reading on now come to order thank you all for being here and welcome to our new digs we're obviously there refurbishing the house armed services room and rayburn and so we're using this room today and we hope that everybody's going to be comfortable here the mental health status and needs of service members their families retirees and their families relate to most if not all hearings held by th subcommittee whether we are discussing p t s d family support programs frequency of deployment access to health care and or the aftermath of a sexual assault the importance of mental well being is always involved we also dedicate one year solely to mental health issues this year's hearing on mental health was originally intended to examine the increased incidence of suicide in the military and to review what actions the office of the secretary defense and the military services were taking to address this troubling trend however we know that suicide is not a discrete occurrence or problem it is the final step in the individual takes when they can no longer deal with the stressors in their lives and therefore in order to determine the suicide rate has increased the entire spectrum of stressors must be considered further there is a zero sum game aspect to mental health neither the department of defen nor the country in general have enough mental health provider any resources directed towards prevention will have to be directed away from their current allocation so it's important to examine of naval operations admiral patrick walsh commandant of the marine corps general james amos and the vice chief of staff of the air force general in frayser gentleman we look forward to your testimony and hope to lea this hearing with a clear understanding of how each of your services is addressing the issue it's important for the headquarters of each military department to acknowledge and to address this issue and it's also just as important for individual commanders to understand the problem and take positive action at their level for our second panel than we have chosen to highlight the positive actions taken by commanders of their own accord to address the psychological stress experienced by their command we have a tenet general rick lynch of the army commanding general of the third corps and fort hood to participate in our hearing general lynch has used his command authority to make fundamental changes to the way his with the goal of providing soldiers and address psychological stress are disjointed and not well coordinated or communicated and i am anxious to hear from our military leaders on our panel what steps have been taken to develop a comprehensive  island naval hospital that i have the privilege of representing and i want to thank you for participating the hearing today i appreciate your providing young people the extraordinary opportunity of military service which protects american families i look forward to your testimony thank you very much general madam chairwoman ranking member wilson distinguished members of the subcommittee i thank you for the opportunity to appear before you today to provide a status on the united states army's efforts to  the number of suicides across our force this is my first to appear before this committee and i pledge to always provide an honest and forthright assessment i've submitted a statement for the record and i look forward to answering your questions  the conclusion of opening remarks as all of you know it's been a busy time for our nation's military we are at war we've been at war for nearly eight years that is undeniably put a strain on our people and our equipment unfortunately and a growing segment of the army's population we've seen increased stress and anxiety manifests itself through high risk behaviors including acts of violence excess use of alcohol drugs reckless driving consequence in the most extreme cases has been an increased incidence incidence of suicide earlier this year i visited six posts in eight days in order conduct sensing sessions collect data and evaluate suicide prevention efforts and programs  came clear to me after leaving the third installation that our mission our mission extended far beyond suicides simply stated we must find a way and ways to improve the behavior wellness of soldiers and their families after repeated deployments in the context of eight years of war and that is why secretary of the army general george casey consciously made the decision to expand our efforts to improving the overall behavioral health and well being of the force alternately we want to get left of this very serious problem and to do so we must improve the resiliency of our soldiers and their family members in the past the army's approach was primarily reactive that is change today is in fact proactive to identify or assess and mitigate early on before they become significant concerns to educate soldiers in order to ensure they're aware and have access to resources and support programs that can provide them with the most benefit and to assist individuals who are struggling and may need help we are confident that by doing so by improving the overall resilien health and well being of soldiers and their families we will ultimately reduce the number of suicides across our army our approach is based on two big ideas the comprehensive soldier fitness program which is really the big idea that moves us to the left in the campaign plan for health promotion risk reduction and suicide prevention we're also taking steps to eliminate the stigma that is frequently kept soldiers from seeking and receiving help the reality is in all cases there is no simple solution and we must resist any attempt to generalize or oversimplify the challenges we are facing improving the overall health and well being of our world choir a multi dimensional approach to identify effective  i can assure you the members of this subcommittee this challenge remains a top priority for the united states madam chairwoman members of the subcommittee i thank you for your continued support and demonstrated commitment to testify about the organizational command level efforts to prevent suicides in the name suicide ranks as the third leading cause of death in the navy it's a loss that destroys families devastated communities on revels the cohesive social physical and emotional stamina so the target of our policy and practice is the resilience of individual sailors and this means that leaders must look for and connect to those individuals challenge by seemingly intractable troubles with relationships and work financial and legal matters deteriorating physical health as well as mental health issues and depression we must eliminate the stigma in dishonor of asking for help this is not simply an issue isolated to the medical community to recognize and resolve commands have a critical role to play in setting a supportive climate for those who need to admit their struggle and seek assistance some of the more noteworthy policy and programmatic actions that leaders have taken include the chief of naval operations directed establishment of a preparedness alliance which is a consortium led by our chief of naval personnel our chief of naval reserve bureau of medicine and our commander of  installations to address a continuum of care that covers all aspects of individual medical physical psychological and family readiness issues across additionally the scieno instituted an operational stress control program which is a comprehensive approach designed to address the psychological health needs of sailors and their families it's a program led by operational leadership supported by the naval medical community and provides practical decision making tools for sailors leaders and families so they can identify stress responses and problematic tension by addressing problems early individuals can mitigate the effects of personal turmoil and get the necessary help and professional counseling or treatment through training intervention response in reporting the navy prevention programs for all sailors that focus on operational commands to take ownership of suicide training initiatives and tailor them to their unique command cultures feedback is an important element of policy development the navy pulls extensively and tracks statistics on personal and family related indicators such as stress financial health command climate as well as sailor and family support we use this data to monitor the trends in the force and make recommendations for adjustments issue i want to echo their sentiments we must continue to develop and implement programs to maintain the psychological health of our service members your air force is heavily engaged in worldwide operations conditions the air force does not take a business as usual approach to monitoring the physical and the psychological well being of our force the air force suicide prevention program requires a personal attention  lessons we're going to learn that are going to be learned in this study where we've combined the resources of the department of defense harvard columbia university of michigan and put together a world class that is going to have  find a correlate of data that we're looking for you would think that more deployments would be indicative of those that would be more inclined to go down this path and that is not generally do ok we have some vulnerable pockets within the general population but the area that we really need to focus on is when all those checks and balances that coon that they live in on deployment is but even above that i would say that's more frustrating for everything that we provide given the resources that we have and the programs that are in place when an individual does reach out and we're seeing that happen actually our numbers are going up where i think we're seeing that we're getting past that that people are reaching out for help and so you begin to provide that help and then it gets very frustrating when all of a sudden they go along a path and then they are successful to me that's very frustrating because you provided programs who provided mental health care providers or programs that cut across many disciplines within your respective service aimed at preventing recognizing and treating psychological stress in military personnel how do you identify which services are most appropriate for a particular service member and then coordinate the use of those services between the service member the command and the multiple organizations that offer the services in addition when i look at the continuing incidence of even with the number of mental health programs each service has available i can't help but wonder if your programs are working what are your thoughts and how effective are your programs for reducing psychological stress and suicide what and how are you measuring whether your programs are affected and this is one of the panel and beginning with joe corralling last year the army science board study forces they looked into the freezing number of suicides in the army and they of having too many programs it's not knowing which ones are the ones that actually have an effect we feel that we were very successful in getting the focus on this problem with the stand down we conducted in eleven different elements within it and we take a holistic look across all of our programs all the time in this integrated delivery system that we have brings together different elements from different organizations  from the medical community the chaplain i mentioned earlier we've also got investigations we also have the jag corps that's a part of that and also our personnel and we've recently integrated  look across all of our programs and see what can we do better we're also participating in the suicide prevention awareness risk reduction committee that's part of all the services and i think that goes to like to have a briefing from the army or the marine corps or the navy one one marine and give me a classified briefing what was his life year and we go through in great detail eleven cases in about two hours and fifteen minutes we learn and that's what this is all about it's learning and as a commander another commander in another part of united on satisfying because it will leave you with more questions than answers the approach that we take today the questions that we asked and the focus that we placed on leadership beginning with the question of noncommissioned officer and your leadership program with the n g o s and making sure that they break through those barriers and that leadership i think is very much welcome as well i know today we also talked about as far as the stress and the stress going home i know when i was in iraq six years ago one of our nineteen paratroopers committed suicide over in baghdad and that weighs on my heart and i know my colleague that i serve with over there captain john  thought about when he came home the hardest thing about deploying was coming home and that stress there i represent pennsylvania and i could tell you that you know we've had three young heroes in the past seven months this year alone three young heroes who came over from either iraq or afghanistan that committed suicide and it's been really tough it's been tough and we heard similar stories from their families they getting it straight but how are the services working with the families before during and after their loved ones deployment so they can spot the signs of post traumatic stress disorder traumatic brain injury or depression and focused here today on on suicide rates that may or may not be the thing that we need to be measuring or looking at i think and i don't know what is under the water out there i think of all those soldiers that you have right now who are in misery and their families in misery and perhaps children who witness a lot of those and yet because they don't ever actually take the act of some violence toward we track it it is the most difficult of all the data gathered not what it takes place on a military installation but what it takes place off of a military installation but we do our best to collect as much of that data as we can and i think you're one hundred percent right  suicide is the extreme indicator and by the time i'd hit the third installation i realized that this wasn't about suicide prevention this is about the mental wellness soldiers and families that's what this is about mention causation of what you're looking for what what's causing this out there along the chain i was surprised that a diagnosis of depression or or it was not one of the factors where does that fit into the depression is an indicator but when i talk to on that tour what i found from them was their spouse was coming back off of the deployment going through that first thirty day period where everything is wonderful but then getting down into that training period getting ready to go out getting ready to go out in nine to eleven months and the whole process to reintegration if you've ever tried to do that spouses were telling me their husbands  but i think all of you talk about the fact that we have talked about this for some years now that we're doing a better job both in our american civilian culture but also the military culture of acknowledging that having  mental health counseling should not be stigmatized in your army culture what about couples who seek help for marital problems is there a stigma to knowledge as a couple that they're having problems or do you think that is also recognized as a better except that it's ok to go in and knowledge to your folks that you're having difficulty i think marriage counseling is better accepted if there is such a way to put it in the  mental health help and one of the focuses of what we're trying to do is to do everything possible to get rid of that that's one of the reasons why i'm so excited about being able to liver mental health thank you we're going to go vote and then come back we're certainly hopeful that you will be able to and i certainly hope that the members welcome back because this is a very important hearing and we would like to have everybody well that is definitely the focus of ours and it's how you can take a dispersed population when you take a look at the united states army today we have seven hundred ten thousand folks on active duty they're active duty soldiers title ten soldiers  with about four hundred thousand we're in the reserve component they're told numbers are greater but two hundred thousand of them are close two hundred thousand of them are on active duty when they come off of the twelve or a fifteen month deployment able to provide mental health care because we'll be able to move into remote areas and provide reserve component soldiers who are part of the tri care joint and they can do that today with reserve intuitively instinctively i think what we have learned in the course of these discussions is that what multiple deployments do oftentimes under voluntary conditions where the member likes to go back  opinion this is sort of the insight that comes with time trying to dissect what the data is really on the family and the children issue i think i can offer an example here where our collaboration with the marine corps has has provided insight that now apply across the navy in the case of a need to address and about trying to to target families that have gone through multiple deployments and specifically the needs of children the marines with navy medicine piloted a program and work with local universities to come up with a program called focus which is really a program for families that are under constant stress from continuing deployments took that idea naval special warfare saw that like that and then take you back on it now we know what it what it does is it's another set of antenna that get us out inside our own population to understand what the stressors are and what people's needs are we know that is more now than before we know  there's also some regional to seven regional teams that are able to reach out and work with the folks and the families the other things that we have also made sure that we do for the non colocated locations where there may not be active duty or other care or programs provided is how to reach out to them and what can we do somebody has a need has a requirement for some mental health care then we make sure that we  force quitman availability to training as well as psychologically the service members themselves there was an article in the pacific daily news recently our local newspaper that reported on the psychological stress on our national guard force and madam chairman i'll ask that these articles into the record have access to appropriate mental care when they return from deployment now i'm particularly interested to hear your perspective on how you are working to ensure the national guard i believe that the who programs for the active duty and so they have access to all of those programs they've also as you mentioned there the yellow ribbon program we have that we're very much in favor of it we see a lot of positive things coming out of it and we have ensured that that program continues to be viable and the other thing that we do our surveys that we do before individuals deploy give us a baseline that's the preventive health assessment  and they complete those and to go to your point about follow up afterwards that's the reassessment that's done between the ninety to one hundred eighty days so you're able to take a look at  deployment post deployment before they return home and then another reassessment to see if there's been any change which allows us then to be proactive in providing them any help that they may need and that is an indicator the family members are all briefed and so they know the programs that are available so we continue to reach out to all the family members to make sure they're aware of the various programs that are available for those that are non colocated we still have promise counselors right now i don't have enough counselors and we are really really focused on hiring as many as we can but it's up to the individual cancer charity to make a determination on whether it can be handled as an outpatient or whether inpatient  his career to valuate his resilience to do exactly what you talking about so from the army standpoint that's our big idea and what we're looking at to get at the problem you're talking about where are you doing it in terms to i know maneuver our way through to show that the assessment tool has that degree of accuracy that we could make that kind of call realize some of the exact same processes are used as far as our troops go to early on using some of the tools that are available to us to ensure that they get into the right career field as they're stressed in that comprehensive training program are actually proud of the fact that all family programs that we have put so much into these last years all been put into the base budget and everything from child care to all the services available to practices in regards to you know making sure our servicemen and women can be prepared for any situation i wish we didn't have to have because when i was first elected to congress i was asked to go down to the  much for being here if you can stay well for the second pass we would certainly be grateful for that we will return after several boats and then there will be no more interruptions and we really do look forward to hearing the second thank you so davis and ranking member wilson thank you for this opportunity to talk about what's happened this record for good can be more important thank you for your continued support for our soldiers families and your demonstrated to be just having the opportunity to watch the deployed fighting and winning our nation's wars one third of course just recently returned from a deployment and one third of the corporate parent of the boy that's the new normal an operational for sure and one one facet of the our for general person responsible  lives and well being of one hundred twenty five thousand family members and two hundred thousand words in the central texas area and i take that responsibility very personally i believe that engage leaders love their soldiers their families like they love their own children and indeed that's the approach we take it record for to i don't spend a lot of time at fort hood talking about suicide prevention but i spend all my time talking about stress reduction because i'm convinced that the stress of the force be reduced by a positive affirmative action six o'clock because that's where the family uniforms and functions if you're assigned a three corps you leave thursday at three o'clock in the afternoon that allows you more time with your family that allows you to be home when you get home from school that allows you to have some additional family days in the command of the corps this is now over a year ago when a family member came as a general you all are lying to them and what she says you say that you brought our husbands home and called dwell time but we never see your husband he comes home after the kids go to bed he's working all meditate they can talk to people with shared experiences they grow spiritually it's not about religion it's about a spiritual foundation on which to turn to him and to the wellness center and it's not just about how many improve the financial readiness or soldiers which reduces the stress on the family so so very important around the life of his own and people come there not because they've got a problem but because they want to avoid having a problem it's challenging given the increase in extended operational tempo resulting from the war whether deployed at home station the day to day activities or conduct or support requisite training at full steam and almost in perpetual d i'm wondering if you have a sense that you mentioned that things are looking better what about acting out what about people getting into trouble you know in town  know that there are a number of problems that a number of our our military men and women are experiencing that may really be of great concern as we look at the numbers and commanders on statistical trends and one thing i'm working looking at is crime rate on the insulation and all the insulation and it has been significantly reduced over the course of last year to the point of about i think it's about half what it was this time last year so the kids are in issue about the marine corps programs that are specifically focused on reducing stress on the personnel most affected by suicide how do you plan to measure the success of these programs in your estimation appreciate that you talk about the family readiness counselors and i know having met with volunteers in the ombudsman how critical they are when i first came into congress started working with have even though i obviously been living in san diego for many many years i wasn't aware of the role that they play and i was also aware that they were all volunteers and they handled such complex  and everybody that goes into the program and comes out the other end benefits from the program those are the guys we look at what i'm trying to do is spend more time you know addressing a problem before it becomes a problem i don't need to get them into combat or reset center if i difficult situation they thrived in that situation and they grew as an individual so we're trying to do in line with the chief that the army's comprehensive soldier fitness program which really is all about resilience emotional physical spiritual family and social i think we need to provide that support to them they are extremely resilient in many cases but we can't take that for granted because they're working so hard to support you thank you so much we really appreciate your being here we are grateful for what you're doing and we look forward to continuing back and we hope that perhaps some of the examples that we've heard about here today will be followed in other places thank you very much