources. Our
leadership is committed to health, safety and welfare of all Soldiers
and Family members; providing the appropriate linkage to available
resources and assistance closet to where they live is a key component
of that commitment. Venues such as the Yellow Ribbon Reintegration
Program and Strong Bonds facilitate this connection with education and
awareness of local networks of community support most appropriate and
available to our Soldiers. Other resources like our Fort Family
Outreach Center and Army Strong Community Centers assist in virtually
bridging the gap with commensurate services inherent to an active duty
installation. These resources provide geographically relevant
information. We continue to work collaboratively with our sister
components in order to capitalize on both inherent capability and
capacity to connect our Soldiers and Families with the resources and
assistance needed. [See page 28.]
=======================================================================
QUESTIONS SUBMITTED BY MEMBERS POST HEARING
March 21, 2013
=======================================================================
QUESTIONS SUBMITTED BY MS. SHEA-PORTER
Ms. Shea-Porter. 1) What steps are the Defense Suicide Prevention
Office and the Services taking in terms of support and treatment, to
meet the mental health challenges facing spouses and children? There
are some innovative National Guard Yellow Ribbon Programs, like that of
our own New Hampshire National Guard, that follow and support families
as well as Guard members before, during, and after deployment. Are you
talking to the States and incorporating the best practices of such
programs?
Ms. Garrick. Yes. The Department of Defense (DOD), through the
Defense Suicide Prevention Office, has formed a Community Action Team
process comprised of representatives from non-profit organizations,
universities and others to discuss suicide prevention best practices.
In addition, it has recommended policy changes for military justice and
civilian court processing adjudicating Service members who appear in
civilian courts under state jurisdiction diagnosed with psychological
conditions. DOD has expanded the National Guard Chaplain Partners In
Care program, which leverages state community faith-based organizations
responding to Service members, Reserve members and their families.
Family members may be able to recognize warning signs and see
changes in their Service member's behaviors before anyone else since
they interact with them in a less-guarded state. DOD is drafting an
Info Guide ``Supporting Military Families In Crisis: A Guide to help
You Prevent Suicide.'' It is designed to empower military families by
introducing them to the warning signs of suicide, reduce the stigma and
uncertainty associated with seeking behavioral health, and provide ways
to avail resources, get help, and build family resilience.
Ms. Shea-Porter. 2) Do DSPO and the Services have a strategy and
the capacity, to provide adequate mental health screening and care for
families? If not, how are they partnering with civilian social services
and non-profit organizations to fill the support gaps? New Hampshire's
National Guard Yellow Ribbon Program, for example, partners with Easter
Seals to provide needed support.
Ms. Garrick. Yellow Ribbon Reintegration Programs (YRRP) and
Returning Warrior Workshops are retreats that facilitate family member
involvement in the reintegration process. YRRP offers specific pre,
during, and 30, 60 and 90 day post deployment sessions that focus on
managing the stressors related to deployment and the resources for
reintegration.
Military Treatment Facilities and the TRICARE network offer
behavioral health care and support to all beneficiaries. The Patient
Centered Medical Home--Behavioral Health Team (PCMH-BHT) model is
leveraging a primary care behavioral health case management approach
and the Psychological Health Council has incorporated suicide
prevention and family issues into its scope.
The Services have dedicated military family support centers (MFSC)
that help Service members successfully balance and integrate their
military and civilian lives. MFSCs provide relocation assistance,
financial training, and family education/advocacy services. For
National Guard/Reserve members, military and family life counselors
(MFLC) are available to provide short-term, non-medical counseling
during drill weekends and other events or locations where Service
members and their families gather. Family members can also benefit from
Military OneSource's 12 (non-medical brief intervention) sessions to
resolve marital or family challenges. Section 706 of the 2013 NDAA
authorizes the Department to conduct a pilot study on enhancement of
mental health in the National Guard by partnering with community
agencies. The National Guard Bureau has developed a draft pilot
program.
Ms. Shea-Porter. 3) Are family member (spouses and children)
suicides being tracked by DSPO and/or the Services? If not, why not?
Ms. Garrick. DOD does not track at the Department level suicide
deaths for families of Service members, because DOD has no reliable
means to do so. Suicide deaths among spouses or dependents are
determined by a civilian authority and not a medical examiner from the
Armed Forces Medical Examiner System (AFMES). As a result, DOD must
rely on civilian authorities and Service members to report spouse/
dependent deaths. DOD has no authority to require civilian health and
mortality authorities to forward autopsy findings to DOD. Service
members do report dependents' death for beneficiary purposes, but there
are often lags in that information, and manner of death is not always
included.
Ms. Shea-Porter. 4) What authority will DSPO have to ensure the
suicide prevention policies they develop will be implemented by the
Services?
Ms. Garrick. DSPO activities are under the authority of the
Secretary of Defense, who exercises authority, direction, and control
over the Military Department and Services.
Ms. Shea-Porter. 5) What steps are the Defense Suicide Prevention
Office and the Services taking in terms of support and treatment, to
meet the mental health challenges facing spouses and children? There
are some innovative National Guard Yellow Ribbon Programs, like that of
our own New Hampshire National Guard, that follow and support families
as well as Guard members before, during, and after deployment. Are you
talking to the States and incorporating the best practices of such
programs?
General Bromberg. Yes, we are talking to the states to ensure the
best practices are being incorporated. Two major barriers in obtaining
Behavioral Health (BH) care for Military Children and Families are
limited Access to Care and Stigma.
The Army, in an effort to reduce these barriers, established School
Behavioral Health Programs (SBH) and Child and Family Assistance
Centers (CAFAC), specifically designed using the Public Health and
Communities of Practice Models. SBH Programs and CAFACs are currently
in varying stages of development and provide services at a limited
number of Army Installations. These programs are at risk of being
reduced for numerous reasons to include: a critical national shortage
of BH Child and Family providers; lack of sustained funding in the
current fiscal environment; sustainment of programs and proliferation
of new programs supporting the BH needs of Children and Families.
SBH programs currently operate in 46 schools on eight installations
(Tripler, Joint Base Lewis-McChord, and Forts Carson, Campbell, Meade,
Bliss, Bavaria and Landstuhl, Germany). SBH programs, by design,
support resiliency, promote access and reduces stigma. SBH is currently
limited to providing services to on-post schools; however, a pilot
program to provide the services to Military Children in off-post
schools is underway in the communities surrounding Schofield Barracks,
Hawaii.
Child and Family Assistance Centers (CAFAC), are being developed on
10 installations (Schofield Barracks, Joint Base Lewis-McChord, and
Forts Carson, Wainwright, Bliss, Hood, Polk, Bragg, Campbell and Drum);
the majority not being fully operational due to limited BH provider
resources and difficulties in hiring, particularly at more ``rural''
installations.
Ms. Shea-Porter. 6) Do DSPO and the Services have a strategy and
the capacity, to provide adequate mental health screening and care for
families? If not, how are they partnering with civilian social services
and non-profit organizations to fill the support gaps? New Hampshire's
National Guard Yellow Ribbon Program, for example, partners with Easter
Seals to provide needed support.
General Bromberg. The Child, Adolescent, and Family Behavioral
Health Office (CAFBHO), U.S. Army Medical Command, has established
collaborative working relationships with national and state
organizations and professional entities in order to identify and share
best practices in terms of prevention and interventions for behavioral
health problems for Army children and Families. CAFBHO has also
developed, and is implementing, a comprehensive training curriculum for
Army Pediatric Primary Care Providers by using evidence-based practices
for preventing, screening, identifying and treating common behavioral
health disorders in children within the primary care setting.
Partnerships have been established with the following national
organizations and universities in order to collaborate on best
practices and disseminate knowledge:
American Psychological Association
Academy of Child and Adolescent Psychiatry
American Academy of Pediatrics
Center for School Mental Health, University of
Maryland
IDEA Partnership and the National Community of
Practice, Office of Special Education, United States Department
of Education
Military Child Education Coalition
National Association of State Directors of Special
Education
Center for Deployment Psychology
The Beach Center on Disability, University of Kansas
University of South Carolina
University of Washington
Mayo Clinic/REACH
U.S. Department of Agriculture, Operation Military
Kids
Ms. Shea-Porter. 7) Are family member (spouses and children)
suicides being tracked by DSPO and/or the Services? If not, why not?
General Bromberg. The Army tracks Family member suicides of Active
Duty Soldiers; regardless of whether or not the death occurred on a
military installation. Suicides of non-Active Duty Soldiers' Family
members are not currently tracked due to challenges related to the
collection of reliable and substantiated data, identification of data
sources, and legal issues related to obtaining and maintaining civilian
personal information.
Ms. Shea-Porter. 8) What steps are the Defense Suicide Prevention
Office and the Services taking in terms of support and treatment, to
meet the mental health challenges facing spouses and children? There
are some innovative National Guard Yellow Ribbon Programs, like that of
our own New Hampshire National Guard, that follow and support families
as well as Guard members before, during, and after deployment. Are you
talking to the States and incorporating the best practices of such
programs?
Admiral Van Buskirk. Navy offers a full complement of programs
designed to address the needs of Navy families. Working within the
Department of Defense, with other federal agencies, and with state and
local partners, Navy identifies best practices and incorporates them
into our programs. Navy leadership recognizes the unique challenges our
families face and is fully committed to providing them the best
possible support as they support our Sailors and our mission.
Navy's version of the Yellow Ribbon Program is the Returning
Warrior Workshop (RWW). RWW participants have the opportunity to
address personal, family, or professional situations experienced during
deployment and receive readjustment and reintegration support from a
broad array of resources, including: Navy Reserve Psychological Health
Outreach Teams (PHOT), TRICARE Joint Family Support Assistance (JFSAP),
Military and Family Life Consultants (MFLC), Personal Financial Council
(PFC), Military OneSource (MOS), Chaplains, Fleet and Family Support
Centers (FFSC) and Veterans Affairs (VA).
Other Navy and DOD programs to help families cope with the
challenges they face before, during and after deployment include:
-- Ombudsman and Family Readiness Groups (FRG) are the primary
method of family support, outreach and communication with families of
deployed Sailors. The ombudsman program supports a volunteer associated
with the command--typically a spouse, appointed by the commanding
officer, to serve as a confidential liaison between command leadership
and the families. Ombudsmen are trained and certified to disseminate
information both up and down the chain of command, including official
Department of the Navy and command information, command climate issues,
local quality of life (QOL) improvement opportunities, and community
support opportunities. Ombudsmen also provide resource referrals and
are instrumental in resolving family issues.
-- An FRG is a private organization, closely-affiliated with the
command, comprised of family members, Sailors, and civilians associated
with the command and its personnel, who support the flow of
information, provide practical tools for adjusting to Navy deployments
and separations, and serve as a link between the command and Sailors'
families. FRGs help plan, coordinate and conduct informational, care-
taking, morale-building and social activities to enhance preparedness,
command mission readiness and increase the resiliency and well-being of
Sailors and their families.
-- Commander Navy Installations Command (CNIC) Deployment
Readiness Program. CNIC supports unit level family support and
deployment readiness programs with a wide variety of complimentary
training and support activities, including: unit level deployment cycle
training, online information and individualized one-on-one counseling.
-- Navy Project FOCUS (Families Over Coming Under Stress). FOCUS
provides resiliency training to military families, including practical
skills to meet the challenges of deployment and reintegration,
communication techniques, effective problem-solving and family goal-
setting.
-- The Navy Center for Combat & Operational Stress Control
(NCCOSC). Dedicated to the mental health and well-being of Navy and
Marine Corps service members and their families, NCCOSC promotes
resilience, and investigates and implements best practices in the
diagnoses and treatment of post-traumatic stress disorder (PTSD) and
traumatic brain injury (TBI).
-- The Defense Centers of Excellence are responsible for leading a
national collaborative network of military, federal, family and
community leaders; clinical experts; and academic institutions to best
serve the urgent and enduring needs of warriors and their families with
psychological health and/or traumatic brain injury concerns.
-- The Real Warriors Campaign promotes the processes of building
resilience, facilitating recovery and supporting reintegration for
returning service members and their families.
The Navy supports a comprehensive mental health strategy to provide
high quality, evidence-based care for Active Duty Service members,
reservists, and their families. Navy Medicine continues to improve and
enhance access to care for Active Duty members and their families by
increasing the size of the mental health work force and opportunities
to interact with behavioral health providers. The Behavioral Health
Integration Program in the Medical Home Port has being implemented
across 67 Navy sites, as well as 6 Marine Corps sites. This program
embeds behavioral health providers in the primary care setting to
increase access and reduce
stigma.
Navy Medicine continues to focus on the mental health needs of
reservists. In FY12, the Navy and Marine Corps Reserve Psychological
Health Outreach Program (PHOP) provided over 11,000 outreach contacts
to returning Service members and provided behavioral health screenings
for approximately 1,000 reservists. Similarly, as of December 2012 over
12,000 military family members participated in our Returning Warrior
Workshops (RWWs) for reservists. RWWs are funded through Defense Health
Program and Navy appropriations.
Ms. Shea-Porter. 9) Do DSPO and the Services have a strategy and
the capacity, to provide adequate mental health screening and care for
families? If not, how are they partnering with civilian social services
and non-profit organizations to fill the support gaps? New Hampshire's
National Guard Yellow Ribbon Program, for example, partners with Easter
Seals to provide needed support.
Admiral Van Buskirk. Yes; Navy Medicine continues to support a
comprehensive mental health strategy to provide ready access to high
quality, evidence-based, mental health care for military members and
their families. This includes prevention and resilience-building
services, as well as more traditional treatment. For instance, Navy's
FOCUS program (Families Over Coming Under Stress), which is widely
recognized as a model for prevention/intervention psychological health
services for military families, provided services to over 91,000
military family members in Fiscal Year 2012. Outcomes have shown
statistically significant improvements in anxiety and depression among
both children and parents.
Family members can also access mental health care through our
Behavioral Health Integration Program, part of Medical Home Port, which
embeds behavioral health providers in the primary care setting to
increase access and reduce stigma. This program has been implemented
across 67 Navy and six Marine Corps sites.
Navy Medicine also continues to place the highest priority on the
mental health needs of reservists and their families. In Fiscal Year
2012, the Navy and Marine Corps Reserve Psychological Health Outreach
Program (PHOP) provided over 11,000 outreach contacts to returning
service members and behavioral health screenings for approximately
1,000 reservists. PHOP staff made over 500 visits to reserve units
providing over 800 presentations to approximately 19,000 reservists,
family members and commands. As of December 2012, over 12,000 service
members and their loved ones have participated in 100 Returning Warrior
Workshops (RWWs), which assist demobilized service members and their
families in identifying immediate and potential issues that often arise
during post-deployment reintegration.
Ms. Shea-Porter. 10) Are family member (spouses and children)
suicides being tracked by DSPO and/or the Services? If not, why not?
Admiral Van Buskirk. Navy does not track family member suicides.
There is no statutory or policy requirement to do so, and no reporting
mechanism in place by which to track family member suicides.
Ms. Shea-Porter. 11) What steps are the Defense Suicide Prevention
Office and the Services taking in terms of support and treatment, to
meet the mental health challenges facing spouses and children? There
are some innovative National Guard Yellow Ribbon Programs, like that of
our own New Hampshire National Guard, that follow and support families
as well as Guard members before, during, and after deployment. Are you
talking to the States and incorporating the best practices of such
programs?
General Jones. A variety of programs provide support for the mental
health needs of spouses and dependent children. Each installation has a
Family Advocacy Program, which provides outreach and prevention
services to families. One novel Family Advocacy Program approach is the
New Parent Support Program, which provides support and guidance in the
home to parents screened as high risk for family maltreatment.
Educational and Development Intervention Services are provided by a
child psychologist for special education children in Department of
Defense schools. Other programs provide education on common family
issues like good parenting, couples communication, or redeployment
integration. Counseling for families is also available. Military
OneSource is a Department of Defense program using a civilian network
that provides face-to-face, telephonic, or online counseling/
consultation to service members and families for up to 12 sessions.
Also, Office of the Secretary of Defense-funded Military and Family
Life consultants and Child and Youth Behavioral consultants offer
confidential, non-medical, short-term counseling services, which
address issues common in military families such as deployment stresses
and relocation. Family members not able to be seen at military medical
treatment facilities have access to services through community TRICARE
providers. TRICARE network providers offer an array of services from
individual counseling and group therapy, to inpatient behavioral health
care. However, these services vary significantly from location to
location. This is due to a nationwide shortage of doctoral level child
and adolescent psychiatrists and psychologists.
The Yellow Ribbon Program offers resources on behavioral health
issues and suicide mitigation and is offered to Reserve and Air
National Guard (ANG) Airmen and their families pre-deployment, during
deployment, and post deployment. Funded by Yellow Ribbon, the
Psychological Health Advocacy Program (PHAP) is designed to assist
Reserve Airmen and their family members with a variety of needs,
including mental health issues, financial assistance, relationship and
family counseling, and substance abuse through referrals. The ANG
Psychological Health Program (PHP) was developed to address
psychological health needs of ANG Airmen and their families. The PHP
places a licensed behavioral health provider at each of the ANG's 89
wings throughout the 54 states, territories and the District of
Columbia. The program provides three categories of service: leadership
advisement and consultation; community capacity building; and direct
services--to include assessment, referral, crisis intervention, and
case management--that are available daily. The Wing Directors of
Psychological Health are available 24/7 to operational leadership and
provide services to ANG Airmen and their family members regardless of
whether they are at home or on duty status. Both ANG Wing Directors of
Psychological Health and AFRC Psychological Health Advocates work with
their local communities to develop resources, referrals, and
partnerships to maximize services for Airmen. Additionally, mental
health and personnel leaders from ANG, Reserve and each of the services
participate in the Department of Defense and the Department of Veterans
Affairs level committees on suicide prevention and psychological health
where they share best practices and ideas.
TRICARE Reserve Select is available for Reserve Component Airmen
and their family members and provides coverage for both outpatient and
inpatient treatment. Access to military medical care is available to
service members with duty-related conditions through TRICARE and the
Department of Veterans Affairs.
Since Air Reserve Component wingmen (e.g. family, friends) are
often non-military personnel, the ANG's Wingman Project provides
information and resources for suicide prevention on publicly-accessible
websites. The ANG tailors marketing and resource materials for each
state. The primary goal of the Wingman Project, located at http://
wingmanproject.org, is to reduce warfighter, Department of Defense
civilian, and family member suicides through human outreach, education,
and media. The Air Force Reserve Wingman Toolkit is a broad-based Air
Force Reserve initiative designed to empower Airmen and their families
to achieve and sustain health, wellness, and balanced lifestyles by
using the four domains of Comprehensive Fitness. The toolkit is located
at: http://AFRC.WingmanToolkit.org. The Wingman Toolkit provides
Commanders, Airmen, families, and friends (i.e., Air Force Reserve
Wingmen), access to a wide variety of resources, training
opportunities, a dedicated Wingman Day page, promotion of the Ask,
Care, Escort (A.C.E.) suicide intervention model, educational outreach
materials, social media (Facebook, Twitter, Etc.), a mobile phone
application, Short Message Service (SMS) texting capability (``WMTK''
to 24587), inspirational and training videos, a YouTube page, and
partnerships with other organizations.
Finally, the Military (or Veterans) Crisis Line, 1-800-273-8255
(TALK), Press #1, www.militarycrisisline.net, or text to 838255 is
available 24/7 to all service members and their families. It is a joint
venture between the Department of Defense and the Department of
Veterans Affairs' call center, which is associated with Substance Abuse
and Mental Health Service Administration's National Suicide Prevention
Lifeline. Resources include an online ``Veteran's Chat'' capability and
the call center's trained personnel provide crisis intervention for
those struggling with suicidal thoughts or family members seeking
support for a Veteran.
Ms. Shea-Porter. 12) Do DSPO and the Services have a strategy and
the capacity, to provide adequate mental health screening and care for
families? If not, how are they partnering with civilian social services
and non-profit organizations to fill the support gaps? New Hampshire's
National Guard Yellow Ribbon Program, for example, partners with Easter
Seals to provide needed support.
General Jones. Through the TRICARE network and community
organizations, the Air Force Medical Service (AFMS) has a strategy and
the capacity to provide mental health screening and care for families.
Air Force family members' care typically is provided by TRICARE
providers in the community. There are several options to purchase long-
term healthcare insurance for Air Reserve Component family members, to
include TRICARE Reserve Select, if eligible. TRICARE provides coverage
for both outpatient and inpatient treatment.
The Air Force Reserve Wingman Toolkit and Air National Guard
Wingman Project Websites provide 24/7/365 support and information.
These websites provide links to local, city, state, and national
organizations that provide behavioral health services to service
members and their families. Organizations include, but are not limited
to, the Substance Abuse and Mental Health Services Administration,
Military Pathways, and The Center for Deployment Psychology.
Air Force Reserve Psychological Health Advocacy Program (PHAP)
staff are present and conduct break-out sessions for the members
returning from deployment. During these sessions, the members are given
instructions on accomplishment of mental health screening, as well as
recommendations for follow-up. This information is also available on
the PHAP website, as well as through each regional office.
The Air National Guard Psychological Health Program (PHP) was
developed to address psychological health needs of Air National Guard
(ANG) Airmen and their families. The PHP places a licensed behavioral
health provider at each of the ANG's 89 wings throughout the 54 states,
territories and the District of Columbia. The program provides three
categories of service: leadership advisement and consultation;
community capacity building; and direct services--to include
assessment, referral, crisis intervention, and case management--that
are available daily. The Wing Directors of Psychological Health are
available 24/7 to operational leadership and provide services to ANG
Airmen and their family members regardless of whether they are at home
or on duty status.
Finally, Military OneSource is a nonmedical counseling option
available to active duty, reserve component members and their adult
family members.
Ms. Shea-Porter. 13) Are family member (spouses and children)
suicides being tracked by DSPO and/or the Services? If not, why not?
General Jones. The Air Force does track family member (spouses and
children) deaths to disburse monetary benefits and funeral
entitlements; however, the Air Force does not track the cause of each
family member death (specifically, suicides). We do not have access to
specific information about family member deaths other than that in the
public domain; the Centers for Disease Control and the American
Association of Suicidality. The Air Force is collaborating with the
Defense Suicide Prevention Office to study this issue and determine if
a reliable process or database can be developed to track this
information in the future.
Ms. Shea-Porter. 14) What steps are the Defense Suicide Prevention
Office and the Services taking in terms of support and treatment, to
meet the mental health challenges facing spouses and children? There
are some innovative National Guard Yellow Ribbon Programs, like that of
our own New Hampshire National Guard, that follow and support families
as well as Guard members before, during, and after deployment. Are you
talking to the States and incorporating the best practices of such
programs?
General Hedelund. The Yellow Ribbon Reintegration Program supports
reintegration efforts by providing access to programs, resources, and
services geared to minimizing stressors before, during, and after
deployments of 90 days or more. It is not used as a mental health
screening vessel. Counselors are on-site for each event to address
stress and finances as well as address the common challenges our
Service members and their families face. These events are structured to
follow a Reserve Marine and family (family is defined as mom, dad,
spouse, children, significant other) or their designated
representative, throughout their entire cycle of deployment from the
call to mobilization and then their re-assimilation to civilian life.
The more prominent focus of these events is addressing those areas most
likely to trigger stress responses such as employment, finances, and
education. By targeting these areas, and making counselors available at
every opportunity, we hope to address issues prior to them building and
causing a significant stress response by the individual. In FY12
MARFORRES executed 209 Yellow Ribbon events nation-wide, supporting
3,766 family members and designated representatives, and 5,984 Service
members. Supporting programs at each of these events are the
Psychological Health Outreach Team for the Unit/Region (PHOP), Unit
Personal and Family Readiness Program, as well as local Unit
Leadership. Additional assistance remains available on an on-going
basis for every Marine and family through the DSTRESS Program, Unit
Chaplains, and the Unit Personal and Family Readiness Program.
Ms. Shea-Porter. 15) Do DSPO and the Services have a strategy and
the capacity, to provide adequate mental health screening and care for
families? If not, how are they partnering with civilian social services
and non-profit organizations to fill the support gaps? New Hampshire's
National Guard Yellow Ribbon Program, for example, partners with Easter
Seals to provide needed support.
General Hedelund. Medical treatment for diagnosable mental health
conditions is available to family members through the TRICARE system
(either military treatment facility or network providers). Should
specialty care not be available within the system, patients may be
referred to non-network providers. Marine Corps Community Services
(MCCS) offers non-medical, short term counseling programs to Marines
and their family members for problems such as anger management, coping
with loss or separation, parenting, etc. Family members also have
access to counseling from Military OneSource, where they can deal with
a credentialed counselor telephonically or in person with a
geographically local counselor. Both MCCS and OneSource ensure a warm
handoff to the medical system should the family member's condition
warrant a medical referral.
Project FOCUS (Families Overcoming Under Stress), initiated by the
Navy Bureau of Medicine and Surgery (BUMED) in 2008, provides state-of-
the-art family resiliency and psychological health services to military
children and families at over 20 Navy and Marine Corps sites and online
for those in remote locations. FOCUS is a family-centered resiliency
training program developed from evidenced-based interventions that
enhance understanding, psychological health, and developmental outcomes
for highly stressed children and families facing challenges related to
multiple deployments, combat operational stress, and physical injuries
in a family
member.
Ms. Shea-Porter. 16) Are family member (spouses and children)
suicides being tracked by DSPO and/or the Services? If not, why not?
General Hedelund. The Marine Corps tracks suicides by dependents of
active duty Marines. The reporting of the information is not required
by DOD.