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SUICIDE PREVENTION AND TREATMENT: HELPING 

LOVED ONES IN MENTAL HEALTH CRISIS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

SEPTEMBER 18, 2014 

Serial No. 113–177 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TIM MURPHY, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

GREGG HARPER, Mississippi 

PETE OLSON, Texas 

CORY GARDNER, Colorado 

H. MORGAN GRIFFITH, Virginia 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

BRUCE L. BRALEY, Iowa 

BEN RAY LUJAN, New Mexico 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

PETER WELCH, Vermont 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

GENE GREEN, Texas 

JOHN D. DINGELL, Michigan (ex officio) 

HENRY A. WAXMAN, California (ex officio) 

(II) 

(III) 

C O N T E N T S 

Page 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

Prepared statement .......................................................................................... 3 

Hon. Diana DeGette, a Representative in Congress from the State of Colorado, opening statement ...................................................................................... 4 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

opening statement ................................................................................................ 6 

Prepared statement .......................................................................................... 7 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 7 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, opening statement ............................................................................ 8 

Hon. Janice D. Schakowsky, a Representative in Congress from the State 

of Illinois, opening statement .............................................................................. 12 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

opening statement ................................................................................................ 13 

Hon. Bruce L. Braley, a Representative in Congress from the State of Iowa, 

prepared statement .............................................................................................. 104 

WITNESSES

Hon. Lincoln Diaz-Balart, Former Representative in Congress .......................... 14 

Prepared statement 1

Boris D. Lushniak, Acting Surgeon General of the United States, Department 

of Health and Human Services ........................................................................... 16 

Prepared statement .......................................................................................... 19 

Answers to submitted questions ...................................................................... 109 

David A. Brent, Endowed Chair, Suicide Studies, and Professor of Psychiatry, 

Pediatrics, Epidemiology, and Clinical Translational Science, University of 

Pittsburgh ............................................................................................................. 30 

Prepared statement .......................................................................................... 32 

Answers to submitted questions ...................................................................... 119 

Christine Moutier, Chief Medical Officer, American Foundation for Suicide 

Prevention ............................................................................................................. 41 

Prepared statement .......................................................................................... 43 

Answers to submitted questions ...................................................................... 127 

Joel A. Dvoskin, Assistant Professor of Psychiatry, University of Arizona, 

on Behalf of the American Psychological Association ....................................... 60 

Prepared statement .......................................................................................... 62 

Answers to submitted questions ...................................................................... 135 

SUBMITTED MATERIAL

Letter of September 17, 2014, from Robert N. Vero, Chief Executive Officer, 

Centerstone of Tennessee, to Energy and Commerce Committee, submitted 

by Mrs. Blackburn ................................................................................................ 9 

Article of July 14, 2014, ‘‘When doctors commit suicide, it’s often hushed 

up,’’ by Pamela Wible, Washington Post, submitted by Mr. Burgess .............. 86 

Article of September 4, 2014, ‘‘Why Do Doctors Commit Suicide?,’’ by Pranay 

Sinha, New York Times, submitted by Mr. Burgess ......................................... 90 

1Mr. Diaz-Balart did not submit a written statement for the record. 

Page

IV 

Article of August 2014, ‘‘Modifying Resilience Mechanisms in At-Risk Individuals: A Controlled Study of Mindfulness Training in Marines Preparing 

for Deployment,’’ by Douglas C. Johnson, et al., American Journal of Psychiatry, submitted by Mr. Murphy ..................................................................... 93 

Hearing memorandum, submitted by Mr. Murphy ............................................... 105 

(1) 

SUICIDE PREVENTION AND TREATMENT: 

HELPING LOVED ONES IN MENTAL HEALTH 

CRISIS 

THURSDAY, SEPTEMBER 18, 2014 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 11:33 a.m., in room 

2123 of the Rayburn House Office Building, Hon. Tim Murphy 

(chairman of the subcommittee) presiding. 

Members present: Representatives Murphy, Burgess, Blackburn, 

Gingrey, Griffith, Johnson, Long, Ellmers, Upton (ex officio), 

DeGette, Braley, Schakowsky, Castor, Tonko, Yarmuth, and Green. 

Staff present: Gary Andres, Staff Director; Leighton Brown, 

Press Assistant; Karen Christian, Chief Counsel, Oversight and Investigations; Noelle Clemente, Press Secretary; Brad Grantz, Policy 

Coordinator, Oversight and Investigations; Brittany Havens, Legislative Clerk; Sean Hayes, Deputy Chief Counsel, Oversight and Investigations; Robert Horne, Professional Staff Member, Health; 

Emily Newman, Counsel, Oversight and Investigations; Mark 

Ratner, Policy Advisor to the Chairman; Macey Sevcik, Press Assistant; Alan Slobodin, Deputy Chief Counsel, Oversight and Investigations; Sam Spector, Counsel, Oversight and Investigations; 

Jean Woodrow, Director of Information Technology; Peter Bodner, 

Democratic Counsel; Brian Cohen, Democratic Staff Director, Oversight and Investigations, and Senior Policy Advisor; Lisa Goldman, 

Democratic Counsel; Hannah Green, Democratic Policy Analyst; 

Elizabeth Letter, Democratic Professional Staff Member; and Nick 

Richter, Democratic Staff Assistant. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Mr. MURPHY. Good morning. I now convene today’s hearing, ‘‘Suicide Prevention and Treatment: Helping Loved Ones in Mental 

Health Crisis,’’ a fitting topic during this National Suicide Prevention Month. 

In recent weeks we have read what I think were thoughtless, uninformed, and at times callous commentary on the tragic death of 

Robin Williams. Words describing his death as ‘‘selfish,’’ ‘‘heathen,’’ 

and ‘‘coward.’’ The Academy of Motion Picture Arts and Sciences 

2 

tweeted out a picture from the movie ‘‘Aladdin’’ with the caption, 

‘‘Genie, you are free.’’ 

Now, denigrating the man who died or glorifying suicide as an 

escape sends the entirely wrong message and trivializes the loss 

and the pain felt by both the deceased and his or her family. 

Today, we take the conversation of suicide out of the dark shadow of stigma and into the bright light of truth and hope. 

Suicide is the deadly outcome of mental illness. Suicide is what 

happens when depression kills. Suicide is an epidemic and its impact is staggering. 

Now, I know some have come to me and asked if we could have 

a hearing on Ebola, and someday we will. It is a deadly infectious 

disease. But to date, no American has died from the Ebola virus. 

But in 2013, 9.3 million Americans had serious thoughts of suicide; 2.7 million Americans made plans of suicide; 1.3 million 

Americans attempted suicide; and nearly 40,000 died by suicide. 

Suicide is an American public health crisis. It is a world health 

crisis, and that results in more lost lives than motor vehicle crashes, homicide, or drug use. As we will hear today, it is the third 

leading cause of death for young people between ages 15 to 24, and 

the second leading cause of death for adults ages 25 to 34, and 

each day, we lose 22 veterans to suicide. 

In 90 percent of suicide, an underlying diagnosis of mental illness was a contributing factor. Suicide is the very definition of a 

‘‘mental health crisis.’’ The problem is clear and the need for action 

is urgent. But our national response to this crisis has been tepid 

and ineffectual at best. The age-adjusted death rates for heart disease, cancer, stroke, and diabetes are all trending downward as the 

result of a focused public and political will to address them. Yet in 

that same period, the suicide rate has climbed a stunning 16 percent, despite substantial Federal spending over the past 60 years 

and the development of Federal programs and strategies meant to 

reduce suicide. 

We have randomized clinical data supporting the effectiveness of 

certain treatments to prevent suicide. However, it is unclear what 

we are doing to ensure that evidence-based treatments are reaching out to our loved ones in need. 

Suicides, and suicidal behavior, remain underreported, undertreated, and cloaked in a stigma that infects our discussion of all 

aspects of serious mental illness. The existing data collection instruments we use are weak, our research is lagging, and evidencebased treatments often fail to reach those who can be helped. People do not report suicides because of stigma, worry about insurance 

claim issues, or misattribution of causes. 

Following the December 14, 2012, elementary school shootings in 

Newtown, Connecticut, this subcommittee has been reviewing mental health programs and resources across the Federal Government 

with the aim of ensuring that tax dollars reach those individuals 

with serious mental illness and help them obtain the most effective 

care. I thank all members of this committee for their dedication to 

this difficult but important subject. 

Helping families in mental health crisis remains my highest legislative priority, and if we have the courage to confront mental illness head-on I am certain we can save precious lives. 

3 

Now, as I have been traveling the country meeting with people 

to talk about mental illness, I have found that some still grossly 

misunderstand mental illness. They don’t argue for the right to be 

well but I hear judges say that it is not illegal to be crazy. I hear 

public officials say that they have the right to be mentally ill even 

when we know that there are genetics and neurological components 

that cause this illness. It is a brain disease. It is not an uncomfortable way of life. It is not a non-contentious reality. Mental illness 

is not a state of mind. And people who believe those concepts, that 

we can just will it away with awareness, I say that such thoughts 

are unscientific, that it is uninformed, it is immoral, it is unethical, 

and it is wrong. 

This subcommittee is dedicated to fight for the right of people to 

get treatment and the fight for them to be well, and I think all 

members on both sides of the aisle have been so dedicated in this 

cause. 

So today, to provide some perspective on serious mental illness 

and suicidal behavior, and to begin to dispel the most persistent 

and pervasive myths and as well as effective strategies for suicide 

prevention, we will hear from a number of witnesses. First will be 

the Hon. Lincoln Diaz-Balart, our colleague and our friend who formerly represented Florida’s 21st District in Congress; Rear Admiral Boris Lushniak, the Acting Surgeon General; Dr. David Brent, 

the Endowed Chair in Suicide Studies at the University of Pittsburgh, and Director of the STAR Center, a suicide prevention program for teens and young children; Dr. Christine Moutier, Chief 

Medical Officer of the American Foundation for Suicide Prevention; 

and Joel Dvoskin of the University of Arizona. I thank them all for 

joining us this morning, but I especially appreciate the courage 

shown by our former colleague, Lincoln Diaz-Balart. 

Lincoln, by being here today and sharing your story, I know you 

are helping to save lives. We talk about statistics and numbers. For 

you it is from the heart, and you give help and hope to those families at risk. So on behalf of all those, quite frankly, of us who have 

lost a friend or family member to suicide, we thank you for being 

the voice of all of us. 

[The prepared statement of Mr. Murphy follows:] 

PREPARED STATEMENT OF HON. TIM MURPHY

In recent weeks we have read the thoughtless, uninformed, and at times callous 

commentary on the tragic death of Robin Williams. Words describing his death as 

‘‘selfish,’’ ‘‘heathen,’’ and ‘‘coward.’’ 

The Academy of Motion Picture Arts and Sciences tweeted out a picture from the 

movie ‘‘Aladdin’’ with the caption, ‘‘Genie, you’re free.’’ 

Denigrating the man who died or glorifying suicide as an escape sends the entirely wrong message and trivializes the loss and pain felt by both the deceased and 

his or her family. 

Today, take the conversation about suicide out of the dark shadow of stigma and 

into the bright light of truth and hope. 

Suicide is the deadly outcome of mental illness. Suicide is when depression kills. 

Suicide is an epidemic and its impact is staggering. 

Infectious diseases like the Ebola virus is gaining attention and concern, as it 

should. Some have asked for a hearing on the Ebola virus, but to date, not one 

American has died from Ebola. 

By comparison, in 2013, 9.3 million Americans had serious thoughts of suicide; 

2.7 million made suicide plans; 1.3 million attempted suicide and nearly 40,000 died 

by suicide. 

4 

Suicide is an American public health crisis, that results in more lost lives than 

motor vehicle crashes, homicide, or drug use. As we will hear today, it is the third 

leading cause of death for young people ages 15–24, and the second leading cause 

of death for adults ages 25 to 34. Each day, we lose 22 veterans to suicide. 

In 90 percent of suicide, an underlying diagnosis of mental illness was a contributing factor. Suicide is the very definition of a mental health crisis. 

The problem is clear and the need for action is urgent. But, our national response 

to this crisis has been tepid and ineffectual at best. The age-adjusted death rates 

for heart disease, cancer, stroke, and diabetes are all trending downward as the result of a public and political will to address them. 

Yet, in that same time period, the suicide rate has climbed a stunning 16 percent, 

despite substantial Federal spending over the past 60 years and the development 

of Federal programs and strategies meant to reduce suicide. 

We have randomized clinical data supporting the effectiveness of certain treatments to prevent suicide. However, it is unclear what we are doing to ensure that 

evidence-based treatments are reaching our loved ones in need. 

Suicides, and suicidal behavior, remain underreported, undertreated, and cloaked 

in a stigma that infect our discussion of all aspects of serious mental illness. The 

existing data collection instruments we use are weak, our research is lagging and 

evidence-based treatments often fall to reach those who can help. 

Following the December 14, 2012, elementary school shootings in Newtown, Connecticut, this subcommittee has been reviewing mental health programs and resources across the Federal Government, with the aim of ensuring that tax dollars 

reach those individuals with serious mental illness and help them obtain the most 

effective care. 

Helping families in mental health crisis remains my highest legislative priority. 

And, if have the courage to confront mental illness head on I am certain we can 

save precious lives. 

Some in the country still grossly misunderstand mental illness. They don’t argue 

for the right to be well—but gleefully declare that it’s not illegal to be crazy. Some 

even say they have the right to be seriously mentally ill even though we know it 

is a genetic and neurological brain disease. 

To those people I say this: Mental illness is not a state of mind or an attitude. 

Such a belief is unscientific. It is uninformed. It is immoral. It is unethical, and it 

is wrong. 

This subcommittee is dedicated to fighting for the right to get treatment and the 

right to be well. 

To provide some perspective on serious mental illness and suicidal behavior, and 

to begin to dispel the most persistent and pervasive myths and as well as effective 

strategies for suicide prevention, we will hear from the following: 

The Honorable Lincoln Diaz-Balart, our colleague who formerly represented Florida’s 21st District in Congress; Rear Admiral Boris Lushniak, the Acting Surgeon 

General; Dr. David Brent, Endowed Chair in Suicide Studies at the University of 

Pittsburgh, and Director of the STAR Center, a suicide prevention program for teens 

and young children; Dr. Christine Moutier, Chief Medical Officer of the American 

Foundation for Suicide Prevention; and Joel Dvoskin of the University of Arizona. 

I thank them all for joining us this morning, but I especially appreciate the courage shown by our former colleague, Lincoln Diaz-Balart. 

Lincoln—by being here today and sharing your story, I know you are helping to 

save lives and give hope to those at risk. On behalf of all who have lost a friend 

or family member to suicide, thank you. 

Mr. MURPHY. And now I would like to give Ranking Member 

Diana DeGette an opportunity to deliver remarks of her own. 

OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Ms. DEGETTE. Thank you very much, Mr. Chairman. Your dedication to this issue shows, and I want to commend you for trying 

to work in a bipartisan way to actually do something about it. 

Suicide takes the lives of about 40,000 Americans every year, 

and of course, that leaves behind millions of devastated parents, 

children, spouses, and friends. So if there is anything that we can 

do in this committee to help suicide prevention efforts, we should 

5 

do so, and I want to thank all the witnesses for coming over today 

and talking to us. 

I particularly want to thank our former colleague, Lincoln DiazBalart, who is going to talk today about his son, Lincoln Gabriel 

Diaz-Balart, who suffered from mental illness and committed suicide last year. I can’t imagine as the parent of two young women 

how you could come do this, and I want to thank you for coming, 

and I want to let you know that our hearts and sympathy go to 

you and your family. 

We also have Dr. Boris Lushniak, the Acting Surgeon General; 

Dr. Christine Moutier, who is the Chief Medical Officer from the 

American Foundation of Suicide Prevention; David Brent, a Professor in Psychiatry from the University of Pittsburgh; and Dr. Joel 

Dvoskin, a Clinical and Forensic Psychologist, and member of the 

University of Arizona faculty who is here today. All of you should 

give us a really diverse view on what we can do to begin to deal 

with this. 

We have talked a lot of time in this subcommittee this past year 

about mental health issues. We have learned a lot of important 

things. We have learned about the need to appropriately target 

mental health funding and the need to adequately fund mental 

health research. We have learned about the importance of health 

insurance that provides coverage for people with mental illnesses 

and why the mental health parity of the Affordable Care Act has 

made such a big difference for those patients and their families. I 

think that the testimony that we will take today will only help us 

expand our understanding. 

Some of these issues I know are politically sensitive, and Mr. 

Chairman, I know how badly you want to pass comprehensive mental health legislation. I support that goal. We have been working 

assiduously to try to come up with a bipartisan bill that can be accepted by the leadership on both sides of the aisle, and we have 

Democrats who stand willing and able, as you know, Mr. Chairman, who have sat down with you, who have sat down with other 

members on both sides of the aisle to put this bill together, and so 

I really think it is precisely because we have spent so much time 

on these issues that if we didn’t put the lessons that we had 

learned in these oversight hearings to practice in legislation, then 

it may all be for naught. 

This subcommittee has limited time and resources, and frankly, 

these mental health issues are one of the very important issues 

that we have tackled in this Congress, but we have also done a lot 

of other productive work this Congress on drug compounding that 

led to bipartisan legislation. We have had some high-profile hearings on the GM debacle. I am hoping that that will result in legislation to improve motor vehicle safety. 

And I am also disappointed because I do think there are a couple 

of other issues that we could look at even before the election but 

certainly before the end of this Congress. The first one I have requested a hearing on is the Ebola outbreak, and I am sure, Mr. 

Chairman, you did not mean to imply that simply because no 

American lives have been lost that we shouldn’t look at this because there have been hundreds of lives lost in Africa and with the 

potential of a pandemic if we don’t address this issue. And so I 

6 

think it would be very useful to have a hearing before the end of 

the year on Ebola in this subcommittee, and I think we could really 

help see what our public health system is doing to help address 

these issues. 

The second letter that you have, Mr. Chairman, and I have 

talked to Chairman Upton about this, is a letter asking this subcommittee to look at the way that the NFL and the other sports 

leagues are addressing domestic violence. This committee has oversight over major league sports, and frankly, the way that domestic 

violence has been minimized in the NFL and other sports leagues 

deserves investigation by this committee. There is still time to do 

this, and I would hope that we could work in a bipartisan way to 

make this happen. 

I also hope that we can make progress on the goals of today’s 

hearing, which is reducing suicides and improving suicide prevention efforts. 

So Mr. Chairman, thank you for calling this hearing. I look forward to working with you on this issue and all of the many issues 

that we face, and most importantly, retaining our committee’s jurisdiction over all of these issues. I am trying to channel Mr. Dingell today. Thank you very much. 

Mr. MURPHY. Thank you. I appreciate it. The gentlelady yields 

back. I now recognize the chairman of the full committee, Mr. 

Upton, for 5 minutes. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Well, thank you, Mr. Chairman, and I appreciate 

your statement at the beginning and Ms. DeGette’s as well. 

So today we are here to examine the domestic, and indeed global, 

public health crisis that is suicide. It has been noted that 40,000 

Americans every year commit suicide. This hearing is a natural 

outgrowth of this subcommittee’s groundbreaking investigation of 

Federal programs addressing serious mental illness following the 

December 2012 tragedy in Newtown, Connecticut, and I know for 

a fact that probably every member here on this committee but our 

colleagues and our friends and neighbors at home in fact have been 

impacted with someone who has committed suicide. 

No discussion of the full burden on our society of serious mental 

illness is complete without a discussion of suicide. For over 90 percent of them, the victim had been diagnosed with, yes, a mental illness. And tragically, our Nation’s vets are one of the populations 

hardest hit by the crisis. While one in ten Americans has served 

our country, sadly over the last couple of years, one in every five 

suicides has involved a vet. 

Like other areas covered by our committee’s work on 21st Century Cures, success will depend on our ability to close the gaps between advances in scientific knowledge about treating serious mental illnesses, which have been extensive, and how the Federal Government prioritizes and delivers these treatments to the most vulnerable populations. Our delivery of mental health services must 

keep up with the impressive pace of research and innovation in the 

field. 

7 

There is significant public misunderstanding and misperceptions 

for sure regarding suicide. We hope that our ongoing work will educate the public about the many treatments available to address serious mental illnesses and help correct misconceptions that stand 

in the way of access to life-saving mental health care for many of 

the most vulnerable of our friends, family, and neighbors. The Federal Government has spent billions of dollars on the worthy effort 

of minimizing the impacts of mental illness over the last couple of 

years; we need to ensure that these investments can make a difference. 

I appreciate the witnesses that are here, particularly our good 

friend, Mr. Lincoln Diaz-Balart. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

Today, we are here to examine the domestic, and indeed global, public health crisis that is suicide. Suicide claims nearly 40,000 Americans and over 800,000 lives 

worldwide in any given year. This hearing is a natural outgrowth of this subcommittee’s groundbreaking investigation of Federal programs addressing serious mental 

illness following the December 2012 tragedy in Newtown, Connecticut. 

No discussion of the full burden on our society of serious mental illness is complete without a discussion of suicide. For over 90% of suicides, the victim had been 

diagnosed with a mental illness. And tragically, our Nation’s veterans are one of the 

populations hardest hit by this crisis. While one in ten Americans has served our 

country, sadly over the last 2 years, one in every five suicides has involved a vet. 

Like other areas covered by our committee’s work on 21st Century Cures, success 

will depend on our ability to close the gaps between advances in scientific knowledge about treating serious mental illness—which have been extensive—and how 

the Federal Government prioritizes and delivers these treatments to the most vulnerable populations. Our delivery of mental health services must keep up with the 

impressive pace of research and innovation in the field. 

There is significant public misunderstanding and misperception regarding suicide. 

We hope that our ongoing work will educate the public about the many treatments 

available to address serious mental illness and help correct misconceptions that 

stand in the way of access to life-saving mental health care for many of the most 

vulnerable of our friends, family, and neighbors. The Federal Government has spent 

billions of dollars on the worthy effort of minimizing the impacts of mental illness 

over the years; we need to ensure these investments can make a difference. 

I’d like to welcome Acting Surgeon General Boris Lushniak, as well as the mental 

health professionals appearing before us today, Drs. Brent, Moutier, and Dvoskin. 

I also want to especially thank our former colleague, Mr. Lincoln Diaz-Balart, for 

sharing his deeply personal story. This is an issue that hits very close to home for 

many of us, and we are hopeful today’s hearing aids the national dialogue. 

Mr. UPTON. I yield to Dr. Burgess, who will yield to Mrs. 

Blackburn. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. Thank you, Mr. Chairman, and thank you for 

bringing us here during Suicide Prevention Month. My thanks to 

the witnesses for presenting today. Thank you, Mr. Chairman, for 

correctly outlining that suicide amongst veterans that have recently attracted national headlines, and appropriately so. Perhaps 

this morning we will learn something about what has been learned 

and what is being done. 

I also want to highlight a particular population that is often 

overlooked when we discuss suicide and suicide prevention, and 

that is the Nation’s physicians. America’s doctors, the people on the 

8 

front lines of suicide prevention, are some of the most at risk of 

suicide and having suicidal thoughts. This is troubling, and I hope 

we can hear how it is being addressed. Physicians and dentists are 

the most likely occupations to take their own lives. Physicians are 

more than twice as likely, and as it turns out, female physicians 

are more than three times likely to commit suicide, and it also affects a disproportionate share of young doctors. Dr. Brent’s testimony states that insomnia is the single most significant predictive 

symptom for suicide, and what I would be interested in hearing, is 

that because a symptom of worsening depression or is in fact a 

causative factor that exacerbates some of the things that lead one 

to contemplate taking their own life. The medical profession deals 

with many challenges. Perhaps the most prominent challenge is 

that not every patient can be fixed. Watching patients suffer can 

be very isolating, and it can take a toll. 

We are here today to begin a discussion about why this is the 

case and how Congress can help, and I look forward to hearing our 

witnesses, and yield to the gentlelady from Tennessee, the vice 

chair of the full committee. 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. I thank you, Dr. Burgess, and I do welcome 

our witnesses. 

I want us to think about this: 105. That is the number of individuals that will take their life today: 105. Many more will attempt 

it, and as we have prepared for the hearing, one of the things that 

I have found interesting and of note is that through the decades 

with all the research, with millions of taxpayer dollars spent, what 

we have not seen is a reduction in the suicide rates, the number 

of suicides that are attempted and committed, and I know we are 

all seeking to find answers to this. We each have been touched by 

those that have attempted or have committed suicide, and it is a 

very tender issue. 

I have the Centerstone Research Institute in Nashville that has 

done tremendous work on the issue of youth suicide and is working 

with the juvenile justice system, and Mr. Chairman, I would like 

to submit a letter for the record from Centerstone. 

Mr. MURPHY. Without objection, yes. 

[The information follows:] 

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10 

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Mrs. BLACKBURN. And with that, I thank the witnesses and yield 

back. 

Mr. MURPHY. Thank you. I now recognize Ms. Schakowsky for 5 

minutes. 

OPENING STATEMENT OF HON. JANICE D. SCHAKOWSKY, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. I want to thank 

you for holding this hearing. Suicide affects many, many people. It 

has been close to me as well, and it is entirely appropriate that we 

address this topic. 

I want to tell you, our dear former colleague, Lincoln DiazBalart, how much I appreciate, I think we all appreciate, you coming here today. It takes a special kind of guts to come here and talk 

about your son Lincoln, who suffered from mental illness, committed suicide last year, and I can only imagine the pain of losing 

a child to suicide. My heart goes out to you. 

Mr. Chairman, I applaud your legislative and oversight efforts 

this Congress on mental health issues, and I know that you are 

really trying to make a difference, but I am disturbed by what appears to be a growing disconnect between the facts we hear at oversight hearings and our failure to heed those facts when it comes 

to writing legislation. We have heard a few ongoing themes at this 

Congress’ mental health hearings and forums. We have heard 

about the importance of high-quality health insurance coverage for 

those with serious mental illness. Individuals suffering from mental illness need broad coverage. They need continuity of care. They 

need to be able to afford their treatments. Witness after witness 

has told us the same thing, and we will hear the same thing today. 

Earlier this year, the president of the American Psychological Association said that the availability of this coverage under the Affordable Care Act represented ‘‘a watershed moment in the effort to 

prevent suicide.’’ 

But Mr. Chairman, some of the Republican legislative approaches have ignored this evidence. Your colleagues have voted 

over 50 times to dismantle Obamacare and take health insurance 

away from millions of Americans. And Mr. Chairman, we have also 

heard about the importance of adequately funding mental health 

research. We hear the same about funding for suicide prevention 

efforts today. But Mr. Chairman, the Republican legislative approach has ignored this evidence. Again and again, your colleagues 

have voted on funding on an appropriations bill including sequestration and the Ryan budget that have resulted in stagnant budgets for mental health research. And today, Mr. Chairman, we will 

hear about the availability of guns as a risk factor for suicide. Dr. 

Brent’s testimony says that among healthy youths, and I quote, 

‘‘The only factor that differentiated suicides and controls was the 

presence of a loaded gun in the house.’’ But Mr. Chairman, when 

we talk about legislation to improve mental health outcomes, prevent mass violence, prevent suicide, your Republican colleagues 

refuse to even consider guns as part of the problem. 

The purpose of our oversight hearings ought to be to inform the 

legislative process, but in this committee, that is not happening. 

13 

Over and over again, our witnesses tell us one thing but the Republican majority does something else. That is a shame, Mr. Chairman. I hope we can listen carefully to our witnesses today and finally act on what they tell us. 

And I would like to yield the remainder of my time to Congresswoman Castor. 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. I thank my friend, Congresswoman Schakowsky, for 

yielding the time, and I want to thank you, Mr. Chairman and 

Congresswoman DeGette, for continuing to focus on the challenges 

families have all across this country with mental health issues, and 

I would like to welcome our former colleague, Lincoln Diaz-Balart 

from Florida. Lincoln, you are representing families all across this 

country in speaking out on their behalf, and I want to thank you 

for your courage in talking about your son and his depression and 

suicide last year, and thank you for encouraging improvements in 

public policy when it comes to suicide prevention, and here is why 

this is so important. In America, the rates of suicide are going up, 

particularly among young people and veterans. There is some distressing news that yes, as Congresswoman Schakowsky summarized, there have been budget cuts to the National Institutes of 

Health, the Centers for Disease Control, substance abuse and mental health treatment, and it is going to be much more difficult to 

tackle these problems if we remain in this atmosphere of devolution. 

But the good news is that the Affordable Care Act is now providing coverage to millions of previously uninsured Americans requires that all new individual and small group insurance plans 

cover mental health and substance abuse disorder services as one 

of the ten essential health benefits. Plans are required to cover 

these services at parity with medical and surgical benefits, significantly expanding lifesaving services. A February 2014 report by the 

American Mental Health Counselors Association found 6.6 million 

uninsured adults with serious mental health and substance use 

conditions will be eligible now for health insurance coverage including coverage for mental health and substance abuse through the 

new Affordable Care Act marketplaces and exchanges. 

The president of the Psychological Association of America said 

that notwithstanding the politics of the Affordable Care Act, the 

prospect that millions of Americans will have health insurance covering mental health benefits at a level comparable with their physical health care is a watershed moment that could truly 

destigmatize mental health care and suicide prevention services. 

Thank you. I yield back. 

Mr. MURPHY. Thank you. 

I would now like to introduce our first witness. He is the Honorable Lincoln Diaz-Balart, an attorney and consultant based in 

Miami, Florida. He is a former Member of Congress, where he 

served with great distinction between 1993 and 2011. He is here 

today to share for the first time a moving and personal story about 

Lincoln Gabriel. I greatly appreciate you being here, Lincoln. Normally at this time we would swear in a witness, but after conVerDate Mar 15 2010 11:09 Mar 30, 2015 Jkt 037690 PO 00000 Frm 00017 Fmt 6633 Sfmt 6633 F:\113-177 SUICIDE PREVENT ASK OK 3-27-15\113-177 SUICIDE PREVENT PDF MADE
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sulting with the chairman and the ranking member, we all agree 

that an oath to be sworn is not necessary today because you speak 

from the heart, and the heart binds a voice to the truth far greater 

than a mere oath would. 

So with that, I will now give you time for your opening statement. 

STATEMENT OF HON. LINCOLN DIAZ–BALART, FORMER 

MEMBER OF CONGRESS 

Mr. DIAZ-BALART. Mr. Chairman and Ranking Member DeGette 

and members of the committee, when you called, Mr. Chairman, 

last week and graciously asked if I would consider speaking here 

today, I consulted with my son Daniel. He and his older brother, 

our dearly beloved Lincoln Gabriel—L.G.—were very close, and I 

have ultimate trust in Daniel’s judgment. I explained to Daniel 

what you had told me, Mr. Chairman, with the subcommittee, the 

experts, the Surgeon General, who will testify here today, will consider helping loved ones in mental health crisis. Daniel’s words 

were, ‘‘Of course L.G. would want you to be there. If one person 

who might not otherwise get help is able to get treatment because 

of that hearing and its aftermath, L.G. would be happy.’’ 

My son Lincoln Gabriel was a blessing to all who got to know 

him. He was all love. His was not a theoretical love. It was a constant, practical love demonstrated by his daily actions, and above 

all by his deep respect for all human beings. L.G. was ultimately 

generous. He was intelligent, courageous and of profound religious 

faith. He never allowed his illness, his deep depression, for which 

he took medication, to stop him from demonstrating his respect and 

his love for all human beings he came across. 

Christina, Daniel and I miss him dearly, and we will continue to 

miss him for the rest of our days in the hope of our ultimate reunion with him. 

Congress honored Ukraine today by receiving its President in a 

joint meeting. After their Orange Revolution, I went to Ukraine in 

December 2005, and the First Lady at the time, Mrs. Yushchenko, 

asked if my community would be able to help some of Ukraine’s 

most severely handicapped, physically handicapped, children. I said 

yes, so in October 2007, 10 children arrived in south Florida from 

Ukraine needing prosthetics for arms or legs, or both. Our community and some south Florida firms responded admirably. Nine of 

the ten children were fitted with prosthetics. But I remember my 

then-Chief of Staff, Ana Carbonell, calling me from the airport 

when the children arrived explaining we have so much work to do 

with one particular young woman, 18-year-old Natalia. Natalia, a 

beautiful young woman, was born with extremely small arms and 

legs, and her back structure did not allow her to sit up. Hers was 

not a case for prosthetics. It was much more serious. She lived each 

day on a small wooden platform with wheels face down. The First 

Lady of Ukraine had been very impressed by the fact that, despite 

her physical disability, Natalia is an artist. She paints with a 

brush she holds with her teeth. 

But Natalia’s dream was to be able to sit in a wheelchair and 

face life sitting up. She had had multiple surgeries in Ukraine, but 

they had failed. A south Florida surgeon, Dr. Hari Parvataneni, 

15 

volunteered to operate. The community donated the funds to pay 

for her hospital stay. Natalia’s surgery was successful. After her 

surgery and rehabilitation, she was able to sit upright and live 

independently in her new wheelchair. 

She stayed in south Florida for months for her rehabilitation. 

Ana Carbonell and her husband, Gus Monge, opened their home to 

her. During those months, L.G. became Natalia’s friend. He was so 

proud of what our community had done for those children. L.G.’s 

first and his last Instagram posts were photographs of Natalia’s 

paintings. I carry his last Instagram post with me. Some friends 

of L.G.’s wrote, ‘‘This is pretty cool. Who painted it?’’ ‘‘A family 

friend from Ukraine named Natalia,’’ L.G. answered. 

I have never met anyone more respectful of all human beings 

than my son Lincoln Gabriel. As I said, he was all love. I must 

admit I believed that all you need is love. I never thought our tragedy of May 19, 2013, was possible, but it was possible. Sometimes 

love is not enough. 

Assertive, proactive intervention is sometimes required to get 

needed treatment to those in mental health crisis, and thorough 

discussion of their illness with those who are sick. 

I have come before you today to thank you for focusing on this 

painful issue and to thank the mental health experts, the physicians, those in the NGOs, in the Executive Branch, the Surgeon 

General, all those working to prevent tragedies such as the one my 

family experienced. Please, find common ground. Overcome differences in order to make progress. 

As my son Daniel said, if one person who might not otherwise 

get help is able to get treatment because of this hearing and its 

aftermath, L.G. would be happy. 

Thank you. 

Mr. MURPHY. We thank our friend and our colleague for his 

words of motivation and challenge, and we will heed that challenge. 

Now, as our next set of witnesses are coming to the table, I will 

read your introductions. Please have a seat as your nameplate is 

put down. 

We are going to be joined today by Rear Admiral Boris Lushniak, 

who is the Acting United States Surgeon General. He oversees the 

operation of the U.S. Public Health Service Commissioned Corps 

comprised of approximately 6,800 uniformed health officers. Also, 

Dr. David Brent is the Endowed Chair in Suicide Studies and Professor of Psychiatry, Pediatrics, Epidemiology and Clinical and 

Translational Science at the University of Pittsburgh. Dr. Christine 

Moutier is the Chief Medical Officer of the American Foundation 

for Suicide Prevention, and Dr. Joel Dvoskin is an Assistant Professor of Psychiatry at the University of Arizona and is here today 

testifying on behalf of the American Psychological Association. 

I will now swear in the witnesses. You are aware that the committee is holding an investigative hearing, and when so doing has 

the practice of taking testimony under oath. Do any of you have an 

objection to taking testimony under oath? Seeing none, the Chair 

then advises you that under the rules of the House and the rules 

of the committee, you are entitled to be advised by counsel. Do any 

of you desire to be advised by counsel during your testimony today? 

16 

You all say no. In that case, if you would please rise and raise your 

right hand, I will swear you in. 

[Witnesses sworn.] 

Mr. MURPHY. And all have answered affirmatively, so you are 

now under oath and subject to the penalties set forth in Title 

XVIII, Section 1001 of the United States Code. I am going to ask 

you each to give a 5-minute opening statement. We will begin with 

Dr. Lushniak. 

STATEMENTS OF BORIS D. LUSHNIAK, ACTING SURGEON GENERAL OF THE UNITED STATES, DEPARTMENT OF HEALTH 

AND HUMAN SERVICES; DAVID A. BRENT, ENDOWED CHAIR, 

SUICIDE STUDIES, AND PROFESSOR OF PSYCHIATRY, PEDIATRICS, EPIDEMIOLOGY, AND CLINICAL TRANSLATIONAL 

SCIENCE, UNIVERSITY OF PITTSBURGH; CHRISTINE 

MOUTIER, CHIEF MEDICAL OFFICER, AMERICAN FOUNDATION FOR SUICIDE PREVENTION; AND JOEL A. DVOSKIN, ASSISTANT PROFESSOR OF PSYCHIATRY, UNIVERSITY OF ARIZONA, ON BEHALF OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 

STATEMENT OF BORIS D. LUSHNIAK 

Mr. LUSHNIAK. Thank you so much, Chairman Murphy, Ranking 

Member DeGette and members of the subcommittee. 

What a way to start in terms of hearing the words of the Honorable Lincoln Diaz-Balart. Oftentimes in public health we get 

caught up, certainly in subcommittees we get caught up. We get 

caught up in numbers, we get caught up in programs, we get 

caught up in initiatives and successes and failures. I submit to you, 

sir, starting off with a personal and poignant story such as presented to us really sets the tone for what all this is about, that this 

ends up being that one life at a time, and yet we know that although he came here very heroically to discuss the story of his son 

and their family’s tragedy, the repercussions of that spread out, 

and each and every year, as we already heard, almost 40,000 people have stories like that. Let us remember those 40,000. Let us 

focus on the public health impact of this terrible scourge in our 

land. 

I want to share with you the opening dedication of this, the 2012 

National Strategy for Suicide Prevention, and it goes like this. To 

those who have lost their lives by suicide to those who struggle 

with thoughts of suicide, to those who have made an attempt on 

their lives, to those caring for someone who struggles, to those left 

behind after a death by suicide, to those in recovery, and to all 

those who worked tirelessly to prevent suicide and suicide attempts 

in our Nation. 

This is one of those quintessential components of any program, 

of any initiative, certainly initiatives out of the Office of the Surgeon General that it is not one person, it is not one group. It is incredible clinicians as I have to the left of me. It is incredible political structures and leaders that I see in front of me. It takes that 

proverbial village to have success in public health. 

For over a decade, the Office of the Surgeon General has led in 

this topic matter. This has been a priority. Surgeon General David 

17 

Satcher back in 1999 put out the first call to action, and in 2001, 

the National Strategy for Suicide Prevention. Most recently, my 

predecessor, the former Surgeon General Regina Benjamin, in partnership with the National Action Alliance for Suicide Prevention 

updated this U.S. National Strategy for Suicide Prevention. 

I am here as an Acting Surgeon General. I am a career officer 

in the U.S. Public Health Service, but here committed to demonstrate the commitment of the Office of the Surgeon General to 

continue to be visible and a long-term supporter of our Nation’s 

work in suicide prevention. I don’t come to you as a psychologist, 

psychiatrist, behavioral science expert. These are people to the left 

of me here. We have that expertise behind me. My chief of staff, 

Captain Robert DeMartino, also a member of the U.S. Public 

Health Service, is a psychiatrist by training. He is there embedded 

within the immediate Office of the Surgeon General. I come to you 

as a person trained in family medicine, preventive medicine, and 

dermatology. I bring my commitment to a public health approach 

and public health expertise to these issues. 

Let me define this public health approach. What is the problem? 

We define the problem through surveillance and data. Why did it 

happen? We identify the causes and understand the risks and protective factors. What works? We develop and evaluate innovations, 

programs, and policies. How do you do it and accomplish the goal? 

We implement and ultimately disseminate interventions that work, 

evidence-based interventions. 

While the Office of the Surgeon General doesn’t direct or have 

oversight over specific programs or agencies within the Department 

of Health and Human Services, the ability of that title of Acting 

Surgeon General or the Surgeon General to bring the Nation’s attention and focus onto important public health issues remains an 

important and necessary part of our efforts to prevent suicide in 

our Nation. We play a leadership role to bring together Federal and 

non-Federal partners, inspire them to identify the solutions, take 

collective action to address these key issues. That collaborative 

leadership was fundamental to creation of this, the national strategy. 

Incidence of suicide, as we have heard, in spite of an encouraging 

trend between 1995 and 2005, has sadly remained largely undisturbed. Many people will ask why. The unsatisfying answer is, suicide is a complex problem that defies a simple solution. Still, there 

are many clues out there in the international realm. The United 

Kingdom’s steady, significant reductions in suicide rates included 

access to 24-hour crisis care, assertive outreach for people with severe mental illness. In Taiwan, follow-up aftercare after suicide attempts led to a 63 percent reduction. Means reduction has been 

successful in international settings. Regardless of the means, those 

who die by suicide are far from being the only ones affected by that 

tragedy. 

We have this as a catalyst, the National Strategy for Suicide Prevention, work together by HHS agencies and outside partnerships, 

13 goals, 60 objectives, reducing suicides over the next 10 years. 

We work together with the National Action Alliance for Suicide 

Prevention, a public-private endeavor. We have many examples of 

successes, and yes, sir, many examples of failures in this. 

18 

With the emphasis on effective treatment to prevent suicide and 

reattempts, one of our goals, we have various therapies that are 

out there that are available and need to be utilized in this evidence-based world. We are engaged in a long-term effort to change 

how our society thinks about serious mental illness and suicides. 

We have to work on those changes. 

Mr. MURPHY. If you could wrap up? 

Mr. LUSHNIAK. While much has been done, we know more needs 

to be done. I applaud you for bringing attention to this issue. I urge 

your continued support for suicide prevention. 

Thank you, Mr. Chairman, Ranking Member DeGette and members of the subcommittee, and I look forward to further discussion. 

[The prepared statement of Mr. Lushniak follows:] 

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Mr. MURPHY. Thank you, Doctor. 

Dr. Brent, you are recognized for 5 minutes. 

STATEMENT OF DAVID BRENT 

Mr. BRENT. First, I would like to thank you and your staff for 

inviting me. It is an honor to be here. 

I would like to make a few points about what I think are things 

that we can do now that can decrease the suicide rate, and it starts 

with the premise that the single most important risk factor for suicide remains mental disorder, and there is evidence that if you improve the quality of treatment of mental disorder that you can decrease the suicide rate. This has been demonstrated regionally in 

studies based in primary care. There are pharmacoepidemiologic 

data that show that there is an inverse relationship between prescriptions for antidepressants and the suicide rate, and one of the 

ways that we think about how mental illness contributes to the 

risk for suicide is that it affects a balance between distress and restraint and that when you have low restraint against suicide and 

high levels of distress, that is when suicide ensues, and this is why 

insomnia, I think, is one of the most important risk factors for suicide. It is underrecognized. Many people are not well trained in its 

treatment. The way that it contributes is that it tends to increase 

disinhibition and dysphoria, which is a really bad combination and 

something that can either precipitate or exacerbate suicidal 

thoughts. 

There also are efficacious treatments for suicidal behavioral, and 

the issue is really one of dissemination at this point, and I will just 

mention one of them, dialectic behavior therapy, but there are several others, and what they have in common is that they have a 

clear model for suicidal behavior. They collaborate with the patient, 

and they have a safety plan that the patient can implement when 

they have suicidal urges. 

Another barrier to prevention of suicide, I believe, has to do with 

the inadvertent effects of the black-box warning of the FDA, which 

warns against suicidal events that may occur with antidepressant 

treatment, and what we have seen as an untoward consequence of 

that is a decline in the rate of diagnosis of depression and even a 

decline in referrals for psychological treatments for depression in 

adolescence, and although it is controversial, there are some studies showing that that is correlated with an uptick in suicide. 

Another thing that I think should be in our portfolio has to do 

with evidence-based prevention. The Washington State Institute for 

Public Policy has done cost-benefit analyses on different prevention 

programs and showed that there are certain ones that are evidence-based and yield a very high return for investment, and I 

think that some of these could decrease risk factors that we know 

are related to suicide such as aggression and substance abuse. 

The issue of lethal agents in suicide—guns in the United 

States—having a gun in the house greatly increases the risk of suicide, and it is not only in people who have mental illness, although 

that is the most concerning issue, but in our studies, we found that 

individuals where there wasn’t a clear mental disorder, the only 

factor that differentiated between suicide victims and people in the 

community was having a loaded gun in the home, and so we know 

31 

that there are interventions that can be done in primary care that 

can at least encourage people to store guns in a secure manner so 

that a disinhibited or impulsive act won’t lead to a fatality, and we 

would urge that this be considered as an important public health 

measure. 

There are service system changes that can lead to improvement 

in the suicide rate, and Dr. Lushniak alluded to this, but in England, they showed that implementation of care coordination, 24- 

hour beds, crisis beds, assertive outreach if people don’t show up 

for their appointments, and dual diagnosis treatment, that is, substance abuse and mental disorder combined. When they implemented these recommendations, it was associated with a decline in 

the suicide rate. 

And so to conclude, I just wanted to share what I think are some 

recommendations that may help us to reduce the suicide rate, 

which has to do with improved recognition and treatment, and I 

think the most promising area, and this is in collaborative care 

where mental health treatment is collocated in primary care, dissemination of evidence-based treatments that have been shown to 

reduce suicide, coordination of care and the mental health service 

systems, innovations that have been shown in England to reduce 

suicide, and I think that there are some research areas that could 

have relatively high payoff quickly. One is whether better recognition and treatment of insomnia could have an effect on the suicide 

rate, safety counseling in primary care, whether restriction of 

availability of lethal means could reduce the suicide rate, and I 

think research on trying to find agents that have a more rapid 

onset of antidepressant effect than the ones that we are currently 

using, and finally, evidence-based prevention judiciously used, and 

I think these recommendations, many of them are partly in place 

now, I think could make a favorable impact on the suicide rate. 

Thank you. 

[The prepared statement of Dr. Brent follows:] 

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Mr. MURPHY. Thank you, Doctor. 

Now, Dr. Moutier, if you would pull the mic close to you and turn 

it on. We appreciate your testimony. 

STATEMENT OF CHRISTINE MOUTIER 

Ms. MOUTIER. Mr. Chairman and members of the committee, 

thank you for inviting the American Foundation for Suicide Prevention, AFSP, to testify today. I am Christine Moutier, and I am 

AFSP’s Chief Medical Officer. I would like to submit my full written statement for the record, and Mr. Chairman, thank you for 

your longstanding leadership in mental health and suicide prevention. 

The magnitude of suicide’s toll on our society is immense, but my 

message today is hopeful and actionable. While suicide’s roots are 

complex with biological, psychological, and social determinants at 

play, clearly oftentimes suicide is the result of an unrecognized or 

untreated mental illness, and when one in four Americans have a 

diagnosable mental health condition but only one in five of those 

are seeking professional help, we have a lot of work to do. We must 

elevate the layperson’s understanding of how mental health problems are experienced or what they look like in loved ones, and we 

must highlight help-seeking as the smart, responsible thing to do 

when you sense a change in mental health just like you would be 

proactive with any other aspect of your health. 

Suicide risk tends to be the highest when multiple risk factors 

come together or precipitating life events in a person with a mental 

illness. We can start by better recognizing and effectively treating 

those health problems. On a population level, we can implement 

more upstream approaches such as shoring up community and peer 

support, teaching students social and emotional skills, making 

mental health care accessible and available to all, and addressing 

the health care system’s failures, training frontline citizens like 

teachers, first responders and clinicians, and limiting access to lethal means. 

The good news is that suicide is preventable, and thanks to a 

grassroots movement catalyzed by both suicide loss survivors and 

the emerging voice of those with their own history of suicide attempts, the fight against suicide is reaching a tipping point. I believe we need to focus on three key policy areas to bend the curve 

of our Nation’s suicide rate, and these areas include suicide prevention research, suicide prevention programs, and support programs 

for those who are touched by suicide. 

Research is vitally important to understanding what actually 

works to prevent suicide. Suicide research must focus on the gaps 

in the science, which, if understood, would have the greatest potential impact on reducing suicide burden. 

AFSP uses a strategic approach to fund the best science with an 

eye toward impact. One AFSP-funded study, for example, trained 

primary care physicians in a region of Hungary that happened to 

have one of the world’s highest suicide rates and found that their 

training led to a reduction in suicide rates in that region at least 

until the effect of the training had passed a couple years later. 

Studies of bridge barriers dispel the myth that people bent on suicide will find a way since suicide rates for the whole region diminVerDate Mar 15 2010 11:09 Mar 30, 2015 Jkt 037690 PO 00000 Frm 00045 Fmt 6633 Sfmt 6633 F:\113-177 SUICIDE PREVENT ASK OK 3-27-15\113-177 SUICIDE PREVENT PDF MADE
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ished following their construction, and, as you have heard, clinical 

intervention studies have found promising results for those at highest risk for suicide such as people who have had a suicide attempt. 

AFSP believes that the Federal Government must substantially 

increase funding of suicide research in the hopes of obtaining similar reductions in mortality that have come from strategic investments in other major public health problems like heart disease, 

HIV/AIDS, and cancer. Federal funding of research is far from commensurate with suicide’s morbidity and mortality toll. 

Suicide prevention needs to encompass a broad range of the 

issues that put people at risk for suicide and conversely, prevention 

needs to emphasize the conditions that provide a protective effect 

against suicide. The best strategies are multidimensional and sustained. They use education, media campaigns, targeted screening, 

resilience building, system changes that treat mental health problems as health issues and not disciplinary ones, and they address 

access to lethal means. 

Prevailing cultural perceptions about suicide and mental health 

keep 80 percent of people with a mental health problem from getting help. To address this appalling level of mental health illiteracy, we must provide education universally to eradicate stigma 

and shatter the real and perceived barriers that keep people suffering in silence. Suicide touches many, many lives, but only recently as more and more people are speaking out about their experiences has the need for action become so apparent. Ten years ago, 

our organization had only a handful of people banding together. 

Today we have over 100,000 people walking and raising awareness 

for suicide prevention every year. It is time to wage war on suicide 

and put a stop to this tragic loss of life. I believe we can accomplish 

a goal of reducing the suicide rate in our country 20 percent by 

2025. This is our organization’s goal. Science can provide a clear 

roadmap, and I believe the American people are ready for a greater 

understanding of the issue. If we push hard with an effective strategy, we can save lives. 

Thank you. 

[The prepared statement of Ms. Moutier follows:] 

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Mr. MURPHY. Thank you, Doctor. 

Now Dr. Dvoskin, you are recognized for 5 minutes. Make sure 

the microphone is on and pull it close to you. 

STATEMENT OF JOEL A. DVOSKIN 

Mr. DVOSKIN. Chairman Murphy, Ranking Member DeGette and 

members of the committee, my name is Dr. Joel Dvoskin. I am a 

clinical and forensic psychologist. I am a faculty member at the 

University of Arizona College of Medicine. I also serve as Chairman 

of the Governor’s Advisory Council on Behavioral Health for the 

State of Nevada. I thank you for holding this hearing, and I am 

appearing today on behalf of the American Psychological Association, which is the largest scientific and professional organization 

representing psychology in the United States. APA supports the 

committee’s focus on ensuring that our Nation does all it can to 

prevent suicide. 

As you have heard, suicide is a complex and multifaceted problem. It is also a form of violence, but with access to appropriate 

treatment, it can be prevented, and that is probably one of the 

more important things I want to say to you today, and you have 

heard from other people is that we know how to prevent suicide; 

we just don’t do it. 

Any act of interpersonal violence including mass homicides, 

which have gotten a lot of attention, are suicidal acts. The majority 

of people who commit mass homicide die. They either kill themselves, they are shot by police, or their life as they know it is over 

because they go to prison or hospital for the rest of their life. So 

if we prevent suicide, we will prevent mass homicide; we will just 

never know it because you never know which person would have 

decided to end their life at the expense of many others. 

APA views suicide prevention as an essential part of violence 

prevention. As you have heard from Dr. Brent, suicide is an impulsive act, especially angry impulsivity, where an individual is desperate to relieve their suffering and can’t figure out another way 

to do so. 

Suicide risk can be reduced through identifying and providing 

support to address the factors that drive a person to consider suicide as well as the factors that disinhibit people and allow them 

act on those drives. 

Much of my current work is—I am a board member of the National Association to Protect Children, and one of the important 

points I want to make is that child abuse and trauma is an important risk factor for suicide among a whole bunch of other bad life 

outcomes. Programs such as the National Child Traumatic Stress 

Network are essential to our efforts to prevent suicide. 

Much of my own work is focused on jails and prisons. I was glad 

to hear you mention DBT. Just yesterday, I spent all day in the 

women’s prison in Huron Valley in Michigan, where they have 

done, to my knowledge, the first DBT program in a prison in America as a large part of their effort to prevent suicidal acts among 

their inmate population. 

By using a public health and prevention approach, experience 

shows that we have reduced jail suicides by about two-thirds in 

every jail that has implemented a public health approach to suicide 

61 

prevention. It is very simple. You ask people at the front door if 

they are thinking of killing themselves, and if they say yes, which 

they often do, you keep them alive until the crisis passes. 

You have heard about interagency collaboration and programs. 

One example is the crisis intervention teams, which I know that 

Chairman Murphy has been supportive of, a program that has been 

developed with law enforcement, but CIT is worthless if the police 

don’t have anybody to refer the person to. So in the absence of good 

mental health care, CIT, which is a tremendously valuable program, loses a lot of its effectiveness. 

One of the most important things I want to share with you today 

is the fact that we have completely neglected to use the most important behavioral change agent in America to fight suicide, and 

that is television advertising. Television got everybody in America 

to put deodorant on every morning, but we have never tried to use 

it to change behavior on a much more important thing, and I think 

the committee could use its power to get some cooperation from television advertisers to fight stigma and to get people to tell us when 

somebody they care about, their life is in danger due to suicide. We 

know what works, but not all Americans have access to the effective treatment and crisis intervention that is necessary. 

We need to have more trained professionals including people who 

have been through problems with mental illness and are very effective peer service providers. I very much agree with the chairman’s 

push to at least revisit the Medicaid IMD expansion, which will 

hopefully make more acute crisis beds available for people who are 

now choking emergency rooms where people can’t get lifesaving 

treatment, and it is bad treatment for a serious mental illness or 

a psychiatric crisis as well. 

My time is almost done. I just want to add a couple of other 

things. One of them is that the National Violent Crime Reporting 

System currently only exists in 16 States, and I urge you to consider expanding that nationwide so that we can do some of the research that you have heard about before. 

I want to express my deep appreciation of the committee’s work 

and its ongoing attention to the prevention of suicide and the treatment of serious mental illness in America. Over my many years in 

this field, I have seen tremendous progress in figuring out how to 

fight suicide. We just don’t implement these tools broadly enough. 

Suicide, like so many tragedies, is the direct result of despair, and 

there is only one cure for despair, and that is hope. It is my hope 

that our political parties can join together in a bipartisan effort to 

give people in the most acute despair some measure of hope for a 

better life by improving the services that are provided to people experiencing emotional crisis and psychological pain. This can happen 

to any of us, and we must ensure that help is there in time of crisis. 

Can we afford to do this? I would propose to you that given the 

costs of each suicide, we can’t afford not to. 

Thank you very much. 

[The prepared statement of Mr. Dvoskin follows:] 

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Mr. MURPHY. Thank you. I thank all the panelists for your important testimony. Let me open up questions here for 5 minutes, 

and we will alternate with other questions. 

Surgeon General, in 2010, a progress review on the National 

Strategy on Suicide Prevention prepared by the Suicide Prevention 

Resource Center identified the ultimate policy goal behind the national strategy as reducing the morbidity and mortality of suicide 

behaviors. Is this the aim of the national strategy as you understand it as well? 

Mr. LUSHNIAK. It is to a large extent, and morbidity, I have to 

clarify here. Morbidity is the world of attempts, right? 

Mr. MURPHY. We all know that within the realm of suicide, there 

is a whole spectrum and it starts with the concept of, you know, 

suicide ideation, suicide planning, suicide attempts, and then suicide, and so ultimately within the national strategy is really a concerted effort across multiple Government agencies and with the private sector components to be able to say, as already stated here, 

to reduce that incredible burden on our society, the number of ultimate suicides that do occur. 

Mr. MURPHY. Thank you. Also, in September of this year, in a 

blog post, NIMH Director Tom Insel noted that despite increased 

availability of mental health care and medications for depression, 

the U.S. suicide rate has remained largely unchanged and of, 

course, we also know in some areas, it has gone up. Would you 

agree that this data suggests that our national strategy dating 

back to 2001 has not been effective in reducing the number of 

deaths by suicide and we need to make some changes? 

Mr. LUSHNIAK. Well, I think the changes are in progress of being 

made. I think going back to 2001, we realized in 2001 was the first 

strategy. This most recent strategy came out under Surgeon General Benjamin back in 2012. So actually this is second anniversary 

of the release of this strategy. So it is too early, in my view, to say 

that things are not successful, yet I realize we are all frustrated 

with the fact that success, if it is going to be there, is coming rather slowly, and so there is a frustration. 

Now, built into this are multiple other changes that are going on 

including the idea of, you know, one of the objectives of this, objective 5.4, which focuses on efforts to increase access to and delivery 

of effective behavioral health services. Now, that certainly has 

changed with the Affordable Care Act. The Mental Health Parity 

and Addiction Equity Act will give 60 million people extended access to mental health and substance use disorder services, and depression screening, alcohol misuse screening, and counseling are 

now covered as pre-preventive services under ACA. So my sense is 

that to be able to go back to 2001 saying things aren’t working, my 

sense is, I am going back to 2012 and re-analyzing it. 

Mr. MURPHY. It is clear we have to do something, and as I have 

talked with former Congressman Lincoln Diaz-Balart, he told me 

that access was not a problem, and I am sure we would agree that 

for Robin Williams, insurance and money was not a problem. 

But Dr. Brent, you have seen considerable success in some of 

your research, in particular, the STAR Center. How has the STAR 

Center performed? And I think it is the only one of its kind in 

72 

Pennsylvania, and is it serving as a model for other States in terms 

of ability to have positive results? 

Mr. BRENT. Well, I don’t know how unique it is, but our program 

is funded by the Commonwealth of Pennsylvania and it allows us 

to do things that often clinicians don’t do because it is not billable, 

but I would say that the things that we do that I think lead to our 

effectiveness, we spend a lot of time on supervision and training 

using evidence-based treatment. We work as a team, and so decision-making is shared and you are less likely to make a mistake 

than if you have multiple opinions. We spend time coordinating 

with other institutions so our clinicians will go to schools, inpatient 

units and so on. This is not reimbursed currently but we feel that 

it is important. And I would say that we have a sense of mission 

and discovery, and I think we are critical about our own work, and 

we are always looking to improve. 

Mr. MURPHY. And we hope you will continue to share much of 

that research with this committee because it is an exemplary program. 

Dr. Moutier, the Washington Post ran an article in its August 12, 

2014, issue quoting you extensively in the media treatment of 

Robin Williams’ suicide. In particular, you took issue with a tweet 

by the Academy of Motion Pictures Arts and Sciences which you argued ran contrary to a healthy dialog. I don’t know if we have that 

tweet available. Right there. And it says, ‘‘Genie, you are free.’’ 

How can the American Foundation of Suicide Prevention and similar groups bring the myths and facts about suicide and suicide prevention to the attention of organizations and commentators acting 

on social media? Could you please comment on how we need to 

change that? 

Ms. MOUTIER. Yes. I think that speaks exactly to the disconnect 

and the level of ignorance that is out there. Obviously they meant 

well with that statement, and little did they realize that to a vulnerable individual, especially a young, vulnerable person, that really presents an idea that suicide is being idealized and it is a solution and makes it more acceptable, and I am sure they did not 

mean to do that but that kind of messaging is being done still to 

this day quite frequently. 

My organization partners with other organizations. We have already produced media guidelines for safe messaging, and actually 

maybe even effective prevention messaging about suicide after an 

event has occurred that has the public’s attention. We are doing 

things like working with the media. We just attended a conference 

this week to try to raise this level of education. We have friends 

in the Associated Press who are working to, for example, get the 

term, the phrase ‘‘committed suicide’’ banned from the AP Style 

Guide, which would be a measure of progress as well so that it is 

not associated with a criminal act. 

Mr. MURPHY. Thank you very much. I now recognize Ms. 

DeGette for 5 minutes. 

Ms. DEGETTE. Thank you very much. 

Dr. Lushniak, access to treatment is going to be a key part of 

any efforts we make in suicide prevention and reduction. Is that 

correct? 

Mr. LUSHNIAK. Yes. I think it is a key feature. 

73 

Ms. DEGETTE. Thank you. 

Mr. LUSHNIAK. Let me back up just—— 

Ms. DEGETTE. OK. I need to keep moving. 

And Dr. Brent, in your testimony, your written testimony, you 

say, ‘‘Access to good quality mental health treatment can reduce 

risk.’’ Is that correct? 

Mr. BRENT. Yes. 

Ms. DEGETTE. And I would assume, Dr. Moutier, you agree with 

that as well, that people have to have access to quality treatment, 

right? 

Ms. MOUTIER. Yes. 

Ms. DEGETTE. And Dr. Dvoskin? 

Mr. DVOSKIN. Yes. 

Ms. DEGETTE. OK. So going back to you, Dr. Lushniak, what 

were you going to clarify? 

Mr. LUSHNIAK. Well, it is interesting because I think access to 

be able to diagnose appropriately severe mental illness—— 

Ms. DEGETTE. Right. 

Mr. LUSHNIAK [continuing]. And being able to treat it appropriately is the key feature. 

Ms. DEGETTE. Yes. 

Mr. LUSHNIAK. One of the disturbing factors that we have seen 

in terms of the data that come in is that the majority of suicides 

that do occur have had access to medical care. 

Ms. DEGETTE. Right. 

Mr. LUSHNIAK. They—— 

Ms. DEGETTE. But they don’t necessarily have access to psychological care. 

Mr. LUSHNIAK. But also the issue here is—— 

Ms. DEGETTE. Is that right? 

Mr. LUSHNIAK [continuing]. Whether that issue—whether as you 

are having your blood pressure taken, whether—— 

Ms. DEGETTE. Whether they are asking about that? 

Mr. LUSHNIAK. Exactly. 

Ms. DEGETTE. That is correct. And Dr. Dvoskin, part of the thing 

is that we haven’t had high-quality psychological care, particularly 

for adolescents. Isn’t that correct? I mean, what we have heard in 

all these hearings this year that we have been having is that we 

don’t have nearly enough trained mental health professionals for 

adolescents, and that pediatricians and others who are treating 

these young people don’t have the psychological training. Would 

you agree with that? 

Mr. DVOSKIN. Some do and many don’t. 

Ms. DEGETTE. OK. And Dr. Brent, in your written testimony, one 

of—and actually, Dr. Dvoskin, you talked about this too in your 

testimony. You were talking about DBT, which is dialectic behavior 

therapy. Is that right? 

Mr. BRENT. Yes. 

Ms. DEGETTE. And dialectic behavior therapy is a very intensive 

and expensive therapy. Is that correct? 

Mr. BRENT. Yes. 

Ms. DEGETTE. But it seems to have shown through the studies 

that it works. Is that right? 

Mr. BRENT. Yes. Can I—— 

74 

Ms. DEGETTE. Yes. Turn the mic on, please. 

Mr. BRENT. There are briefer versions and there are other treatments like cognitive behavior therapy. 

Ms. DEGETTE. Right. 

Mr. BRENT. There is one study—— 

Ms. DEGETTE. Right. 

Mr. BRENT [continuing]. In nine sessions, they were able to cut 

the suicide rate in half. 

Ms. DEGETTE. Right, but still, the cognitive behavior study, that 

costs money too and it needs trained professionals to administer. 

Is that right? 

Mr. BRENT. Yes. 

Ms. DEGETTE. Yes? OK. Thanks. So the reason I am asking these 

questions is because, of course, one thing we tried to do when we 

passed the Affordable Care Act is, we tried to give people mental 

health coverage as a result, and in fact, there was a report earlier 

this year by the American Mental Health Counselors Association 

that nearly 7 million uninsured adults with serious mental health 

and substance abuse conditions are now eligible for health insurance coverages under the ACA marketplaces and for 27 States 

through Medicaid, and so Dr. Dvoskin, I wanted to ask you, do you 

think that it is important that we expand mental health coverage 

to people as we are expanding our health care in general? 

Mr. DVOSKIN. Mental health coverage crisis response is terribly 

important, so even if someone is in treatment, if there is—many 

suicidal crises occur late at night when crisis response teams, fire 

and rescue, police agencies are the responders, and a competent 

crisis response has suffered very badly from the decreases in mental health funding in the public mental health system over the last 

15 years. 

Ms. DEGETTE. Right. So even though we are giving people more 

access to mental health in the ACA, we still need to fund that crisis treatment, and we have heard that loud and clear. 

Mr. DVOSKIN. Yes, ma’am. 

Ms. DEGETTE. Dr. Lushniak, I want to ask you if you can talk 

about what has happened that you have seen since the Affordable 

Care Act has given increased coverage of mental health services 

and what that will mean in your efforts for suicide prevention. 

Mr. LUSHNIAK. Well, certainly, I think it is too early to see 

whether we have a success or a failure here. The success is, we do 

have coverage. As I mentioned already, both the Affordable Care 

Act as well as the Mental Health Parity and Addiction Equity Act 

will give 60 million, 6–0 million people expanded access to mental 

health and substance use disorder services. So the idea here is that 

access, will access bring us success? Certainly, I think access is 

going to be a positive influence. 

Ms. DEGETTE. But it is not the only thing. 

Mr. LUSHNIAK. But right now it is not the only thing. It is helpful. It is heading in the right direction but it really dovetails into 

what I think all of our messages was. We are dealing with a very 

complex public health issue here, a very complex mental health 

issue here, and it is multifactorial with multifactorial resolutions. 

There is not going to be one simple answer saying access will solve 

the whole problem. 

75 

Ms. DEGETTE. Thank you. Thank you very much, Mr. Chairman. 

Mr. MURPHY. Thank you. I now recognize Mr. Griffith of Virginia 

for 5 minutes. 

Mr. GRIFFITH. Thank you very much. I appreciate that. 

I will let any of you jump in on this. One of the things that we 

haven’t discussed in detail but is a part of that multi—and I am 

not going to pronounce the word right, but multi reasons why 

someone might commit suicide. I noticed an article that I read indicated that there are families who suffer from depression who have 

multiple members who have committed suicide and other families 

who suffer with a history of depression who do not have suicide, 

not a single one, and I am wondering what the thoughts are. Do 

you all believe—and everybody can answer this. Do you believe 

that there is a gene that we might be able to identify that would 

say these folks with depression are more likely to commit suicide 

than other folks, and do we target or do we put special attention 

on those who have a family history both of the mental illness of 

depression and a resulting suicidal act in the family? 

Mr. LUSHNIAK. And I will start, and then we can open it up to 

the panel. Certainly, there are genetic influences on a variety of 

conditions—substance use, abuse of substances. Alcoholism obviously has a genetic predisposition. There are also mental health 

disorders, severe mental health disorders that do have a genetic 

connection there as well. We know a definite risk factor is having 

a family member who has committed suicide. We know that is a 

risk factor, and the whole idea of genetics and its tie-in with suicide I think is still to be determined in our research world, and I 

will pass the microphone on to the clinicians here to further give 

their opinion on this. 

Mr. BRENT. Well, there is definitely a genetic influence to suicide, 

and the families that you were describing, the two types of families, is strong evidence for that, but that doesn’t mean that it is 

caused by a single gene, and I think that when we deal with families where there has been a completed suicide, we have to tell people actually that you are at increased genetic risk but genetics isn’t 

destiny. If you have a risk that is 40 per 100,000 instead of 10 per 

100,000, the odds are still with you, and so I think it is important 

not to oversell that. At the same time, we are chasing what might 

be some genetic factors that could be contributing to suicide risk 

but it is not going to be one gene. 

Mr. DVOSKIN. I would just add that looking at this through a 

public health lens, it is very easy to identify the people who are deserving of extra attention, who is at higher risk, people who have 

tried before, people who have close families who have killed themselves. So we don’t lack for an ability to identify the at-risk population. 

Mr. GRIFFITH. Did you want to add anything? 

Ms. MOUTIER. Well, I think I will just say, as you heard, we have 

things that we can implement now. Research is fine and good, but 

if it doesn’t translate into something that is actionable to actually 

help people, I think in many cases what you are hearing is that 

we have evidence-based strategies and now we have growing access 

to care. Now we have to link the two. So I think there are things 

that we need to do now, and continuing to more robustly fund reVerDate Mar 15 2010 11:09 Mar 30, 2015 Jkt 037690 PO 00000 Frm 00079 Fmt 6633 Sfmt 6633 F:\113-177 SUICIDE PREVENT ASK OK 3-27-15\113-177 SUICIDE PREVENT PDF MADE
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search is very important. We are probably some years away from 

that genetic answer for predicting suicide risk but it could be there, 

absolutely. 

Mr. GRIFFITH. Well, I appreciate that and hope that while I know 

that is just one piece of the puzzle, I would hope that the researchers and both private and governmental areas would continue to 

look into that. 

Switching gears, I would ask the Surgeon General if he could 

comment on the possibility of using the U.S. Air Force’s suicide 

prevention program as a possible model for the other branches because obviously we are all concerned with the high increase and 

the large numbers of our armed forces who returned from combat. 

Mr. LUSHNIAK. Certainly. I think it is a discussion that I can certainly have and will have with the other Surgeons General of the 

Army and Navy as well as the Air Force, my fellow surgeons, if you 

will. That being said, I think the Air Force is a great model. The 

Air Force has two components to their program. One component is 

the wingmen component, which is servicemen watching out for 

other servicemen. The other component is actually built into a 

youth prevention program. 

I think the bottom line to all of this, and it really goes back to 

this public health model that I described earlier, ultimately, we are 

looking for what works. Part of what works is to be able to look 

at innovations, look at changes and properly evaluate them because 

ultimately as we go further to implement this, whether it is across 

the armed services or whether it is across the Nation, I have to 

have proven systems that work before nationwide implementation 

goes. But I think we are on that pathway to find out what is working and to see how it is implementable, even in terms of further 

pilot studies. 

Mr. GRIFFITH. And Mr. Chairman, if you all will indulge me, I 

am going to go back to the first question because something came 

to my mind. 

One of the factors is also substance abuse, and I am wondering 

if there are any programs out there—we talked earlier about educating people on what you might do and why television—we have 

learned, you know, everybody should use deodorant but we haven’t 

learned how to deal with suicide. For those families that have a 

history of both substance abuse and suicide, I wonder how much 

work is being done on encouraging those families to be abstinent 

when it comes to both alcohol and other substances. 

Mr. LUSHNIAK. I think certainly when we look at all the risk factors—and I think we sort of described it earlier—we know a lot of 

the risk factors that exist out there. Now, how all these are bundled together, which is the family’s history component in addition 

to the substance use or abuse component, we certainly look and try 

to strengthen our specific prevention activities within those populations, but in essence, we sometimes break them apart. In other 

words, the substance use is treated differently than the family history one. But again, I will turn to the clinicians here who do this 

on a daily basis. 

Mr. BRENT. So substance abuse prevention is an interesting issue 

because it is so prevalent, especially in adolescents and young 

adults, that there is argument that a universal prevention actually 

77 

makes more sense than targeting people that are at high risk, and 

in that policy institute I mentioned, the Washington State Policy 

Institute, they have identified several intervention programs that 

are low-cost that are, you know, relatively brief that have shown 

to reduce substance abuse by about a third in communities where 

it had been implemented. 

Mr. MURPHY. The gentleman’s time is expired but if you could 

get us copies of—any time any of you reference any study, I hope 

you will get us copies. That is valuable. 

Mr. GRIFFITH. Thank you, Mr. Chairman. I appreciate the committee’s indulgence. 

Mr. MURPHY. Thank you. Now Ms. Castor is recognized for 5 

minutes. 

Ms. CASTOR. Thank you, Mr. Chairman, and thank you to the 

panel. 

I don’t think it is an understatement to say that there is a suicide crisis among America’s veterans. The Department of Veterans 

Affairs estimates that 22 veterans commit suicide every day. I am 

not going to use that, I have learned. What is the proper way to 

say it then? 

Ms. MOUTIER. Died by suicide. 

Ms. CASTOR. Twenty-two veterans die by suicide every day, about 

7,000 per year. Veterans are three times as likely to die by suicide 

as non-veterans. The number of suicides among veterans is outpacing the number of combat deaths. So this is a real national 

tragedy. 

Dr. Lushniak, why are we seeing these trends. I think people 

kind of understand the stresses, but what can you tell us? 

Mr. LUSHNIAK. Well, again, you know, the big question is why, 

why we see such trends. I mean, we certainly know one of the risk 

factors is serving in military. Certainly in military during wartimes, the stressors increase. The issues as, you know, Chairman 

Murphy well knows by going on—he was sharing with me his experiences going to Walter Reed twice a month to be able to treat and 

to diagnose and to assist in individuals who are coming back with 

traumatic brain injuries, who come back with PTSD. We are in a 

time where there are more such service members who are coming 

back. That is part of the issue. The other issue also is the issue 

of serving in any of our uniformed services brings with it its stress, 

its separation from family, its separation from one’s normal environs. So there are multiple reasons for that. 

Let me tell you to some extent sort of the cooperation that is 

going on right now, to a great extent the cooperation that is going 

on right now, and this specifically goes back to a question we had 

earlier in terms of the surveillance. Part of the way we get risk factors is being able to monitor what is going on out there, and we 

heard a little bit about the National Violent Death Reporting System, that it is only in 18 States right now. I can tell you today that 

the CDC has awarded new grants to expand this from 18 to 32 

States. But on top of that, there also now is an expansion to actually both CDC and NIH working with the Department of Defense 

and working with the Veterans Administration system to link their 

data sets or the data across their data sets. Now, why is this important? Ultimately, I am still looking, you know, for further inforVerDate Mar 15 2010 11:09 Mar 30, 2015 Jkt 037690 PO 00000 Frm 00081 Fmt 6633 Sfmt 6633 F:\113-177 SUICIDE PREVENT ASK OK 3-27-15\113-177 SUICIDE PREVENT PDF MADE
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mation about risk factors, and if I can get more precise information 

from VA databases, if I can get more information from the Department of Defense databases, for those individuals who have died 

from suicide, this is very helpful for us to plan the next series of 

strategies. 

Ms. CASTOR. I represent the Tampa Bay area, and in Tampa we 

have the Haley VA Hospital. It is known as the busiest VA in the 

country and it is home to one of the five polytrauma centers, so we 

see the most severe cases of TBI and spinal cord injury, but I was 

there a couple of weeks ago talking to a veteran that had been deployed about three or four times and was from Fort Bragg and was 

a tough guy and was known as a leader, and he said to me, let me 

tell you my story, you know, I am a tough guy and I came back 

and I had my wonderful family and they are supportive and things 

were going all right, and then a couple of months later something 

just snapped, and he said I recommend that the VA system and all 

of you do a better job up front when folks come home, even if we 

say, oh, we are fine and we are OK, and they are physically 

healthy, to not just accept it, and I think the Congress has put a 

lot of resources into this but Dr. Lushniak, what can you tell us 

now about what the Federal Government is doing? We have heard 

a good summary, but how it is really working? Oh, I am sorry. I 

mean Dr. Dvoskin. 

Mr. DVOSKIN. I agree that the Federal Government could profit 

from better coordination of its efforts, and I also think the efforts 

needed to be targeted along the lines that you have heard today 

from my colleagues, but just to give you one example, access to care 

doesn’t mean very much if you can’t get to a psychiatrist or a psychologist, and there aren’t nearly enough mental health professionals in the United States, not nearly enough. There are wonderful clinicians in the VA but there aren’t enough of them. It takes 

5 years to expand a residency program in psychiatry, and medical 

schools are loathe to go into the process, so we are automatically 

something we have done to ourselves 5 years behind the curve to 

increase the number of psychiatrists that are being trained at some 

of these wonderful medical schools, and you can’t bill for a resident. 

You can’t bill Medicaid for the services provided by a resident. 

Well, this is something we are doing to ourselves. There is no reason in the world for that rule, but it is something that we do. 

So there are a lot of ways that the Federal Government could 

streamline existing programs, coordinate existing programs, and 

add the kind of evidence-based practices that my colleagues have 

talked about today. 

Mr. MURPHY. Thank you. The gentlelady’s time is expired. And 

now Dr. Gingrey is recognized for 5 minutes. 

Mr. GINGREY. I thank Chairman Murphy, Dr. Murphy, for the 

hearing. This legislative hearing of course is extremely important 

and I commend him for his bill, H.R. 3717. I gave him the thumbsup just a second ago that I absolutely want to be signed on as cosponsor of this legislation. It is a hugely important issue, and I 

thank him for that. 

Let me, Dr. Moutier? Is that—— 

Ms. MOUTIER. Moutier. 

79 

Mr. GINGREY. Moutier. Yes. Let me ask you a few questions and 

then maybe the time remaining, the other panelists, the Surgeon 

General. 

Dr. Moutier, in addition to the factor of age, ethnicity also plays 

a role in the incidence of suicides, why has there been a consistently high suicide rate for elderly white men relative to all other 

groups? Any information on that? 

Ms. MOUTIER. Sure. I can speak to that while we also speak to 

the largest rise that we have seen in suicide rates perhaps ever, 

which is in middle-aged men actually, 35 to 64 years old. Over the 

last decade, their rates of suicide rose almost 50 percent. I would 

speak to a number of things including all the basic things that you 

have already heard about the prevalence rates of mental health 

problems and distress and what happens when we don’t take 

proactive care of ourselves. I would cite the role of culture that we 

have had in particular segments of society and we think about military veteran, physician, and first responder populations, what they 

all have in common is higher rates of suicide than the general population and a very tough macho sort of can’t acknowledge being a 

human being type of culture. 

Mr. GINGREY. Well, let me just interrupt you. Thank you for that, 

and I just intuitively think, you know, the pressures of life as you 

get a little older and the financial pressures are greater and maybe 

the children and the grandchildren didn’t turn out quite the way 

you wanted them to and you get a little depressed, and so that 

leads—well, not a little depressed. That leads to my next question, 

and if you would comment on the statistic that 90 percent of the 

people who commit suicide were previously diagnosed with mental 

illness. Is it known what percentage of these diagnoses are comprised of—well, would quality as a serious mental illness? 

Ms. MOUTIER. That is a really good question, and it is actually 

that in greater than 90 percent of the cases of suicide that have 

been studied through this method of psychological autopsy method 

had a diagnosable mental health condition. In most cases, they actually had not necessarily been diagnosed or treated. So that method is a little bit tricky. 

Among those who had a diagnosable mental health condition, the 

majority of them, it was a substance abuse combined with a mood 

disorder. So depression is actually the most common mental illness 

represented in those studies but next comes substance abuse, substance abuse combining with depression and bipolar disorder, and 

then other conditions like personality disorders and psychotic disorders. All of those are represented by the vast majority of that 90 

percent is depression, substance abuse, and other mood disorders. 

Mr. GINGREY. Well, your response is why really I am so excited 

about Dr. Murphy’s bill because it addresses a lot of those issues 

and gets right to the core of the problem. 

Mr. Lushniak. 

Mr. LUSHNIAK. Lushniak, yes. 

Mr. GINGREY. Oh, what the heck. Dr. L, our Surgeon General, let 

me ask you this. Suicide among those who serve in our armed 

forces and among our veterans is a matter certainly of national 

concern. The 2012 National Strategy for Suicide Prevention identified the United States Air Force suicide prevention program as a 

80 

possible model for use in other settings including civilian. Are there 

particular evidence-based programs in use at either the Department of Veterans Affairs or the Department of Defense like the Air 

Force that you would recommend expanding to our civilian health 

care system as well? 

Mr. LUSHNIAK. Well, certainly there are multiple programs within the VA system, within the DOD, within Health and Human 

Services. I will provide one example. Although, you know, evaluation is always the difficult thing with any programs, but I will describe the Lifeline, the crisis call-in line that exists out there. I 

mean, here is an example where last year in 1 year alone, a million 

calls come in to a Lifeline system. This is a call-in system that already—and there is evidence saying that once people have called 

in, there are positive repercussions from that call-in. 

So the reality is, we have systems built in all through, and the 

real question that ends up—and I will sort of go back to the Robin 

Williams tragedy recently, is the fact that there was another peak 

right after that tragedy of call-ins to that Lifeline, and it really 

does dovetail into, there are so many aspects to this, so many programs that exist right now, and I think right now, 2 years after 

the release of this strategy, we still are in the evaluation stage, 

along with the experts that are here at the table to come up with 

that final, you know, final set of recommendations, if you will, 

which is, what are we going to go with nationwide, what are we 

really going to push, because right now we have multiple pilots 

going on, and I think that we will be soon ripe for a time period 

where we can evaluate those programs and decide what really 

works, and it is going to be multiple answers. It is not going to be 

one—— 

Mr. GINGREY. General, or I should say Admiral, thank you so 

much. I realize my time—and thank you for your patience, Mr. 

Chairman, and I yield back. 

Mr. MURPHY. Thank you. I now recognize Mr. Tonko for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair, and thank you to our witnesses. Many of you mentioned the impact that suicide has not 

only on the victim but the toll it takes on surrounding family, 

friends, and community. I would venture to say that everyone in 

this room today has been personally affected by suicide at some 

point in his or her life. The numbers surrounding this epidemic are 

astounding. While we are in this hearing today, it is estimated that 

nine people across this country will complete suicide. 

Dr. Moutier, just to ensure that everyone in this room and 

watching this hearing has access to accurate information, what actions should one take if they or someone they know is expressing 

risk signs for suicide? 

Ms. MOUTIER. Sure. I think the first thing to say, which sounds 

very basic, but if it is somebody that you know and not yourself is 

to don’t write it off, don’t write off that thing that you just observed 

to the stress of the day because we do a lot of that in our society. 

So I think just approaching the person in a caring, concerned way 

and engaging in a caring conversation just like you would normally. Mental health, we need to get all the, you know, mysterious 

sort of stigma out of it and just start having normal conversations 

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that express caring, that say if you are in that kind of distress, I 

want to help you get the help that is going to get you back to your 

normal baseline way of being, that this is something that can happen to anyone of us. It is part of the human condition, so normalizing that. 

If it is a matter of safety, then of course you have to act a little 

more urgently, and in that case, certainly local emergency departments are available. Also, the National Suicide Prevention Lifeline, 

1–800–273–TALK is a number to call 24/7 for yourself or for somebody you are concerned about. 

Mr. TONKO. Thank you. And Dr. Moutier, the Affordable Care 

Act in conjunction with the Mental Health Parity and Addiction 

Equity Act, all of those have strengthened insurance coverage for 

mental health benefits for an estimated 60 million people, yet according to a recent New York Times story detailing experiences in 

Kentucky, many people are still having trouble accessing coverage 

due to an overwhelmed delivery system. Failure to access services 

in a timely fashion could be devastating for those contemplating 

suicide as you just indicated. What more do we need to do to ensure that there will be an adequate supply of providers to handle 

the mental health needs of our community? 

Ms. MOUTIER. I think it starts with both improved training of the 

existing health care workforce as well as down the pipeline, the 

medical students and other disciplines who are coming up. People 

may be shocked to know that in only two States in our country is 

suicide education a small module on suicide even mandated for 

mental health clinicians who are in training. So we have so much 

work to do, and in some ways I would say that should give us hope 

because we can do that kind of thing. You have already heard that 

to expand the workforce of mental health clinicians is right now we 

sort of just tied our own hands behind our back. We are not able 

to do that when we can’t even expand our residency training programs and other disciplines as well. So I think there are a number 

of things that can be done from a policy standpoint that we should 

really take a hard look at that are creating the obstruction. 

Mr. TONKO. Thank you very much. 

Admiral Lushniak, in your testimony you refer to the recent 

World Health report on suicide. Does this report tell us where the 

United States stands in comparison to other nations in preventing 

suicides, and if so, are there lessons to be learned from other countries, other cultures that are doing a better job of preventing suicide? 

Mr. LUSHNIAK. Well, in terms of the lessons, where we stand, I 

will have to get back with you on that data set in terms of how 

we stand relative to other nations, but certainly when we look at 

what is going on in the world, right, we know that national-based 

programs tend to work, and it really goes back to what I have said 

earlier. We start off small but things that do work ultimately can 

be put at the national level. We mentioned examples of the United 

Kingdom, right, where there are access, for example, a 24-hour crisis line, assertive outreach for people with severe mental illness, 

written policies on follow-up for those patients. Taiwan, I talked 

about a 63 percent reduction. We also have evidence that means 

reduction, right, the means of that suicide being reduced, and I will 

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describe something that sounds very strange but in Australia, as 

a result of motor vehicle exhaust suicides, there was a link to 

changes in their carbon monoxide emission standards. So an engineering improvement, an air pollution improvement in fact led to 

a change, to a decrease in carbon monoxide poisonings. I think we 

have to look at the world and learn from those aspects, that in fact 

we haven’t talked much about the means of suicide and we talked 

a little bit about safety, we talked about the idea, but across the 

board, if we are able to have some control of the means of that 

death by suicide, we can actually have impacts, and we see that 

from the international realm. 

Mr. TONKO. Thank you. Some very interesting concepts, and with 

that, Mr. Chair, I yield back. 

Mr. MURPHY. The gentleman yields back. I now recognize Ms. 

Schakowsky for 5 minutes. 

Ms. SCHAKOWSKY. You know, Dr. Moutier, I was concerned after 

Robin Williams’ suicide that some people were saying in their tributes to him, he is now finally at peace, that he is in a better place. 

I am glad to hear that there were more calls to suicide hotlines but 

were there more suicides? 

Ms. MOUTIER. That won’t be known for some time because of this 

problem with surveillance that you have been hearing about, so 

even when we ask the question, is the program working for preventing suicide, we are operating on the most recent data from the 

CDC, which is 2011. We are 3 years—— 

Ms. SCHAKOWSKY. I just think that—and you were talking about 

language before. I think when someone does take his or her own 

life that people should be encouraged to say if you are feeling suicidal, get help, you know, rather than oh, finally, you know, like 

sometimes we will say someone who has been suffering with cancer 

where they are finally out of their misery and in a better place. 

That is not applicable, I don’t think, here. 

The other thing, Dr. Brent, I know you focus on, or you have 

dealt with adolescents and young adults. I hope all of you actually 

will check out—I have a bill called the Mental Health on Campus 

Improvement Act. A friend of mine, her son at Harvard committed 

suicide, just horribly tragic, and it has a public health component, 

a campus health component but also authorizes a grant program 

to give campuses more resources to address mental health, and I 

know the Association for University and College Counseling Centers directors have been very supportive of this legislation. 

So, Dr. Brent, are we doing enough in our educational institutions and on campuses? 

Mr. BRENT. Well, obviously, I don’t think we can ever say we are 

doing enough, but I think that the Jed Foundation, which is a foundation focused on college suicide that is based in New York, has 

done a tremendous job with setting certain standards for what 

campuses ought to have in terms of availability of mental health 

and actually certifying campuses as having exemplary programs, 

and I believe there have even been some evaluations of these interventions that have shown some beneficial effects. 

Ms. SCHAKOWSKY. The Jet Foundation? 

83 

Mr. BRENT. Jed, J-e-d. It is named for—Phil and Donna Satow, 

it is named for their son, who committed suicide when he was at 

Arizona State University. 

Ms. SCHAKOWSKY. Dr. Lushniak or Dr. Dvoskin, I wondered if 

you want to just comment on that. 

Mr. LUSHNIAK. Let me go back to sort of the first part of your 

question and the issue—and it is a flabbergasting issue and the 

issue of sort of how the media can portray can really affect the public perception of this, and we saw this come on as Robin Williams’ 

suicide. We have goals within our national strategy, and two of 

them are very particular to this. Goal number two is implement research and foreign communication efforts, and goal number four is 

promote responsible media reporting, and this framework for successful messaging, it is an initiative designed to advance this national strategy of changing the public conversation about suicide 

and suicide prevention. The Alliance that I had mentioned, this 

National Action Alliance for Suicide Prevention, the private-public 

partnership, in fact has an institute that is now set up to provide 

journalists with crucial training to effectively communicate to the 

public about suicide and mental health. 

I think there are two aspects to this from a public health perspective, public health communication perspective, one of which is, 

we can’t stigmatize the concepts of severe mental illness, mental 

health issues nor stigmatize a conversation about suicide. Long 

gone are the days that these are whispered in hallways—oh, did 

you hear what happened, this is terrible. We need to bring it front 

and center as a public health issue with scientific evidence that can 

solve that public health issue. 

At the same time, we have to be able to work with the media, 

we have to work with public communications aspects of our society 

that don’t portray suicide as an answer to a problem. 

Ms. SCHAKOWSKY. Right. 

Mr. LUSHNIAK. That somehow it is successful, that somehow it 

is glorified. We really have to be able to still have that public perception that this is something that has innate and multiple factors 

associated with it, but it is preventable. 

Ms. SCHAKOWSKY. Thank you. 

Mr. LUSHNIAK. I will follow up with one last imagery, and that 

is my daughter last night at dinner, and she asked me, ‘‘Dad, what 

are you doing tomorrow?’’ I said I was honored to be brought in 

front of this subcommittee. ‘‘What are you talking about, Dad?’’— 

a 17-year-old senior in high school—and I said I am talking about 

suicide prevention. Her answer was, ‘‘It is not preventable, it just 

happens,’’ and we have to change that. That is the daughter of the 

Acting Surgeon General. We had a long conversation afterwards. 

Ms. SCHAKOWSKY. Doctor, I know Dr. Dvoskin wants to say 

something. 

Mr. DVOSKIN. I just wanted to add, in Vienna, Austria, they had 

a spate of suicides by people jumping in front of subway trains, and 

they were all on the front page above the fold of the two newspapers in Vienna. They were owned by families, and the two publishers got together and had a meeting that was occasioned by a 

social science researcher who said to them, you are making this 

worse because every time you publicize these suicides in this manVerDate Mar 15 2010 11:09 Mar 30, 2015 Jkt 037690 PO 00000 Frm 00087 Fmt 6633 Sfmt 6633 F:\113-177 SUICIDE PREVENT ASK OK 3-27-15\113-177 SUICIDE PREVENT PDF MADE
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ner, the rate goes way up. They made a gentlepersons’ agreement 

to stop doing it. They stopped putting the suicide reports on the 

front page, and the phenomenon stopped immediately. There is a 

study that is published—I will get it to the chairman—— 

Ms. SCHAKOWSKY. I would be interested, because in Chicago 

area, we have had that problem with people jumping in front of 

trains. It has been in the—— 

Mr. DVOSKIN. We had the same thing with mass homicide. They 

put the picture of the perpetrator three times the size of the anchor 

and it makes the perpetrators of mass homicide the most interesting, fascinating people in America, which is exactly what they 

wanted, and it makes it seem like a way to be cool and to matter 

and to no longer be depressed and sad and disconnected and feeling 

insignificant. All you got to do is kill a bunch of people, and the 

electronic media is making it worse. 

Ms. SCHAKOWSKY. Get us the Hamburg study. I would like to see 

it. Thank you. 

Mr. MURPHY. I thank the members. I thank the panelists. 

Just clarifying questions, Dr. Moutier and Dr. Brent. You said 

substance abuse, that increases risk. Any particular substances? 

Ms. MOUTIER. It is across the board but certainly alcohol would 

be the most common, and just to clarify, there are people with addictions who are at risk for suicide, and then there is the use of 

substances in the act of dying by suicide, and they are overlapping 

but sort of separate subsets, and in about half the cases of suicide, 

a substance was at play. 

Mr. MURPHY. Thank you. I just want to clarify too, in the study 

referred to as the Good Behavior Game that was referenced, my 

understanding is that the authors of that study said it did reduce 

suicide ideation but had no impact on suicide acts, but the idea 

that you are all bringing up is evidence-based is important. 

Now, I want to end this with an important note and ask you each 

a simple question. Can we prevent suicide with proper intervention? Dr. Lushniak? 

Mr. LUSHNIAK. Without a doubt, sir. 

Mr. MURPHY. Dr. Brent? 

Mr. BRENT. Yes. 

Mr. MURPHY. Dr. Moutier? 

Ms. MOUTIER. Absolutely, yes. 

Mr. MURPHY. Dr. Dvoskin? 

Mr. DVOSKIN. Yes. 

Mr. MURPHY. Does treatment work for people with mental illness? Dr. Lushniak? 

Mr. LUSHNIAK. Yes. 

Mr. MURPHY. Dr. Brent? 

Mr. BRENT. Some of the time, but it is better than no treatment. 

Mr. MURPHY. Dr. Moutier? 

Ms. MOUTIER. Yes, and it needs to be the right treatment. 

Mr. MURPHY. Thank you. And Dr. Dvoskin? 

Mr. DVOSKIN. Yes. 

Mr. MURPHY. And that is important what you said. The proper 

treatment will work, and that is why we have to get people to access with the right trained professionals. 

85 

Now, one more time, Dr. Moutier, what is that phone number 

people can call? 

Mr. BRENT. 1–800–273–TALK, and that is the National Suicide 

Prevention Lifeline. 

Mr. MURPHY. And there are lifelines in people’s communities as 

well they can look up. 

I want to thank this committee. I know that we will be breaking 

here for the next few weeks and Congress will not be here. This 

committee is exemplary. I continue to get comments around the 

Nation as I visit communities to talk about mental health. This is 

an issue that Congress has not been willing to take up at all, let 

alone in the depth, so this is exemplary, and my colleagues on both 

sides of the aisle share the passion for helping people in mental 

health crisis. I want to thank you all. 

I also want to ask unanimous consent. Dr. Burgess asked if we 

can include articles, one from Health and Science, ‘‘When doctors 

commit suicide, it’s often hushed up,’’ and an article from the New 

York Times, ‘‘Why Do Doctors Commit Suicide?’’ I would also like 

to submit for the record an article from the American Journal of 

Psychiatry, ‘‘Modifying Resilience Mechanisms in At-Risk Individuals: A Controlled Study of Mindfulness Training in Marines Preparing for Deployment,’’ by Drs. Johnson, Potterat, and others. 

Without objection, I will include those in the record. 

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Mr. MURPHY. Let me also say, I ask unanimous consent that the 

members’ opening statements be introduced in the record. Without 

objection, those will be there. 

I would like to thank all the witnesses and members that participated in today’s hearing. I remind members they have 10 business 

days to submit questions to the record, and I ask that all the witnesses agree to respond promptly to the questions. 

Thank you so much for your dedication and passion, and with 

that, I adjourn this hearing. 

[Whereupon, at 1:16 p.m., the subcommittee was adjourned.] 

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