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i 

56–936 2010

[H.A.S.C. No. 111–90] 

PSYCHOLOGICAL STRESS IN 

THE MILITARY: WHAT STEPS ARE 

LEADERS TAKING? 

HEARING 

BEFORE THE

MILITARY PERSONNEL SUBCOMMITTEE 

OF THE

COMMITTEE ON ARMED SERVICES 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

HEARING HELD 

JULY 29, 2009 
(II) 

MILITARY PERSONNEL SUBCOMMITTEE 

SUSAN A. DAVIS, California, Chairwoman 

VIC SNYDER, Arkansas 

LORETTA SANCHEZ, California 

MADELEINE Z. BORDALLO, Guam 

PATRICK J. MURPHY, Pennsylvania 

HANK JOHNSON, Georgia 

CAROL SHEA-PORTER, New Hampshire 

DAVID LOEBSACK, Iowa 

NIKI TSONGAS, Massachusetts 

JOE WILSON, South Carolina 

WALTER B. JONES, North Carolina 

JOHN KLINE, Minnesota 

THOMAS J. ROONEY, Florida 

MARY FALLIN, Oklahoma 

JOHN C. FLEMING, Louisiana 

DAVE KILDEE, Professional Staff Member 

JEANETTE JAMES, Professional Staff Member 

JAMES WEISS, Staff Assistant 
(III) 

C O N T E N T S 

CHRONOLOGICAL LIST OF HEARINGS 

2009 

Page 

HEARING: 

Wednesday, July 29, 2009, Psychological Stress in the Military: What Steps 

Are Leaders Taking? ............................................................................................ 1 

APPENDIX: 

Wednesday, July 29, 2009 ....................................................................................... 49 

WEDNESDAY, JULY 29, 2009 

PSYCHOLOGICAL STRESS IN THE MILITARY: WHAT STEPS ARE 

LEADERS TAKING? 

STATEMENTS PRESENTED BY MEMBERS OF CONGRESS 

Davis, Hon. Susan A., a Representative from California, Chairwoman, Military Personnel Subcommittee ............................................................................. 1 

Wilson, Hon. Joe, a Representative from South Carolina, Ranking Member, 

Military Personnel Subcommittee ...................................................................... 2 

WITNESSES 

Amos, Gen. James F., USMC, Assistant Commandant, U.S. Marine Corps ...... 6 

Chiarelli, Gen. Peter W., USA, Vice Chief of Staff, U.S. Army ........................... 3 

Fraser, Gen. William M., III, USAF, Vice Chief of Staff, U.S. Air Force ........... 7 

Lefebvre, Maj. Gen. Paul E., USMC, Deputy Commanding General, II Marine 

Expeditionary Force, U.S. Marine Corps ........................................................... 37 

Lynch, Lt. Gen. Rick, USA, Commanding General, III Armored Corps and 

Fort Hood, U.S. Army .......................................................................................... 35 

Walsh, Adm. Patrick M., USN, Vice Chief of Naval Operations, U.S. Navy ...... 4 

APPENDIX 

PREPARED STATEMENTS: 

Amos, Gen. James F. ........................................................................................ 79 

Chiarelli, Gen. Peter W. ................................................................................... 56 

Davis, Hon. Susan A. ....................................................................................... 53 

Fraser, Gen. William M., III ............................................................................ 90 

Walsh, Adm. Patrick M. ................................................................................... 67 

Wilson, Hon. Joe ............................................................................................... 55 

DOCUMENTS SUBMITTED FOR THE RECORD: 

Two articles from the Pacific Daily News of Guam, dated March 25, 

2009 and July 4, 2009 .................................................................................. 101 

Washington Post article, ‘‘Crime Rate of Veterans in Colo. Unit Cited,’’ 

July 28, 2009 ................................................................................................. 105 

WITNESS RESPONSES TO QUESTIONS ASKED DURING THE HEARING: 

Mr. Jones ........................................................................................................... 109 

Ms. Shea-Porter ................................................................................................ 109 

Ms. Tsongas ...................................................................................................... 109 
Page

IV 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING: 

Mr. Loebsack ..................................................................................................... 115 

Mr. Wilson ......................................................................................................... 113 
(1) 

PSYCHOLOGICAL STRESS IN THE MILITARY: WHAT 

STEPS ARE LEADERS TAKING? 

HOUSE OF REPRESENTATIVES, COMMITTEE ON ARMED SERVICES, MILITARY PERSONNEL SUBCOMMITTEE, Washington, DC, Wednesday, July 29, 2009. 

The subcommittee met, pursuant to call, at 2:07 p.m., in room 

HVC–210, Capitol Visitor Center, Hon. Susan A. Davis (chairwoman of the subcommittee) presiding. 

OPENING STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE FROM CALIFORNIA, CHAIRWOMAN, MILITARY 

PERSONNEL SUBCOMMITTEE 

Mrs. DAVIS. The meeting will now come to order. Thank you all 

for being here, and welcome to our new digs. We are obviously refurbishing the House Armed Services room in Rayburn, and so we 

are using this room today. We hope that everybody is going to be 

comfortable here. 

The mental health status and needs of servicemembers, their 

families, retirees and their families relate to most, if not all, hearings held by this subcommittee. Whether we are discussing posttraumatic stress disorder (PTSD), family support programs, frequency of deployment, access to health care, missing in action 

(MIAs), prisoners of war (POWs), or the aftermath of a sexual assault, the importance of mental well-being is always involved. We 

also dedicate one hearing a year solely to mental health issues. 

This year’s hearing on mental health was originally intended to 

examine the increased incidence of suicide in the military and to 

review what actions the Office of the Secretary of Defense (OSD) 

and the military services were taking to address this troubling 

trend. However, we know that suicide is not a discrete occurrence 

or problem. It is the final step an individual takes when they can 

no longer deal with the stressors in their lives. And, therefore, in 

order to determine why the suicide rate has increased, the entire 

spectrum of stressors must be considered. 

Further, there is zero-sum-gain aspect to mental health. Neither 

the Department of Defense (DOD) nor the country in general have 

enough mental health providers. Any resources directed towards 

suicide prevention will have to be directed away from your current 

allocation. So it is important to examine what is going to be shortchanged in order to resource any new suicide prevention program 

and to consider if this will have any negative unintended consequences. 

For today’s hearing we will have two panels. In the first we are 

fortunate to have the four vice chiefs of the services here to talk 
2 

about what they are doing to deal with the psychological stress on 

their soldiers, sailors, marines and airmen. We have the Vice Chief 

of Staff of the Army, General Peter Chiarelli; the Vice Chief of 

Staff of Naval Operations, Admiral Patrick Walsh; the Assistant 

Commandant of the Marine Corps, General James Amos; and the 

Vice Chief of Staff of the Air Force, General William Fraser. 

Gentlemen, we look forward to your testimony and hope to leave 

this hearing with a clear understanding of how each of your services is addressing the issue. It is important for the headquarters 

of each military department to acknowledge and to address this 

issue, and it is also just as important for individual commanders 

to understand the problem and take positive actions at their level. 

For our second panel, then, we have chosen to highlight the positive actions taken by commanders of their own accord to address 

the psychological stress experienced by their command. We have 

Lieutenant General Rick Lynch of the Army, Commanding General 

of III Corps and Fort Hood, to participate in our hearing. General 

Lynch has used his command authority to make fundamental 

changes to the way his installation is run with the goal of providing soldiers and, just as importantly, their families stability and 

predictability in their schedules. 

From Marine Corps we have Major General Paul Lefebvre, Deputy Commanding General of II Marine Expeditionary Force. General Lefebvre created the Office of Suicide Prevention Training Program and the Operational Stress Control and Readiness Extender 

Program. 

The problems that we are discussing today cannot be solved 

today. We wish they could, but we know that is not possible. But 

we must continue to understand and confront the psychological 

stress that our servicemembers and families have to deal with 

every single day. We must continually evaluate actions taken, 

gauge their effectiveness, and then press to determine what must 

be done. 

[The prepared statement of Mrs. Davis can be found in the Appendix on page 53.] 

Mrs. DAVIS. Mr. Wilson, I turn it over to you for your comments. 

STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM 

SOUTH CAROLINA, RANKING MEMBER, MILITARY PERSONNEL SUBCOMMITTEE 

Mr. WILSON. Thank the Chairwoman Davis. And thank you for 

holding this hearing today. 

Today’s hearing continues our commitment to work with the Department of Defense to find ways to address the psychological 

stress that our servicemembers are struggling to overcome and to 

continue to improve mental health services for our military personnel and their families. I am encouraged by the direction that 

the Department and the military services are taking to recognize 

and alleviate psychological stress experienced by our troops, particularly our combat veterans. 

From my own service as a veteran in the National Guard and 

Reserves, with four sons currently serving in the military, I understand the responsibility for finding the right answers to this problem does not lie solely with the military medical departments. This 
3 

is also a leadership challenge, and I commend the military service 

for making the mental health of our military and their families a 

leadership priority. 

With that said, as the former president of the Mid-Carolina Mental Health Association, I remain concerned that the programs that 

each of the services are implementing to address psychological 

stress are disjointed and are not well coordinated or communicated. 

I am anxious to hear from our military senior leaders on our two 

panels what steps have been taken to develop a comprehensive 

multidiscipline approach to addressing psychological stress. 

I would like to welcome our witnesses, thank them for their services, and I am particularly grateful to see persons who have served 

at Fort Jackson Marine Air Station/Beaufort, at Parris Island/ 

Beaufort Navy Hospital that I have the privilege of representing. 

And I want to thank you for participating in the hearing today. I 

appreciate your providing young people the extraordinary opportunity of military service which protects American families. I look 

forward to your testimony. 

Mrs. DAVIS. Thank you very much. 

[The prepared statement of Mr. Wilson can be found in the Appendix on page 55.] 

Mrs. DAVIS. And we will begin, General, please. 

STATEMENT OF GEN. PETER W. CHIARELLI, USA, VICE CHIEF 

OF STAFF, U.S. ARMY 

General CHIARELLI. Madam Chairwoman, Ranking Member Wilson, distinguished members of the subcommittee, I thank you for 

the opportunity to appear before you today to provide a status on 

the United States Army’s efforts to reduce the number of suicides 

across our force. This is my first occasion to appear before this esteemed subcommittee, and I pledge to always provide an honest 

and forthright assessment. I submitted a statement for the record, 

and I look forward to answering your questions at the conclusion 

of opening remarks. 

As all of you know, it has been a busy time for our Nation’s military. We are at war. We have been at war for nearly eight years. 

That has undeniably put a strain on our people and our equipment. 

Unfortunately, in a growing segment of the Army’s population, we 

have seen increased stress and anxiety manifest itself through 

high-risk behaviors, including acts of violence, excess use of alcohol, 

drug abuse and reckless driving. The consequence in the most extreme cases has been an increased incidence of suicide. 

Earlier this year I visited six posts in eight days in order to conduct sensing sessions, collect data and evaluate suicide-prevention 

efforts and programs. It became clear to me after leaving the third 

installation that our mission extended far beyond suicide. Simply 

stated, we must find a way and ways to improve the behavioral 

wellness of soldiers and their families after repeated deployments 

in the context of eight years of war. And that is why Secretary of 

the Army Pete Geren and our Chief, General George Casey, consciously made the decision to expand our efforts to improving the 

overall behavioral health and well-being of the force. 

Ultimately we want to get left of this very serious problem, and 

to do so we must improve the resiliency of our soldiers and their 
4 

family members. In the past the Army’s approach was primarily reactive. That has changed today. It is, in fact, proactive, to identify 

or assess and mitigate issues early on before it becomes significant 

concerns; to educate soldiers in order to ensure they are aware and 

have access to resources and support programs that can provide 

them with the most benefit; and to assist and treat individuals who 

are struggling and may need help. We are confident by doing so, 

by improving the overall resiliency, behavioral health and wellbeing of soldiers and their families, we will also ultimately reduce 

the number of suicides across our Army. 

Our approach is based on two big ideas: the Comprehensive Soldier Fitness program, which is really the big idea that moves us 

to the left, and a campaign plan for health promotion, risk reduction and suicide prevention. We are also taking steps to eliminate 

the stigma that has frequently kept soldiers from seeking and receiving help. 

The reality is in all cases there is no simple solution, and we 

must resist any attempt to generalize or oversimplify the challenges we are facing. Improving the overall health and well-being 

of our force will require a multidimensional approach to identify effective programs and mitigation strategies. And it will take a total 

team effort across all Army components, jurisdictions and commands, as well as in cooperation with the Department of Health, 

Congress, National Institute of Mental Health (NIMH) and other 

willing civilian health-care providers, research institutes and care 

facilities. I can assure you, the members of this subcommittee, that 

this challenge remains a top priority for the United States Army. 

Madam Chairwoman, members of the subcommittee, I thank you 

for your continued and generous support and demonstrated commitment to the outstanding men and women of the United States 

Army and their families. I look forward to your questions. 

Mrs. DAVIS. Thank you very much. 

[The prepared statement of General Chiarelli can be found in the 

Appendix on page 56.] 

Mrs. DAVIS. Admiral Walsh. 

STATEMENT OF ADM. PATRICK M. WALSH, USN, VICE CHIEF 

OF NAVAL OPERATIONS, U.S. NAVY 

Admiral WALSH. Madam Chairwoman, Congressman Wilson, distinguished members of the subcommittee, thank you for the opportunity to testify about the organizational and command-level efforts 

to prevent suicides in the Navy. Suicide ranks as the third leading 

cause of death in the Navy. It is a loss that destroys families, devastates communities and unravels the cohesive social fabric and 

morale inside our commands. 

While the symptoms of those who contemplate suicide are unique 

to each person, a common thread to all victims is a sense of psychological emptiness that leaves individuals impaired and unable to 

resolve problems. Therefore, the steps that leaders take to find solutions to this tragedy must address the underlying causes that affect the ability of an individual to recover from change or misfortune and regain their physical and emotional stamina. So the target of our policy and practice is the resilience of individual sailors 

and their families. This means that leaders must look for and con-
5 

nect to those individuals challenged by seemingly intractable troubles with relationships and work, financial and legal matters, deteriorating fiscal health, as well as mental health issues and depression. 

We must eliminate the perceived stigma, shame and dishonor of 

asking for help. This is not simply an issue isolated to the medical 

community to recognize and resolve. Commands have a critical role 

to play in setting a supportive climate for those who need to admit 

their struggle and seek assistance. 

Some of the more noteworthy policy and programmatic actions 

that leaders have taken include the Chief of Naval Operations 

(CNO) directed establishment of a preparedness alliance, which is 

a consortium led by our Chief of Naval Personnel, our Chief of 

Naval Reserves, Bureau of Medicine and our Commander of Installations Command, to address a continuum of care that covers all 

aspects of individual medical, physical, psychological and family 

readiness issues across the Navy. 

Additionally, the CNO instituted an Operational Stress Control 

Program, which is a comprehensive approach designed to address 

the psychological health needs of sailors and their families. It is a 

program led by operational leadership, supported by the naval 

medical community, and provides practical decision-making tools 

for sailors, leaders and families so they can identify stress responses and problematic tension. 

By addressing problems early, individuals can mitigate the effects of personal turmoil and get the necessary help when professional counseling or treatment warrant. Through training, intervention, response and reporting, the Navy executes prevention programs for all sailors that focus on operational commands to take 

ownership of suicide training initiatives and tailor them to their 

unique command cultures. 

Feedback is an important element of policy development. The 

Navy polls extensively and tracks statistics on personal and familyrelated indicators such as stress, financial health, command climate, as well as sailor and family support. We use this data to 

monitor the trends in the force and make recommendations for adjustments in deployment practices, as well as track all suicidal acts 

and gestures. 

In conclusion, on behalf of the men and women of the United 

States Navy, I thank you for your attention and commitment to the 

critical issue of suicide prevention. By teaching sailors better problem-solving skills and coping mechanisms for stress, the Navy will 

make our force more resilient. We will do everything possible to 

support our sailors so that in their eyes their lives are valued and 

are truly worth living. 

Thank you. 

Mrs. DAVIS. Thank you. 

[The prepared statement of Admiral Walsh can be found in the 

Appendix on page 67.] 

Mrs. DAVIS. General Amos. 
6 

STATEMENT OF GEN. JAMES F. AMOS, USMC, ASSISTANT 

COMMANDANT, U.S. MARINE CORPS 

General AMOS. Thank you, Chairwoman Davis, Ranking Member 

Wilson and distinguished members of this subcommittee, for the 

opportunity to report on the Marine Corps suicide and psychological stress prevention efforts. On behalf of the more than 

242,000 active and Reserve marines and their families, I would like 

to extend my appreciation for the sustained support Congress has 

faithfully given to its corps. 

As we begin this hearing, I would like to highlight a few points 

from our written statement. The tragic loss of a single marine to 

suicide is deeply felt by all of us who remain behind. We lost 42 

marines to suicide in 2008, up from 33 in 2007 and up from 25 in 

2006. This is unacceptable, and we are taking action to turn this 

trend around. The Commandant cares deeply about this and is 

committed to work with the leadership of the Marine Corps to fix 

it. 

The data shows that the marine most likely to die by suicide corresponds to the Marine Corps’ institutional demographics. He is a 

Caucasian male. He is 18 to 24 years old, between the ranks of private and sergeant E–1 through E–5. The most prevalent common 

thread is a failed relationship. Male marines are significantly at 

greater risk of suicide than female marines. The most common 

methods of suicide within the Marine Corps are gunshot or hanging, similar to our civilian counterparts. 

Suicide prevention is required training for recruits in boot camp 

and for all our new officers at The Basic School. It is part of the 

curriculum at our staff non-commissioned officer (NCO) academies, 

our commanders courses, and at other professional military education venues. Simply put, suicide prevention training is incorporated into our formal education and training at all levels of professional development and throughout a marine’s entire career. 

Regretfully, there is no single solution that will likely turn this 

trend around. Rather, we believe it will be a combination of efforts 

whose consistent themes are value-based training, behavior modification and leadership. At a planning session this past November, 

some of our Corps’ very brightest and best young non-commissioned 

officers asked us to provide them with the additional training so 

that they could take ownership of suicide prevention for their peers 

and for their marines. 

Our NCOs have the day-to-day contact with these marines, and 

as such have the best opportunity to see changes in behavior and 

other problems that can mark marines in need of help. As a result, 

we have developed a high-impact leadership training program focused on our non-commissioned officers and our corpsmen. It is designed to provide them with additional tools to identify and assist 

marines at risk for suicide. 

Additionally, I directed the Marine Corps Combat Development 

Command to take an independent look at our suicide-prevention 

training throughout the Marine Corps. A special task force began 

their work earlier this month on how we are specifically training 

our marines. It will explore how we can modify training at all levels to improve resilience, decrease stigma and reinforce the themes 

that marines thrive in hardship, that marines persevere through 
7 

the strength of our fellow marines, and that marines don’t quit 

when the going gets tough. In other words, we want to get to the 

left of the suicide. 

To rapidly raise the level of awareness across the Marine Corps, 

100 percent of all marines received additional training in suicide 

prevention during the month of March this year. The training 

package was delivered by Marine leaders and educated all marines 

on warning signs, engagement with their buddies, and how to access the variety of local and national support resources. With support from the Navy, we are increasing the number of our mentalhealth professionals, embedding more of them in our deploying 

units where they can develop close relationships with our marines 

all in an attempt to reduce the stigma of seeking help and to identify potentially affected individuals earlier. 

While there is no single answer that will solve this crisis of rising suicides, we are committed to exploring every possible solution 

and using every resource we have available. I promise this committee that I will not rest until this is turned around. I thank each 

and every one of you for your faithfulness to our Nation and your 

confidence in the leadership and commitment of our Corps. 

Mrs. DAVIS. Thank you, General. 

[The prepared statement of General Amos can be found in the 

Appendix on page 79.] 

Mrs. DAVIS. General Fraser. 

STATEMENT OF GEN. WILLIAM M. FRASER III, USAF, VICE 

CHIEF OF STAFF, U.S. AIR FORCE 

General FRASER. Chairwoman Davis, Representative Wilson, distinguished members of this committee, I want to thank you for the 

opportunity to appear before you today. It is a privilege to join with 

the other vice chiefs of our sister services in addressing this very 

important issue. I want to echo their sentiments and believe we 

must continue to develop and implement programs to maintain the 

psychological health of our servicemembers. 

Your Air Force is heavily engaged in worldwide operations. The 

demands of frequent deployments and increased workloads at home 

station, compounded by other external factors such as economic 

pressures, continue to place a heavy burden on our airmen and 

their families. Under these conditions the Air Force does not take 

a business-as-usual approach to monitoring the physical and the 

psychological well-being of our force. The Air Force Suicide Prevention Program requires the personal attention of every airman. Secretary Donley and General Schwartz, our Chief of Staff, have led 

the charge in making it clear that whether you are on active duty, 

Guard, Reserve or civilian, leaders across our force must deal with 

this problem head on. 

Through a total force approach, we are strengthening our focus 

on the suicide preventions. We are working diligently to heighten 

awareness and reduce the stigma of seeking help. Our goal is to ensure that every airman is as mentally prepared for deployments 

and redeployments as they are physically and professionally. 

We continue to institutionalize our Air Force Suicide Prevention 

Program, focusing heavily on 11 program elements that enhance 

the psychological and health treatment and management programs. 
8 

Recognizing the importance of collaboration in this effort, we are 

bringing together key representatives from across the Air Force in 

working groups to ensure that we anticipate, identify and then 

treat the psychological health issues that are before us. 

We are also working closely with our joint teammates to capitalize on best practices as seen in the other services. While there 

is some comfort in the impact these programs are having, even a 

single suicide is one too many. Individually and collectively, the Air 

Force is committed to taking care of our most valuable asset, that 

is our airmen. 

I want to thank you for your continued support of America’s airmen. I look forward to your questions and further discussion on 

how we can best serve those that serve our Nation. 

Thank you. 

Mrs. DAVIS. Thank you. 

[The prepared statement of General Fraser can be found in the 

Appendix on page 90.] 

Mrs. DAVIS. I want to thank all of you. And I know from your 

statements that you have submitted, as well as your comments 

today, that you take this very seriously, and we certainly appreciate that. I wonder if you could just expand on your statements 

a little bit and share with us what has been the most frustrating 

part of trying to deal with these issues? What would you like us 

to know as you have had to deal with this? 

General Chiarelli. 

General CHIARELLI. Well, the most frustrating thing is trying to 

find the cause. And that is why we have asked the help of the National Institute of Mental Health to do a study. And we feel that 

this could be huge, huge for the Army, Department of Defense and, 

quite frankly, for America, because I think many of the lessons 

that are going to be learned in this study, where we have combined 

the resources of the Department of Defense, Harvard, Columbia, 

University of Michigan and put together a world-class team, that 

it is going to have the Army and the Marine Corps to use, to gather 

the data that I think are really going to unlock some of the mysteries of why this happens with some individuals. And I think it 

will get us out of the speculation of someone who spent 36 years 

with troops trying to figure out and look at statistics and determine 

a cause, it will get me out of that business and into the business 

of finding out what the real cause is, what works and what does 

doesn’t work, so that we can provide for our commanders that 

which I think will help them in helping to prevent suicide. 

Mrs. DAVIS. Have they shared how you might make real-time use 

of that data as they are developing their study? Is that something 

that you have been able to move forward on? 

General CHIARELLI. They realize this is not business as usual, as 

General Fraser said. We are into this, and we are not going to wait 

for the results of a study or anything else. And the National Institute of Mental Health understands that. And we rolled out the 

study team a week ago, and we already have calendared their first 

comeback to us of initial study results in early November of this 

year. They will do that every single quarter. So we will learn as 

they are collecting the data and analyzing the data, and that is exciting. 
9 

I think the other thing that is frustrating to me is I really think 

the thing that will give us a leg up on this that will help us out 

so much is to increase the amount of dwell time that our soldiers 

have at home. There is no doubt in my mind that this reduced 

dwell time, turning it around in rotations every 12 to 15 months, 

is causing a tremendous amount of stress on the force, on soldiers, 

families, and I have to believe that the National Institute of Mental 

Health will identify that early as one of the stressors that is affecting us. 

Mrs. DAVIS. Thank you. 

Admiral Walsh, did you want to comment? 

Admiral WALSH. It is actually hard to organize our thoughts 

when it comes to that question because there is so many different 

ways to approach this at so many different levels. So on a very personal note, I would like to play a constructive, impactful role. And 

in this particular area, because you are dealing with so many unknowns and variables that are very hard to even describe and 

grasp, it is hard to come forward asking for more resources and 

programmatic solutions to something that requires a connection to 

take place between people. 

And so that is why we try and take a balanced approach to this 

that really pulls on the command and operational sorts of roles 

that need to be played in trying to carve out time and space to look 

at people and see what people need. And what I have heard across 

the panel here is absolute consensus on a climate that allows for 

that kind of dialogue and feedback; absolute consensus on we will 

leave no good idea on the table; shared best practices between the 

services in terms of how they will adapt initiatives to their particular culture and domain. 

What is frustrating for us is not to find the correlative data that 

we are looking for. In one sense you would think that more deployments would be indicative of those that would be more inclined to 

go down this path, and that has not been the case for Navy. In fact, 

what this conversation provokes is really an inward look inside our 

own cultures to see where are the checks and balances, where is 

the accountability, where are the authorities, and how do we look 

after people. And what we find is that we have built our culture 

on our deployment model, and that while there may be some exceptions, the problems that we find in the case of suicide is that our 

folks, while they are deployed, generally do okay. We have some 

vulnerable pockets within the general population of sailors. 

But the area that we really need to focus on is when all those 

checks and balances and that sort of cocoon that they live in on deployment is now taken away, and they come back off the deployment. And so the first six months for those who return from deployment are those who are in the area that is most vulnerable, as 

well as those who have never deployed. And so what that does is 

it sort of strikes in the face of what many in the general population 

think, is that we are handcuffed off to deployment, and that we 

have to do this, and therefore, it is more stressful for us. 

The reality of it is the target for this needs to be the assimilation 

of those who have served back into the general population dealing 

with the day to day, whether it is families, their kids, their education, their bills and the relationship stressors associated with it. 
10 

Mrs. DAVIS. Thank you. 

General Amos and General Fraser, if the panel doesn’t mind, if 

Members don’t mind, we are going to go ahead and finish our 

panel. Thank you. 

General AMOS. I share my colleagues’ exact sentiments here. It 

is interesting because the Marine Corps, like all of us, have been 

deployed in some pretty tough conditions for the last seven years 

and have done quite well. And when you visit, and I know probably 

all the committee members have visited them forward-deployed in 

combat, they are a happy lot. Even though they are full of stress, 

and there is an awful lot going on, it is very dangerous, they are 

a happy lot. And when they come home, that is typically when we 

have issues. 

The Marine Corps is unique in that 70 percent of the marines, 

actually about 71 percent of our 204,000 marines we have on active 

duty today are on their first enlistment. So we are the youngest of 

all the services. We have got 42 percent of our marines are lance 

corporal and below; 24 percent of that 204,000 aren’t even of drinking age yet. So this is a very, very young population that we have. 

The frustrating part for us in the Marine Corps, and I know it 

is shared by my brothers here, is trying to find those common 

threads that you can actually put your fingerprints on and try to 

do something about. I mentioned in my opening comments that one 

of the typical threads is a failed relationship. That seems to—that 

seems to be for the marines, the young men, that 18 to 24 that are 

taking their lives, seems to be a common thread, but it is never the 

thing that seems to push it over the edge. 

There are a pile of stressors that in many cases, if taken by 

themselves, and you could carve them out and set them aside, they 

can deal with them quite nicely. And the fact of the matter is most 

marines do deal with them. But it is the compilation of those 

stressors and all of us trying to figure out, okay, how do we identify 

those ahead of time, and how do we do something about it to kind 

of stop this chain of events that finally leads somebody to take 

their lives. That is the frustrating part, Chairwoman. And we are 

working very hard, but we have only found a couple of things that 

seem to be common. 

Mrs. DAVIS. General Fraser. 

General FRASER. Thank you. And I, too, would echo the comments that have already been made. But let me just say that most 

frustrating is the fact that there is no one single answer. But even 

above that, I would say it is more frustrating, for everything that 

we provide, given the resources that we have in the programs that 

are in place, is when an individual does reach out and they seek 

help, and we are seeing that happen. Actually our numbers are 

going up where I think we are seeing that the stigmatism is—we 

are getting past that, that people are reaching out for help. And 

so you begin to provide that help. And then it gets very frustrating 

when all of a sudden they go along a path, and then they are successful in executing suicide. 

To me that is very frustrating because you have provided programs, you have provided mental health care providers or chaplains or whatever else it may be that they were reaching out for, 
11 

but for some reason it wasn’t enough, and to me that is the most 

frustrating. 

And we do have some rather small numbers from 2003 to this 

time period here. About 25 percent of those have actually been receiving care of some sort, but yet something wasn’t good enough, 

and that is disappointing. And so we go back and we take a hard 

look at that, but I would say that is the most frustrating is when 

you provide things, and then still it is just not enough. And you 

never, ever really know what else could I have done or could we 

have done to help them to not lose hope and despair and then commit that fateful act. 

Mrs. DAVIS. Thank you. Thank you all for responding. 

Mr. Wilson. 

Mr. WILSON. Thank you very much. 

And again, thank you for your participation today. 

General Amos, I want to particularly thank you for pointing out 

the morale of our troops who are serving overseas. I have had the 

privilege of visiting 10 times in Iraq, 8 times in Afghanistan. Actually I visited with my former National Guard unit in Afghanistan. 

And I have had two sons serve in Iraq. They are proud of their 

service. And we go over to actually encourage them. Every time I 

go, I come back inspired by the young people serving our country. 

For all of you today, each of you have described a broad spectrum 

of programs that cut across many disciplines within your respective 

service aimed at preventing, recognizing and treating psychological 

stress in military personnel. How do you identify which services 

are most appropriate for a particular servicemember and then coordinate the use of those services between the servicemember, the 

command and the multiple organizations that offer the services? 

In addition, when I look at the continuing incidence of suicide, 

even with the number of mental health programs each service has 

available, I can’t help but wonder if your programs are working. 

What are your thoughts and how effective are your programs for 

reducing psychological stress and suicide, and how are you measuring whether your programs are effective? And this is for each one 

of the panel, and beginning with General Chiarelli. 

General CHIARELLI. Sir, last year the Army Science Board did a 

study for us as they looked into the increasing number of suicides 

in the Army, and they found 14 pages of programs. So a young 

commander going to look at what he needed to do to work this 

issue would be faced with 14 pages of programs. And it is clear to 

all of us that this is not a problem of having too many programs, 

it is not knowing which ones are the ones that actually have an effect. 

We feel that we were very successful in getting the focus on this 

problem with the stand-down we conducted in the March-April 

time period where we used the Beyond the Front video followed up 

by a chain teach. But we know the National Institute of Mental 

Health is going to help us to identify which programs in that 14 

pages work. And we also feel that the Comprehensive Soldier Fitness will move us to the left of this problem as today we have 

young non-commissioned officers who are taking training at the 

University of Pennsylvania in resiliency training that will go back 

to their units and begin to work with soldiers from the time they 
12 

enter the Army until the time they leave the Army. And we hold 

great hope that that is going to move us to the left. 

Admiral WALSH. Sir, I would put it in the category of mental welfare and the programs associated with that. For Navy we really 

focus our energy around a concept of operations here that involve 

line leadership. We feel that we cannot just develop something in 

the medical community and have it stand in isolation, which may 

or may not actually connect to people. 

So the focus of our effort that is now under way today, that is 

too early to assess but instinctively and intuitively tells us we are 

on the right path, is our Operational Stress Control Program. The 

way we are going to track this is really relying heavily on assessments and feedback. And the question that that then promotes is 

what do you do with that feedback once you get it. 

We have learned over the course of this war that we have to 

have the ability to get mental-health professionals on site, and we 

have direct examples of this, where we have looked at detainee operations, for example, in Afghanistan, where we were looking at 

the rotation rates, the dwell time, and just the amount of effort 

that it took for sailors to take on that duty and responsibility. 

When we had the flyaway team get boots on ground and actually 

take a look at it, the feedback that we got, the surveys that we 

used to target that particular population, then influence, then policy changes in terms of who we identify for those types of billets, 

how long they have those billets, the dwell time that they need to 

have after having a job like that, and then whether or not they are 

good candidates for returning to the area of responsibility (AOR). 

So in response to your question, whatever program that we come 

up with has to have an understanding that unless we are able to 

assess it and measure it, then we have no idea whether or not it 

is taking any traction. And that is the spirit in which we are unveiling the Operational Stress Control Program this fall. 

Mr. WILSON. Thank you. 

General AMOS. Sir, I think the programs that we have had in the 

past, if you go back and look at history, the Department of Defense 

hasn’t kept, didn’t start keeping accurate records on suicides until 

post-Vietnam. That was probably sometime in the 1980s. But I remember looking at a chart. In 1996, the Department of Defense 

began to focus on suicides, and across the services you saw a drop. 

So I think the fact that this subcommittee, our Secretary of Defense, our service secretaries and our service chiefs are putting this 

much attention to it is going to have an effect. 

It is too soon to tell. Certainly if you ask me today, how are you 

doing today, I will tell you we are doing abysmal, we are not doing 

well. But the programs that we have had have worked up, I think, 

until probably just the last couple of years. It has—this generation, 

this—where we are in kind of the state of the Marine Corps with 

the consistent persistent deployments and, I think, the young men 

and women we are bringing in, which are the best we have ever 

seen by far, requires a different approach. It requires an approach 

that is more meaningful to them. And we are going back to what 

the basics of the Marine Corps is, which is leadership; not just a 

platitude, not a plaque, but fundamental leadership. Leadership, 

the same leadership we had while we are deployed in Iraq. And we 
13 

watch them, and we know everything that goes on in their brains 

when we are together on the ground, and yet we come home, and 

we don’t have a lot of time at home, and we are not spending that 

detailed leadership and attention to detail and attentiveness to 

those young men and women back home. 

We are changing that. We are instituting the NCO leadership 

panel or training period, which I was telling you about in my opening statement. 

And then this final thing that I think is going to take root, and 

it may have the most significant effect, and that is to go into entrylevel training, to Parris Island, South Carolina, and to Marine 

Corps Recruit Depot in San Diego, and with those senior drill instructors and those other two junior drill instructors, and they look 

at those young men and women, and they are making them marines in 12 weeks, they change their behavior for life. We are working right now to figure out what those precise messages are so that 

when that senior drill instructor who they will never forget tells 

them that marines endure hardship well, we don’t take the easy 

way out. 

That is where we are going, sir. So it is too soon to tell, but we 

are working fervently on this thing right now. 

General FRASER. Sir, one of the things that we are doing and 

continue to do is build upon the program that we instituted back 

in the 1997 time period as far as our Air Force Suicide Prevention 

Program goes. It has 11 different elements within it, and we take 

a holistic look across all of our programs all the time. And this integrated delivery system that we have brings together different elements from different organizations, from the medical community, 

from the chaplaincy I mentioned earlier. We have also got Office 

of Special Investigations (OSI) for investigations. We also have the 

Judge Advocate General (JAG) Corps that is a part of that, and 

also our personnel, and we have recently integrated safety as a 

part of this. And what we do with this type of holistic approach is 

look across all of our programs at the wing, the numbered Air 

Force, the Major Command (MAJCOM) and even at the headquarters level. And so we are able to look across all of our programs and see what can we do better. 

We are also participating in the Suicide Prevention Awareness 

Risk Reduction Committee that is now a part of OSD across all the 

services. And I think that goes to the point that you were trying 

to make is how are we reaching out and getting best lessons from 

others, best practices, so that we can integrate them in. And so not 

only at the wing, Numbered Air Force (NAF), MAJCOM and headquarters level, but even across the services we are trying to take 

this approach to see what can we do better. 

We have learned some things. In March of this year, I instituted 

a Suicide Prevention Working Group. And just in the short time 

that they had been meeting every single week, just recently they 

outbriefed me with 33 different initiatives that we are going to be 

looking into that go across training, policies and other types of programs that we can actually institute. So we are seeing some positive things come about to ensure that we are maximizing everything that is available to us and to our troops. 
14 

Mr. WILSON. We look forward to receiving your updated reports. 

Thank you very much. 

Mrs. DAVIS. Thank you. 

Mr. Jones. 

Mr. JONES. Madam Chairman, thank you very much. And I sit 

here listening very carefully. And thank you, gentlemen. You have 

got one tough damn job, truthfully, because of the war in Iraq and 

Afghanistan. And I am looking at an article in Marine Times, and, 

General Amos, this is not a criticism, this is praise really. At least 

seven marines are believed to have killed themselves so far in July, 

officials said, putting the Corps on a record pace despite broadbased efforts introduced to reduce suicides. 

I think you and those who work with you got an impossible situation, but I want to thank you for accepting it not as impossible. 

I guess you know when you really want to look at this, this Nation continues to wear out and break the military. And no matter 

how tough that marine is or that soldier, airman, seaman, whatever, a tough human being is a human being. And I guess my question, if I have one, I want to know, these seven marines, and it 

could have been seven soldiers, when you get the report that Sergeant X or Private X has committed suicide, where does that report 

go? Does it come all the way up the chain? 

My point of what I am trying to ask is what I would love to 

know, just one tragedy, the history of that one soldier or that one 

marine, and wanting to know that if he or she had been there— 

let us say that it is because of frequent deployments. You said 

sometimes it is not, and I understood, and I agree with that. It 

could be family situation, it could be financial situation. But I really would like to have a briefing from the Army or the Marine Corps 

or the Navy just taking one soldier or one marine and give me a 

classified briefing of what was his life like, what signs did you see 

or not see; and I don’t mean you individually, but that lieutenant 

or that captain or that major. Did they see any signs? Because I 

truthfully—I don’t think you all could be doing any more than you 

are doing, and that is my own personal feelings. But I have sat 

here, and I want to thank the Chairlady and the Ranking Member. 

We have had numerous hearings, and I have sat here, and I think 

you all are doing the very best job you can do. And I commend not 

only you, but the organization, the service that you work with. But 

I don’t know if we can get a handle on, unless we had several classified briefings about it, Chairman, and let you give us a soldier 

or five soldiers or five marines or five seamen or airmen to tell us 

what was that person’s life like, why was it not—why was it 

missed? I am not sure that would help us give you any better direction, to be honest with you, but I think it would better help us understand. 

Does that make any sense to you that we could be briefed individually if not as a committee to try to understand? 

General AMOS. If I could take that. I think it makes complete 

sense. And you need to know, and the committee needs to know, 

that in our organization we have a thing, and it is not a fancy term 

and it is a heartbreaker, but it is called a death debrief. And you 

go to visit General Hejlick down at Camp Lejeune, and General 

Hejlick gets a brief. It doesn’t matter whether it is an airplane acci-
15 

dent, or whether it is a marine who takes his life, or we have an 

accident out there and a kid has a single-vehicle accident and loses 

his life. That thing is dissected at the lowest level, the Lieutenant 

Colonel command level, all those people in his chain of command 

or her chain of command, sergeant major right down to platoon sergeant right down to the squad leader. Everybody comes into General Hejlick’s office, to include all the generals in between, and he 

will sit down for probably about a 21⁄2- to 3-hour debrief to include 

pictures, to include family history, all the things that you had mentioned. All that is peeled back at General Hejlick’s. 

That happens across the Marine Corps for the very reasons—and 

parts of that comes to me within eight days. That is the Assistant 

Commandant. It comes up. I get to see it, I see the pictures, I get 

the preliminary reports. And for the very reasons that you were 

asking, Congressman Jones, is because we just—I don’t ever want 

it to be just another statistic. I want it to be a face, a name. He 

belongs to somebody. Some mother and father loaned him to the 

Marine Corps, or her. 

And so we can do that. We would be happy to do that. 

[The information referred to can be found in the Appendix on 

page 109.] 

General CHIARELLI. Sir, I sat in a video teleconference this morning with commanders from all over the United States where 11 suicide cases were briefed to me. Those cases took place between February and March of this year. Every single suicide is briefed to me 

this year. And we go through them in great detail; 11 cases in 

about 2 hours and 15 minutes. We learn. And that is what this is 

all about. It is learning. And as a commander briefs, another commander in another part of the United States, Iraq, Afghanistan, 

Hawaii or Japan is on that video teleconference being able to apply 

the lessons learned from each individual case to situations that he 

might find himself in with the smaller population that he commands. And we could very easily provide you with that information. 

Mr. JONES. Yes, sir. 

Admiral WALSH. Typically I will see the information either the 

day of or the night after in terms of the summary of what happened, which then will prompt a series of questions, because we 

know where our pockets of vulnerability are typically with our individual augmentees who are serving apart from deployed units on 

their own in support of the ground fight. While our statistical evidence suggests that we have not had a problem in that area, that 

is one of the first areas we start looking for. Then we look for deployment history. That briefing will go up to the Chief of Naval Operations so that everyone is aware. 

I am happy to provide you that information. It is unsatisfying because it will leave you with more questions than answers. The approach that we take today, the questions that we ask, the emphasis 

and the focus that we place on leadership, beginning with the question of why didn’t you know, you should have known, actually are 

not our words. Those words were written in 1995 by Mike Boorda 

months before he committed suicide. 
16 

So we are a service that has lived with these lingering questions 

and no answers for many years, and this is something that we 

can’t put enough focus and emphasis on. 

Mr. JONES. Madam Chairman, I guess my time is about up. I 

want again to say I don’t really want to see the reports. I know you 

are doing your job. And I guess I want to bring that point up just 

to say I think you are doing everything that you can possibly do 

in a situation that is just unbelievable, because these young men 

and women are being stressed beyond belief. And you cannot— 

again, in closing, you cannot be—I don’t care how strong you are, 

there comes a time that the body just says, I cannot do much more. 

And this country needs to face this. This is not your problem. This 

is the problem of this Administration as it was the past Administration, and we need to face the facts that we are in a bad situation. 

Thank you. 

Mrs. DAVIS. Thank you, Mr. Jones. 

And we have been a little loose with the time today because I 

know that it takes a while sometimes to even express how some 

of these programs and concerns are moving along. And so I appreciate taking a little more time. 

I wanted to just ask unanimous consent for Mr. Coffman to be 

able to participate and ask questions. Hearing none, I move on to 

Mr. Murphy. 

Mr. MURPHY. Thanks for that, Madam Chairwoman. 

Gentlemen, thank you for your candor and tact on such a difficult issue with suicides in our military and the psychological 

stress that our heroes are going under during these times. 

General Chiarelli, I appreciated your comments regarding being 

more proactive than reactive of a change in philosophy, and we do 

appreciate that; and also your partnership with the University of 

Pennsylvania, that resiliency training classes that your folks are 

going through. 

General Amos, I appreciate your comments, too. As far as we all 

know, in the Army this is the year of the non-commissioned officer 

and your leadership program with the NCOs and making sure that 

they break through those barriers, and that leadership, I think, is 

very much welcome as well. 

I know today we also talked about as far as the stress on deployments and the stress going home. I know when I was in Iraq 6 

years ago, 1 of our 19 paratroopers committed suicide over in Baghdad, and that weighs on my heart. And I know my colleague that 

I served with over there, Captain John Soltz, he talked about when 

he came home the hardest thing about deploying was coming home 

and that stress there. 

I represent the Eighth District of Pennsylvania, and I can tell 

you that we have had three young heroes in the past seven months 

this year alone, three young heroes who came home from either 

Iraq or Afghanistan that committed suicide, and that has been 

really tough, that has been really tough. In each of these cases we 

heard similar stories from their families. They knew that their 

loved ones were having problems, but they just didn’t know how to 

help or where to turn. 
17 

So my question, I think, are—you know, I know the earlier testimony about there was 14 different programs and making sure that 

we are syncing this up and getting it straight. But how are the 

services working with the families before, during and after their 

loved one’s deployment so they can spot the signs of either posttraumatic stress disorder, traumatic brain injury or depression and 

know how to take action? If you can comment about that, I would 

be very much appreciative. 

General AMOS. Sir, two years ago the Commandant got ahold of 

our family team—what we call our family team-building or family 

readiness focus and said, let us put this on a wartime footing, when 

it became apparent that we are going to be at this for some time. 

Not that money is an indication of focus, but it does give you a 

sense of prioritization for our Commandant. And it is $400 million 

in 2008, $400 million 2009, and just about that, in fact a little bit 

more than that, in 2010. And the whole purpose is to build those, 

of all those awareness programs, all the predeployment efforts, the 

briefings, bringing in the health advisors, bringing in all the folks 

that pull a family together as a unit, to prepare them for their deployment. 

Now, there is a host of things that the young marine goes 

through, all the combat training, as you know. I am talking about 

the family readiness part. I am talking about getting the spouse 

prepared for the deployment, what is it like, what can you expect, 

how is it as you get closer, and what it is like when you are in the 

middle of it; and then what is it going to be like, as you said, sir, 

when you come home, what is that like? I mean, that is a different 

set of dynamics. 

We have looked at all three of those periods of time, and without 

getting into just huge details, we have put a lot of effort in there 

to include communications tools, to include staying plugged into 

them with volunteers and paid workers to help us stay plugged 

into those families. In there are all the different ways. You can 

bring your children and get them help if they are in school and 

they are struggling with it. We worked very hard at that, sir. And 

it is all begins six months before the deployment and comes back 

when they come back home. 

Mr. MURPHY. Thank you, General Amos. 

General Chiarelli, could you comment. 

General CHIARELLI. The most successful program we have seen 

in recent years is the military family life counselors. They have 

been absolutely fantastic, and we are pushing them down to battalion level. Prior to having that asset that you could use, the only 

thing you found down at the battalion level, that formation of anywhere between 500 and 800 individuals, was the chaplain. We have 

always had one chaplain, but, you know, in today’s world, after 

eight years of war, we need two chaplains, I would argue, down at 

those battalion headquarters along with the military family life 

counselors. 

Substance abuse counselors. What I found when I went to visit 

seven installations in eight days was that we still had the same authorizations for substance abuse counselors in 2009 that we had in 

2001. And there is no doubt in my mind that the incidence of substance abuse has increased in the United States Army, and it is 
18 

part and parcel to the deployments we are under. So we are today 

hiring as quickly as we can to provide the additional substance 

abuse counselors we need. 

And you all know the problem with mental health counselors in 

trying to get enough. We are looking for new and innovative ways. 

And we really believe that being able to provide mental health 

counseling on line, and one day, I hope by November or December, 

an individual will be able to do that at his or her home. We made 

available to all families as well as soldiers in the privacy of their 

own home, and we think that this is one way we can get around 

a national shortage we have by being able to bring them together 

in an on-line capability that will service all the Department of Defense. 

Mr. MURPHY. Thank you. 

Gentlemen, I think my time is up. I don’t want to get reprimanded by the Chairwoman, but I would appreciate the next 

round we can further discuss. Thank you. 

Mrs. DAVIS. Thank you. 

Dr. Snyder. 

We actually have some votes coming up. I think we can probably 

work for at least another Member asking questions and maybe a 

second. 

Dr. Snyder. 

Dr. SNYDER. Thank you, Madam Chair. 

General Amos, when you were talking about Marine Corps Recruit Depot (MCRD) in both the east and west coast, it is 42 years 

next month I began, and I don’t remember much in terms of the 

teddy bear counseling quality of my drill instructors. On the other 

hand, I think I remember everything they ever said, so I think 

your point is probably a good one. 

I wanted to direct my questions to you, General Chiarelli, if I 

might, since you have the study going on by the National Institute 

of Mental Health, and more in the spirit of just open questions. We 

are focused here today on suicide rates. That may or may not be 

the thing that we need to be measuring or looking at. I don’t know 

what is under the water out there. I think of all those soldiers that 

you have right now who are in misery and their family is in misery 

and perhaps children who witness a lot of this are in misery, and 

yet because they don’t ever actually take the act of some violence 

towards himself, we may not know about it. And I don’t know what 

that is for every completed suicide. Is it 5 families, is it 20 families, 

is it 200 families? But I think that is—you know, what do we measure, and what do we look at? And I think that your study from the 

National Institute of Mental Health may point to what we look at. 

Do we measure the suicide rates of spouses or the suicide rates of 

children of military members? 

General CHIARELLI. We collect as much of that data as we possibly can, and we track it. It is the most difficult of all the data 

gathered not when it takes place on a military installation, but 

when it takes place off of a military installation. But we do our 

best to collect as much of that data as we can. 

And, sir, I think you are 100 percent right. Suicide is a the extreme indicator. And by the time I hit the third installation, I realized that this wasn’t about suicide prevention, this is about the 
19 

mental wellness of soldiers and families. That is what this is about. 

And what our programs have to be directed at is that mental 

wellness, not at the extreme. And if we get at that, I really think 

we are going to see the incidence go—— 

Dr. SNYDER. I think that is right. When you talk about the factors, failed relationships, I think, was one that you specifically 

mentioned. Again, the causation is what you are looking for; what 

is causing this out there along the chain? I was surprised that a 

diagnosis of depression was not one of the factors. Where does that 

fit into this? 

General CHIARELLI. Depression is an indicator, but when I talked 

to spouses on that tour, what I found from them was their spouse 

was coming back off of a deployment going through that first 30- 

day period where everything is wonderful, but then getting down 

into that training period as he is getting ready to go out or she is 

getting ready to go out in 9 to 11 months. And the whole process 

of reintegration, if you have ever tried to do that, spouses were telling me their husbands were not reintegrating with the family. 

They just realized that that was too hard to do in the short period 

of time they had, and they would back off from the family, which 

creates the relationship problem, which you know spirals out of effect. 

Dr. SNYDER. Is there—you all—I think all of you talked about 

the fact that we haven’t talked about this for some years now, that 

I think we are doing a better job both in our American civil culture, 

but also the military culture, of acknowledging that seeking mental 

health counseling should not be stigmatized. In your Army culture 

what about couples who seek help for marital problems? Is there 

a stigma to acknowledge as a couple that they are having problems, or do you think that that is also recognized as better accepted, that it is okay to go ahead and acknowledge to your folks that 

you are having difficulty? 

General CHIARELLI. I think marriage counseling is better accepted, if there is such a way to put it, than the stigma of seeking mental health help. And one of the focuses of what we are trying to do 

is to do everything possible to get rid of that stigma. That is one 

of the reasons why I am so excited about being able to deliver mental health counseling on line. It has been done in Australia. They 

have had tremendous success. The people are more willing to open 

up on line. And that gets the geographically separated people who 

don’t have the cocoon of a military post to fall under. 

Dr. SNYDER. Are there any duty assignments that a person can’t 

hold for a while, such as flying or air traffic controller, if they are 

placed on an antidepressant or a medicine for depression or a mental health illness? 

General CHIARELLI. There are, and flying is one for sure. 

Dr. SNYDER. So that can be a factor in how we deal with some 

of these signs. 

General CHIARELLI. It can. But I worry about something other 

than that. I worry that we are overprescribing. I worry that we are 

having such a rough time determining the causal effect of this that 

in many instances I fear that our own doctors, at least I will state 

Army doctors, at times are throwing prescriptions at soldiers because they are either overworked or just don’t know what to do, 
20 

and there is enough evidence-based information to indicate that in 

some instances drugs do—— 

Dr. SNYDER. Do you track allegations or confirmed episodes of 

child abuse in military families, in Army families. 

General CHIARELLI. We do and those numbers are available also. 

Dr. SNYDER. Do you know what the trend is in that? 

General CHIARELLI. I believe last year we were down. 

Dr. SNYDER. I think my time is up, Madam Chair. Thank you. 

Thank you all for your service. 

Mrs. DAVIS. Thank you. We are going to go vote and then come 

back. We are certainly hopeful that you all will be able to stay, and 

I certainly hope that the members will all come back, because this 

is a very important hearing and we would like to have everybody’s 

input. 

So can I count on members to come back, hopefully? Thank you. 

[Recess.] 

Mrs. DAVIS. We want to thank everybody for your patience. It always takes longer than we think it will. I want to turn to the next 

member, Mr. Loebsack. 

Mr. LOEBSACK. Well, thank you, Madam Chair. Speaking of 

chairs, I will allow everyone to get in their chairs. 

I really appreciate your being here, all of you. Thank you so 

much for your service and for what you are doing on this particular 

issue. I guess I might just mention a couple of things at the outset 

here before I ask specific questions. 

The whole issue of stigma, I am glad that that was brought up. 

You know, obviously whether it is mental health in the civilian sector or the military sector, I think stigma is probably maybe the 

most important factor in all of this and doing all we can to overcome the stigma of mental health. 

I have some personal connection to this. My mother as I was 

growing up and throughout my whole adult life, as long as I can 

remember, there has been a struggle with mental health and stigma was a huge issue. And we had Rosalyn Carter speak before the 

Education and Labor Committee on Mental Health Parity and a 

number of folks, including her, focused on that particular issue. 

And never having served in the military, but I can only imagine 

that that issue may be even more significant in the culture of the 

military, and you can correct me if I am wrong, if I am wrong 

about that. As I said, I have never served. 

Also the issue of multiple deployments, I think that just seems 

to be coming up over and over again. And clearly that is just an 

important issue with not a lot of dwell time in between. I know we 

are trying to improve on that in all the services. And I really hope 

that we can continue to do so. 

I want to also maybe focus on or drill down a little bit more on 

the families and the children. It was mentioned, I think General 

Amos is the one who mentioned that predeployment there is a lot 

of work done with the families. Obviously postdeployment. This is 

a very important issue. There was a National Public Radio story 

recently about children of the Guard, Reserve Components. We do 

not have a lot of big bases, we have none in fact in Iowa, but we 

have a lot of National Guard folks. I like to mention that every 

hearing I possibly can. And clearly I think it is just absolutely crit-
21 

ical we do everything we can for the families, not just of the active 

service folks, but also those Reserve Components. And I am just 

wondering if you folks, one or all of you, whatever number would 

like to could speak to the Reserve Components, especially those 

Guard folks and their families, those folks who have had these 

multiple deployments. And everyone is trying to balance a lot of 

different things when they are deployed and when they come back, 

but those Guard folks in particular. Whoever wants to start, please 

do. 

General CHIARELLI. Well, sir, that is definitely a focus of ours. It 

is how you can take a disbursed population. When you take a look 

at the United States Army today, we have 710,000 folks on active 

duty, they are active duty soldiers, Title 10 soldiers. With about 

400,000 who were in the Reserve Components. Their total numbers 

are greater, but 200,000 of them, close to 200,000 of them are on 

active duty. When they come off of a 12- or 15-month deployment 

within 3 or 4 days they are back in their community. And that 

community won’t have the support base of a Fort Hood or a Fort 

Bragg. And that is why we are so excited about being able to provide mental health care on-line, because we will be able to move 

into remote areas and provide Reserve Component soldiers who are 

part of the TRICARE, who join TRICARE, and they can do that 

today with TRICARE Reserve Plus. They and their families will 

have access to that on-line mental health care counseling. And I 

think you all know the tremendous impact the Yellow Ribbon Program has made on Reserve Component soldiers in bringing them 

back and giving them the opportunity to go through some reintegration training at different periods after they return home 

from deployment. 

So definitely a focus and concern of the Army, one of the toughest things we have to try to get at. 

Admiral WALSH. If I could speak to the multiple deployments, we 

don’t have correlative data that with more deployments we have 

more suicides, but intuitively, instinctively, I think what we have 

learned in the course of these discussions is that what multiple deployments do, often time under voluntary conditions where the 

member elects to go back, sometimes sooner than required, is it 

puts off the family integration challenge, and it just allows this to 

take more time and to fester in some cases. This is personal opinion. This is sort of an insight that comes with time, trying to dissect what the data is really telling us. 

On the family and the children issue, I think I can offer an example here where our collaboration with the Marine Corps has provided insights that now apply across the Navy in the case of needs 

addressed in Pendleton about trying to target families who have 

gone through multiple deployments and specifically the needs of 

children. 

The Marines, with Navy Medicine, piloted a program and worked 

with local universities to come up with a program called FOCUS, 

which is really a program for families that are under constant 

stress from continuing deployments. Took that idea, Naval Special 

Warfare saw that, liked it and piggybacked on it, and now we use 

that Navy-wide. 
22 

What it does is it is another set of antenna that get us out inside 

our own population to understand what the stressors are and what 

people’s needs are. We know that the stress is more now than it 

has been before. We know that there are a number of factors that 

contribute to it. To look at the service culture and isolation is not 

fair to the problem, nor is it accurate. 

So our reintegration efforts with folks who return from deployment who empirically we know are at risk need to take into account these factors of trying to plug people back with their families 

and help them assimilate into problem solving for their families, 

because that is really an issue. 

And then finally on the Guard component, for us it is the Reserves, you have given me an opportunity to highlight. We couldn’t 

be where we are without the help of Reserves. The Reserves have 

been a tremendous force multiplier for us in terms of the skills 

they offer and the patriotism they bring to the mission. 

The challenge that we have in this particular area is not so much 

those who affiliate, it is those who then choose not to affiliate after 

they have served and then we lose track of them. 

Typically the way things work in the service culture is that if we 

have got our eyes on it, we will fix it, we will work with it, we will 

support and we will find ways to help. But if we are not looking 

so then we don’t see it. So this is an area of concern for us. 

General AMOS. Sir, we get to the children through the parents. 

That is how we touch our children, both on active duty and on our 

bases and stations where we have DOD schools, like Lejeune and 

Pendleton, and overseas where the children live on the base. That 

is actually the easiest of how we get to them. In fact most of those, 

if not all of those DOD schools, they have added counselors, because of deployments. The teachers are seeing the results of the deployments on the behavior of the children in the school. 

So it is not quite as easy outside in the public school systems, 

which is clearly where the majority of 100,000 children reside. But 

to the Reserves—we don’t have Guard in the Marine Corps, we 

have Reserves, and they have been very, very effective. We have 

deployed the socks off them in the last four or five years. Every 

unit has deployed at least twice, and so we are resetting many of 

those units right now. 

Eighty plus percent of our Reserves are in what we would call 

whole cloth units; In other words, an infantry battalion, Marine 

wing support squadron. And when they go what has happened with 

the Reserve side is we have mirrored all the family readiness programs, all the things I talked to Congressman Murphy about. We 

have mirrored all that for those units that are in the Reserve. So 

they had the benefit of all the training, everything. The ones that 

are troublesome are the individual log meds, what we call the IRR, 

the Individual Ready Reserve that kind of goes out onesie, twosie. 

They come out of your state, they come out of my home state. They 

deploy and they come back. That is what Chiarelli was talking 

about, this Yellow Ribbon Program, this reunion effort which is 

fantastic. So the focus effort that came out of University of California Los Angeles (UCLA) that was just talked about, Web-based 

opportunities. We call now every single one of the families. We are 

doing our best to stay plugged into them. Through them the par-
23 

ents we can get to the children, but there are programs available 

for our children and our families that are out there, even if you are 

an individual log med. It is just the level, degree of difficulty of 

that is significantly higher. 

General FRASER. Sir, we look at it from a total force perspective 

and so all the programs that we have for the active duty are certainly available for our Guard and the Reserve. We have a very active Yellow Ribbon Program in every state and territories now, and 

it is funded and we are actively engaged in that. 

We do also have some new positions with respect to the Guard, 

there is psychological director that has been established, a directorate, and is being manned. There is also seven regional teams 

that are able to reach out and work with the folks in and the families. 

The other things that we have also made sure that we do for the 

non-collocated locations where there may not be active duty, or 

other types of care, or programs provided is how to reach out to 

them, and what can we do. If somebody has a need, has a requirement for some mental health care, then we make sure that we get 

that to them or we will bring them to a location where they can 

receive health care. 

The other thing that we have done is utilizing our Preventive 

Health Assessments, PHAs, before they deploy. That then gives us 

a baseline. We then do a post deployment health assessment. Then 

there is another mandatory one after that, 90 to 180 days after the 

deployment for a reassessment. Then that gives three looks at the 

individual so that we can see are there any other indicators so that 

we can be proactive. Where they may not be coming forward but 

we see something through these assessments, that allows us then 

to reach out to the individuals or to the families if we are seeing 

things, too. So that has been very hopeful. 

Mr. LOEBSACK. Madam Chair, I would like to submit a question 

or two for the record to our witnesses because I am going to have 

to go to another meeting. 

Mrs. DAVIS. If you can submit those, that would be fine, Mr. 

Loebsack. 

Mr. Kline. 

Mr. KLINE. Thank you, Madam Chair. Thank you, gentlemen, for 

being here and for your outstanding service. 

Looking at the testimony of all of you and the numbers, I think 

it is interesting to note that while both the Army and the Marine 

Corps have suicide rates in the 19 to 20 per thousand and the 

Navy and the Air Force about 11 per—per 100,000, I am sorry— 

per 100,000, that puts you at or near the national average or just 

barely above half of the national average. And so one could say you 

could potentially say well, we are really okay, we are doing as well 

as the country as a whole or we are doing a little better than the 

country as a whole, but you are not saying that. You are not satisfied at any suicide rate and you are digging in, and we all ought 

to be grateful to you and your leadership and the service for 

digging into that because we share your concern that it is not okay. 

But I think it is also important to recognize that this isn’t an extraordinary suicide rate. This is very much in keeping, sadly, with 

what is going on in the Nation as a whole. 
24 

I would like to address questions to all of you, but I am not going 

to do that. I am always tempted to go directly to General Amos for 

the Marine Corps tie, but I am not going to do that. 

General Chiarelli, I want to chat with you for just a minute and 

pick up on some of the conversation we have had here. We have 

been active in a Yellow Ribbon Reintegration Program in Minnesota for the National Guard, and the Marine Reserves there have 

been actively participating in that. We think it is working very 

well. Part of the program is to bring those soldiers back on a regular schedule, 30 days, 60 days and 90 days, so that they can get 

some marriage counseling, there is a marriage retreat program in 

Minnesota. You can go to up with of the finest hotels in the Twin 

Cities, quite a nice event. There is counseling and a chance to reunite, and so forth. So I think that has been a great program. I am 

glad that it is expanding and the states are picking it up, and it 

seems to be working for the Reserve Component. 

The question is when you look at the active component, I think 

that for a long time we have sort of made the assumption that because you are back with the family, if you will, you are back on 

a big post or station, you have got medical facilities, you have got 

resources there, that we don’t have to worry about that periodic 

checking. And I am just wondering particular for the Army, and 

perhaps the others could take it for the record, are you looking at 

that set period, we are going to look at these soldiers, the active 

soldiers on purpose at 30 days or 45 days or some time and again 

at 60 and again at 90, specifically looking at the how are you doing, 

you know, are there signs of undue stress? 

General CHIARELLI. Well, if I am not mistaken sir, Minnesota led 

with the Yellow Ribbon Program, it is true. 

Mr. KLINE. Thank you, I didn’t plant that question, but thank 

you very much. 

General CHIARELLI. And it was always a frustration to me that 

we brought active component soldiers home and made them go to 

14 consecutive days of reintegration training, we brought mobilized 

soldiers home and got them demobilized in two days and that was 

success. It never made any sense. That is exactly in my opinion the 

right template to use, to bring them back. 

The Army force generation model has provided us a brigade centric force. We don’t deploy divisions anymore, all we deploy is brigades. There are some second and third order effects that our task 

force is finding. One of them is we normally change out commands 

and leaders at the 30- to 60-day mark upon return from a deployment. And when you do that, you break down that leadership 

knowledge where you knew that Private Chiarelli had a rough time 

in that last deployment, and if you don’t have a handover to someone who is taking over the platoon or battalion where you tell 

Chiarelli’s story, he can very easily get lost in now a desire to get 

ready to go on the next deployment as quickly as you possibly can, 

with the new leadership team that is totally focused on not only 

what you have done, but what you are getting ready to do. So this 

is something that we are going to have to work very, very hard to 

make sure we are bringing soldiers back at the 90- and 100-day period, that leaders are passing off good continuity books to ensure 

that they know who had problems and who didn’t. 
25 

I know for a fact that one of the biggest issues I have got is I 

don’t have the number of mental health care providers I need. I 

send a psychologist on rotation, he comes back within 30 days, he 

comes back to the military treatment facility where his practice is 

and we leave a unit without someone who was with the unit doing 

those kinds of things. 

So you are spot on. 

Mr. KLINE. Thank you, General. My time is about to expire. I 

very much appreciate the answer, and I hope that all core services 

are looking at that issue, because there is leadership turnover, 

there is personnel turnover. And we need some continuity, which 

ironically we now have the Reserve Component, Guard and Reserve, that I am afraid we may not have in the active component. 

Again thank you very much. I yield back. 

Mrs. DAVIS. Thank you. Ms. Tsongas. 

Ms. TSONGAS. Thank you all for being here today to talk with us 

about this most difficult issue. I was recently in Iraq and Afghanistan with Congressman Wilson where a young soldier had been lost 

to suicide, and I know how hard the commanders took it. So this 

is not a simple issue by any means. 

I have a question more directed to what happens after somebody 

has chosen to take their life and you learn of it, what is in place? 

Are there protocols in place to deal with family members? And also 

how do you deal with it within the unit of the military, because all 

you have to do is look, for example, when a young high school student is lost to violence or whatever and the way in which schools 

come together to provide counseling and understanding and try to 

move people forward. Is there any attempt to address the unit after 

something like this happens? And also do you track data to see can 

it become viral, can the issue of suicide and the existence of suicide 

become viral so it travels within the unit once it takes place, unfortunately takes place? 

I direct that to all of you. I don’t know who wants to begin. 

General AMOS. Ma’am, if we lose a Marine through a suicide, 

that family member is treated just as if that Marine fell in the battlefield in Iraq or Afghanistan. That great sense of dignity and care 

of the family is precisely what happens. The casualty assistance officer is assigned, the whole unit from that unit all the way up to 

Headquarters Marine Corps turns its spotlight on that family to 

provide all those things that family members have happen to them 

after the loss of a loved one. 

So there is zero stigma, it is not a matter of we are not going 

to take care of you because you did something that—you know, it 

is precisely with the same dignity we would do with the fallen Marine. So I want you to know that all the way from the family members all the way to the burial, and the staying reconnection typically between that unit and that family member. So I want you to 

feel good about that. 

Ms. TSONGAS. Is there an effort to identify that it may be different for a family member in the instance of suicide and something different might be required to be supportive? 

General AMOS. I don’t know. I suspect probably our there are 

cases where that might be. But I would also opt just about every 

time a door is knocked on at 2 o’clock in the morning and the cas-
26 

ualty assistance officer is there or the notification, each family, 

each one of those situations are always different. We have the way 

we do it, but each one of them has probably 20 percent of the entire 

effort is different because family members are different. So I would 

say that if there are differences and things that had to be handled 

as a result of a suicide instead of a Marine that was lost in combat, 

they would do that. They would know how to do that. 

The issue within units by all means. What typically happens, we 

lost a Marine last week. The report I got was the unit stood down. 

We brought all the leadership to the unit, it was an infantry battalion, brought all the leadership of the unit together, to include 

the entire unit in pieces and companies as a battalion, and they sat 

down and talked about it. In other words, the last thing we want 

to do is hide it. We want the Marines to know about it and we 

want them to understand there is an obligation that they have to 

the family if they are close to that family, and that we talked about 

it. We bring the chaplains in, and that is where it begins. And then 

from that point if there are issues, like best friend kind of issues, 

then we are sensitive to that and we will route that young man or 

young woman to the right help that we do. We pay very close attention to that. 

The final thing I would tell you is that I am always nervous 

about when a unit has a suicide it might then make somebody else 

think that this is an option. And I worry about that. I can’t tell you 

that I have seen that, but I will tell you I am always concerned 

about that. 

Ms. TSONGAS. So there is no actual data around that? 

General AMOS. We actually have data, we can certainly tell because we have tracked all the suicides since the early 90s, so we 

can tell precisely what unit and where they are. 

Ms. TSONGAS. I would be curious to see that from all the services 

if that was possible. 

General AMOS. Okay. 

[The information referred to can be found in the Appendix beginning on page 109.] 

General CHIARELLI. I have some pretty strong feelings about 

that. The literature that I have read indicates that there is not a 

tendency for suicides to multiply through a unit or an organization 

because of a single or a second suicide. And I think sometimes out 

of frustration people want to go there. And I think it is exactly the 

wrong place to go. I totally agree with Jim, in the requirement to 

sit down and talk about this from every single incident. 

As far as the stigma, I would like to say we are as good as our 

Marine brethren, but I fear we are not, because stigma still exists 

in the United States Army. I know that for a fact. We are making 

great strides at trying as hard as we can to change that, but stigma not only resides in the United States Army, it resides in the 

civilian world. And I would hope that some day the family and parents of suicide victims would be treated exactly the same. We will 

do everything we can from the Headquarters Department of the 

Army (DA) level to be able to do that, but I fear that it is not the 

same across the board in every single unit in the United States 

Army. 
27 

Mrs. DAVIS. Ms. Tsongas, I am going to move on because we have 

a few people who have not had an opportunity yet. I also want to 

ask unanimous consent for Mr. Kennedy to be able to participate 

and ask questions. Hearing no objection, thank you. 

Next we move to Ms. Bordallo. 

Ms. BORDALLO. Thank you very much, Madam Chairman, and 

thank you to all our witnesses here today. General Amos, a special 

hello to you, and I hope that all things are still a go with the Marines coming to Guam and that the community on Guam will receive the full and uncompromised support of the Commandant and 

the Marine Forces Pacific as we go forward with the realignment 

and the buildup. Thank you. 

I am very concerned about the mental well-being of the men and 

women in the Army and Air National Guard, since we have such 

large numbers of guardsmen and reservists, the highest number 

per capita of any State in the Union. Given their increased assignments over the past six years, we have seen a significant stress on 

their force from equipment availability, to training, as well as psychologically on the servicemembers themselves. 

There was an article in the Pacific Daily News of Guam recently, 

our local newspaper, that reported on the psychological stress on 

our National Guard force. And Madam Chairman, I will ask that 

these articles be entered into the record. 

Mrs. DAVIS. Yes. 

[The information referred to can be found in the Appendix on 

page 101.] 

Ms. BORDALLO. In the article one woman soldier stated, ‘‘There 

is incidences where my daughter would say something to me and 

I would snap. And she’d come back and say, mom, we are not the 

enemy, you are at home now.’’ And this woman soldier goes on to 

say, how do I adjust? How do I adapt to the changes that I am 

bringing home? 

So my question is for General Chiarelli and General Fraser, what 

are the Army and Air Force doing to ensure that our guardsmen 

and women have access to appropriate mental care when they return from deployment? Now I am particularly interested to hear 

your perspective on how you are working to ensure a home station 

mobilization and demobilization for the National Guard. I believe 

that the home station demobilization, known to some of us as the 

Yellow Ribbon Program, and that was referred to earlier here, 

helps in identifying these symptoms early, but additionally after 

demobilization what specific steps are being taken to watch for any 

symptoms that may develop over time? And is there a program in 

place to monitor this type of activity? And is there any follow-up 

with individual soldiers beyond the 30-, the 60-, the 90-day checkup 

periods after demobilization? 

General FRASER. Yes, ma’am. With all of our Reserve Component, and more specifically with the Guard, we do the same thing 

with them as all of our programs for the active duty. And so they 

have access to all of those programs. They have also, as you mentioned there, the Yellow Ribbon Program, we have that and we are 

very much in favor of it. We see a lot of positive things coming out 

of it, and so we have ensured that that program continues to be 

viable. 
28 

And the other thing that we do is our surveys, that we do before 

individuals deploy, give us a baseline. That is the Preventive 

Health Assessment. And so now they complete those. 

And to go to your point about follow-up afterwards, that is the 

reassessment that is done between the 90 to 180-day. And so you 

are able to take a look at predeployment, postdeployment before 

they return home, and then another reassessment to see if there 

has been any change, which allows us then to be proactive in providing them any help that they may need. And that is an indicator. 

The family members are all briefed, too. And so they know the 

programs that are available. So we continue to reach out to all the 

family members to make sure they are aware of the various programs that are available. 

For those that are non-collocated though, we still have work to 

do. And that is the hardest one that we are trying to make sure 

that we accomplish now, because they don’t have everything that 

is available to them. So we keep working it as hard as we can, we 

are not perfect yet, but we will stay at it. 

Ms. BORDALLO. Thank you. 

General Chiarelli. 

General CHIARELLI. Initially counseling happens as a soldier returns from deployment and the demobilization time period. Then I 

have indicated to you that we are very excited about being able to 

provide mental health care on-line. That will be kicked off in a test 

program in three States that I know of in the National Guard armories, where soldiers will be able to go to the armory and go online and get that kind of care. And then Military One Source also 

offers the opportunity for up to 10 appointments to an individual 

feeling that he needs to see a mental health care professional in 

person. 

Ms. BORDALLO. Thank you. 

Mrs. DAVIS. We are going to have another vote. What I would 

like to do, we have three individuals, three members who want to 

ask questions. If we can get through those three in the time before 

voting, and then we are delighted that some of you may be able to 

stay. We would love it if you could all stay for the second panel in 

case there are some additional questions, and we will return after 

the votes. They are the last votes. So we wouldn’t be interrupted 

again. 

So if I could go on to Ms. Shea-Porter and then we will have Mr. 

Coffman and Mr. Kennedy. If you could all try to keep your questions really brief so they can respond in the time, that would be 

helpful. 

Ms. SHEA-PORTER. Thank you. And General Chiarelli, thank you 

for your comments. Your comments were wonderful. I have a question though. I wondered if you know what percentage of your suicide victims had drug or alcohol problems. 

General CHIARELLI. I can’t give you that number off the top of 

my head right now. I know it is lower than one might think, but 

definitely an issue that we are really working hard at right now, 

because we know that drug abuse and alcohol abuse has increased 

since the start of the war. There is no doubt about it. I will get that 

number to you. 
29 

[The information referred to can be found in the Appendix on 

page 109.] 

Ms. SHEA-PORTER. Thank you. Because I know a lot will selfmedicate to ease some of the pain. So first of all, what is the process for discovering that someone has drug and alcohol problems 

and how do you treat them? 

And I am going to say it all at once so you will be able to answer 

it in one question. Can you describe the treatment you do after diagnosis, do you have intervention, and what is the length of your 

treatment, and do you work with the family as well? 

General CHIARELLI. The length of the treatment depends on the 

soldier. There are two major ways. There used to be only one. We 

were very reactive before. We waited until an incident occurred, 

and you were command referred either because you came up hot 

on a urinalysis for some kind of drug abuse or you did something 

like get picked up for driving while intoxicated. It kicked off a pilot 

program at three installations, only at one right now, where we are 

allowing soldiers to command refer themselves, to literally selfrefer themselves, self-refer themselves for drug and alcohol counseling, and their command is not informed. So you can go in, we 

have set up special hours that are after duty hours on Saturdays 

and Sundays where these appointments can be made where a soldier who self-refers can go in, get the care and the counseling he 

needs, and hopefully head off a problem before we end up in the 

reactive mode. 

Ms. SHEA-PORTER. I think self-referral and being able to keep 

their privacy is absolutely critical for soldiers to step forward for 

treatment. But again, if you recognize them—the length of time 

that they are in treatment is critical. A lot of the programs that 

fail in the general population, like three days inpatient and then 

they don’t have the support around them when they are discharged. So if you find somebody and you recognize that they do 

have to be hospitalized and treated for this, what is the range of 

the program, is it available to all? 

General CHIARELLI. My problem is counselors right now. I don’t 

have enough counselors. We are really focused on hiring as many 

as we can. But it is up to the individual counselor to determine the 

severity of the case and make a determination on whether it can 

be handled as an outpatient or whether inpatient care is required. 

If inpatient care is required, we have a number of facilities we use 

throughout the United States where we will send individuals for 

the requisite amount of time to handle the substance abuse problem that they have. 

Ms. SHEA-PORTER. And do they have to wait for the referral because of your backlog? 

General CHIARELLI. That is exactly the problem I have got. When 

you don’t have enough substance abuse counselors and you get a 

series of command referrals, what I found with the recidivism rate 

that I had, where the number of soldiers who had come up hot on 

a urinalysis for drugs, the time it was taking to get them referred 

and get them seen by a counselor was so long because of a higher 

incidence rate and not enough counselors. So that is an issue that 

we have had to attack and we are attacking it as hard as we can. 

I couldn’t kick off the pilot program because it wouldn’t do anybody 
30 

any good to self-refer yourself for an alcohol problem to be told 

well, come back in eight weeks and we will take care of you. 

Ms. SHEA-PORTER. And sadly the same problem exists in the general population. 

Thank you, I yield back. 

Mrs. DAVIS. Thank you. 

Mr. Coffman. 

Mr. COFFMAN. Thank you, Madam Chairman. First of all, I want 

to compliment you on something you are doing and encourage you 

maybe to enhance that or certainly stress that, and there are two 

things that I think are very effective. One is I guess the 

postdeployment briefs prior to leaving the theater of operations. I 

found during the Gulf War, in leaving Iraq in 2006 of the United 

States Marine Corps, that those briefings, those postdeployment 

briefings were extremely helpful in readjusting, in my case, back 

to civilian life. So I want to obviously I was an individual 

augmentee and I think that certainly the Marine Corps was covering everybody, and I want to encourage everybody that that is extremely helpful. 

And the second thing that is being done that I want to certainly 

stress that you continue doing, if not enhance, and that is the decompression period, particularly for the Guard and Reserve, that 

they come back somewhere and that there is a period of time where 

maybe they are processing out, but it is extended a little bit prior 

to sending them back out to civilian life. I think that is another important feature that you all do. 

Last is a question that I have in terms of a preventative tool. I 

was in Army in between a Marine Corps infantry, combat training 

and combat is tough stuff. It requires people that are physically 

and mentally tough. And you can’t sugarcoat that. That is just the 

way it is. And what tools have you developed, or are you looking 

at, or I would hope that you would look at, that when you are looking at that intake, when you are looking at that potential recruit, 

people have varying thresholds to stress. And there are people that 

by the nature of their makeup are going to break a lot earlier than 

other people. Are you being able to look at those recruits, potential 

recruits, and develop tools to say, you know, this person just isn’t 

going to make it, they are going to fall apart, and this person has 

the characteristics to be successful. I think that is absolutely important to try to address this problem preemptively instead of dealing with it after the fact. 

So if you all could address that, I would appreciate that. 

General CHIARELLI. Well, that is why I am so excited about comprehensive soldier fitness, because it has such a robust assessment 

tool on the front end. It will not only be used when a soldier comes 

into the Army but will be used throughout his career to evaluate 

his resiliency and his ability to do exactly what you are talking 

about. So from the Army’s standpoint, that is our big idea and 

what we are looking at to get at the exact problem you are talking 

about, sir. 

Mr. COFFMAN. Are you doing it in terms of looking at potentially 

saying, you know, you meet all the standards, but we think that 

given there are some behavioral characteristics here, based on as-
31 

sessment tools, that maybe you are not meant for the United 

States Army, certainly you are not meant for ground combat? 

General CHIARELLI. That is an excellent question. We can do the 

assessment. I have asked the same question. Once we get this totally in place, there will be some legal issues that we will have to, 

I know, maneuver our way through to show that the assessment 

tool has that degree of accuracy that we could make that kind of 

call. 

Admiral WALSH. From the Naval perspective, we have sailors 

serving on the ground. The assessment tools that we have rely on 

the judgment of leaders, and that is where we see this warrior 

ethos passed from one generation to the next. We see it in the 

training pipeline for Naval Aviation, we see it in the Recruit Training Command, we see it in Special Warfare Command. The way we 

have been able to tailor our training command pipeline so that we 

do put stress on folks to see how they react and respond under 

stressful conditions, however artificially induced, gives us a preview of how they will react over time in the duress of combat, not 

perfected. 

Mr. COFFMAN. Thank you. 

General AMOS. Sir, at recruit training, in the next session we 

will have maybe General Lefebvre up here sitting in this spot and 

he commanded the recruit depot at Parris Island, so he will be able 

to give you precisely. But we specifically and very purposely put an 

enormous amount of stress at boot camp for a 24-hour period of 

time. And what we want to do is find out those young men and 

women that can’t handle it. This isn’t machoism, it is just a function of the unit, you know, what the Marine Corps is. And after 24 

hours they get what they call the moment of truth, that is where 

the drill instructor takes his hat off and says, okay, it is now time, 

those of you that have now figured out that you’re in the wrong 

spot, no harm, no foul. You can leave the depot, and of course we 

do that. So that is how it happens entry, in the early entry. We 

rely on those drill instructors, and as you know, they are pretty 

doggone good. 

A little bit farther down the pipeline for bona fide card-carrying 

Marines, we have immersion training that we put them in, where 

the sights, the smells, the sound, the fear, the noise builds their 

level of stress while they are doing their training up to the point 

where the guys that are combat vets, if they have any issues in 

some cases that comes out during this immersion training. So we 

give that. We have a combat fitness program now that the Commandant started about a year ago which actually gets us in shape 

to do the kinds of things we find in Iraq, and then we finally rely 

on small unit leadership, those NCOs and those staff NCOs and 

those young officers paying very close attention. 

Mr. COFFMAN. Thank you. 

General FRASER. Some of the exact same processes are used as 

far as our troops go too. Early on using some of the tools that are 

available to us to ensure they get into the right career fields. As 

they are stressed in their comprehensive training program, some 

are actually dismissed and possibly then retrained in other areas 

because they still want to continue to serve. Part of going into theater though, it is a comprehensive, realistic training environment 
32 

to stress them as best we can and then relying on those leaders to 

make that assessment if they are ready to go. 

Mr. COFFMAN. Thank you, Madam Chairman. 

Mrs. DAVIS. Thank you. 

Mr. Kennedy. 

Mr. KENNEDY. Thank you, Madam Chair. Thank you for the 

honor of able to participate with this panel. I appreciate my colleagues agreeing to let me speak. 

I first want to thank all those members of the armed services 

who are here for their service to their country. It is an enormous 

sacrifice. You are not in it for the money, that is for sure. You are 

in it for your service to our country, and for that on behalf of my 

constituents I want to thank you for your service, especially at this 

time while we are at war. You never know when you serve, when 

you will be serving, whether it is at peacetime or wartime, or 

where you will be serving and whether you will be in a place where 

you might be called upon to put your life at risk. And all of us want 

to say thank you for your service to our country and to say thank 

you to your families as well for the sacrifice they make on behalf 

of our country. 

It is really in that regard that I wanted to ask all of our panel 

what they think of the opportunity for us to get treatment for and 

really for our soldiers by helping support our family members, because really the family is our first line of defense in helping those 

returning servicemen and women when coming back. And we found 

with the Veterans Committee the benefits all go to the veteran, but 

it might be good if we kind of broaden the definition of beneficiary 

to include the spouse and the kids in terms of reimbursement for 

services, because, you know, they are suffering from secondary 

post-traumatic stress disorder when they see their family member 

overseas and in harm’s way, and of course they are away from 

their family member for so long that is a stressor. But when their 

family member comes home, would you not agree that if it were up 

to us, it would be good to get them ready to know how to identify 

and be ready for and support their loved one so that they can help 

them reacclimate to family life, and don’t you think we need to be 

kind of helping to reimburse for whatever services that may be 

needed for those family members? 

Can we start with you General Chiarelli. 

General CHIARELLI. Well sir, the military family life counselors 

I think has been a huge, huge improvement in the last few years 

to provide that kind of a service and care for families down to that 

battalion level. They are working inside the battalion. But I am 

very proud of the fact that all family programs that we have put 

so much into these last years, they have all been put into the base 

budget in everything from child care to all the services available 

to families are there and available throughout the deployment and 

once soldiers come back home. So I really think the emphasis has 

been placed on this has been emphasis well placed, and it has had 

a huge impact on the United States Army. 

Mr. KENNEDY. If I could follow up, I know my previous colleagues, Representatives Coffman and Carol Shea-Porter, both 

asked about how to screen soldiers before they come in to make 

sure that they are adequately prepared for the stresses of combat 
33 

and military life and then how to best treat a soldier who might 

be suffering from substance abuse disorders and the like. 

I have introduced, along with Walter Jones, the SUPPORT Act, 

Supporting Uniform Personnel By Providing Oversight and Relevant Treatment, SUPPORT in short, and that is to oversee basically all of the substance abuse and treatment programs that are 

out there within DOD to assess what are working and what aren’t 

and bring some coordination and see to it that we are using the 

best practices in our treatment efforts. 

And in regards to making sure our servicemen and women can 

be prepared for any situation, I wish we didn’t have to have a stigma, because when I was first elected to Congress I was asked to 

go down to the John F. Kennedy Special Warfare Center, and there 

our elite Green Berets have available to them psychiatrists 24 

hours a day, 7 days a week. And you might ask why would the elite 

of the elite have psychiatrists available to them. Well, it was believed by the commanders that it made them better at what they 

do to have a clear head and a healthy state of mind when they 

were called into combat duty. 

Now if that was the thinking for our elite forces, why isn’t it the 

thinking with the rest of our forces if they are now being called in 

to all kinds of dangerous situations to have a healthy state of 

mind? Why do we look at this as a weakness? Why don’t we look 

at this as proactive, as my colleague Representative Coffman said, 

and think of this as a strengthening tool rather than as a reactionary tool to only treat people who may be looking as though they 

are falling apart? We look at this as strengthening. They can better 

be resilient, and they can better make decisions under combat in 

stressful situations, and they can be better soldiers in the process. 

So what would all of you like to say about that? 

Admiral WALSH. We have mental health specialists that deploy 

with our services, with our units, with our carrier strike groups. So 

it is viewed as an asset that helps to sustain the force. So the capability is there no matter what happens, under what conditions, to 

help servicemen, regardless of their rank or their rate or gender or 

background, whatever help that they need. And so we see it as the 

embedded concept works at sea and helps sustain the force. 

Mr. KENNEDY. What troubles me is that with the Marines having 

just in 2006 put the suicide prevention program in place, I mean, 

this is many years after the war started and then the funding for 

suicide preventions remain relatively stagnant in spite of the fact 

that suicide has gone up. Am I right or did I not get the testimony 

correct? 

General AMOS. Sir, the funding is not an issue. We have never 

had an issue with funding, both from the perspective of if we ever 

asked for it we can get it. Quite honestly, the Services are more 

than willing to realign programs to get the money to do it. So funding is not an issue. 

Honestly, I think this has been an evolutionary process. Prior to 

stepping across the border in March of 2003, we had a military 

that hadn’t been to combat since the Gulf War, for all intents and 

purposes. So now we spent probably the first two or three years not 

in denial, but this effort of combat stress, the issue of what is this 

doing to our force, because quite honestly I think everybody 
34 

thought well, this war will be over, we will be able to come back 

and reset, and we are going to be okay. 

Now we are coming at this from my perspective probably a little 

bit late within the last three years I would say, certainly in my 

service the last three years, have been huge efforts put towards 

this thing. I will tell you there is not enough mental health folks 

right now. What you have described with the special forces is exactly what we would like to have happen. We have got 24 mental 

health folks in Afghanistan with our 10,600 Marines right now. We 

want more, we want to get them there. In a perfect world you 

would want to have as many of those kinds of folks as you possibly 

could get and higher down with those units for the very reason you 

have talked about. Quite frankly, they are not there. 

Mrs. DAVIS. Thank you, Mr. Kennedy. We are going to have to 

close. 

What I would ask you to do, I think, is you have spoken about 

the need. Is it necessarily money? It is obviously trained people 

who would be available and either in the service or in some cases, 

whether it is TRICARE or family care, help for our children. It is 

through the health programs that their families are engaged with. 

Thinking about what would it look like if we actually were covering 

these issues at a better level, what would that mean? How many 

personnel are we really looking for and what areas particularly 

might they be, the full spectrum in terms of our servicemembers 

and their families. I think trying to maybe see ideally where we 

ought to be, that might help us. If we think in terms of strategically where we need to be, we wouldn’t want to even think out five 

years, maybe even three years for that matter. Because I think 

looking at the mental health work that is being done, the research, 

trying to follow up, go through the data and understand it better, 

we know that that is in the future a little bit before we have all 

of that information. 

You have great information. I think you all are doing what needs 

to be done, and it may be that some of the concerns that we have 

had over the years haven’t necessarily been met because it has 

been hard to figure out what you really need. And now we have an 

opportunity to perhaps see that clear. And we would certainly hope 

that with those budget requests that we were able to at least understand the extent to which we are able to meet the most critical 

needs. And if we can help with that, we would certainly like to 

know what does that picture really look like. 

Mr. KENNEDY. Madam Chair, there was an article in the Washington Post I would like to submit for the record about the crime 

rate on base at the 4th Infantry Division in Fort Carson being 114 

times higher than the surrounding Colorado Springs community, 

and the issue here is how are we going to deal with the servicemen 

and women dealing with their stress and getting caught up in the 

criminal justice system and even the court-martial system. 

Are we going to make special allowances to the fact that much 

of this is due to their post-traumatic stress? How is the military 

going to deal with this? Are we going to end up locking up all of 

our soldiers because of the crisis they are facing emotionally as a 

result of their service? 
35 

[The information referred to can be found in the Appendix on 

page 105.] 

Mrs. DAVIS. Thank you, Mr. Kennedy. Thank you all so much for 

being here. If you can stay a while for the second panel we would 

certainly be grateful for that. We will return after several votes, 

and then there will be no more interruptions. And we really do look 

forward to hearing the second panel. 

Thank you so much. 

[Recess.] 

Mrs. DAVIS. Thank you. We are pleased to start with our second 

panel. And we are delighted to have you here. Lieutenant General 

Rick Lynch and Major General Paul Lefebvre. Thank you. Please. 

STATEMENT OF LT. GEN. RICK LYNCH, USA, COMMANDING 

GENERAL, III ARMORED CORPS AND FORT HOOD, U.S. ARMY 

General LYNCH. Thank you, ma’am. Chairwoman Davis and 

Ranking Member Wilson, thank you for this opportunity to talk 

about what has happened in III Corps and Fort Hood, but candidly, 

more important, thank you for your continued support for our soldiers and their families and your demonstrated commitment. Just 

having the opportunity to watch the engagement with the service 

vices shows me how dedicated you are to truly helping us take care 

of our soldiers and their families. 

I am privileged to command III Corps in Fort Hood. That is 

63,000 soldiers, over 10 percent of the Army, and one-third of the 

Corps is currently deployed fighting and winning our Nation’s 

wars, one-third of the Corps just recently returned from a deployment, and one-third of the Corps is preparing to deploy. That is the 

new normal in an operational force here and one facet of the Army 

Force Generation (ARFORGEN) model. 

I am personally responsible for the lives and well-being of 

125,000 family members and 200,000 retirees in the central Texas 

area, and I take that responsibility very personal. I believe that engaged leaders love their soldiers and their families like they love 

their own children, and indeed that is the approach we take at III 

Corps and Ford Hood. 

I don’t spend a lot of time at Fort Hood talking about suicide prevention, but I spend all my time talking about stress reduction. Because I am convinced that the stress of the force can indeed be reduced by positive affirmative actions. And if you don’t mind I would 

like to highlight four of those things for you now and then take 

whatever questions you would like towards the end. 

The first thing is we have declared III Corps and Fort Hood as 

the family first Corps. If you are assigned to III Corps, you are 

home for dinner every night by 6:00 because that is where the family unit forms and functions. If you are assigned to III Corps, you 

leave Thursdays at 3:00 in the afternoon. That allows you more 

time with your families, that allows you to be home when the kids 

get home from school, that allows you to have some additional family activities. And if you are assigned to III Corps in Fort Hood, you 

don’t work on weekends without my personal approval. 

Because the only thing you cannot do once you deploy is spend 

time with your family. So what we have to do is mandate quality 

family time. It was only three days in the command of the Corps, 
36 

this is now over a year ago, when a family member came and said, 

General, you all are lying to us. I said, ma’am, what? She said, you 

say that you brought our husbands home in this thing called dwell 

time but we never see our husbands. He comes home after the kids 

go to bed, he is working on weekends, you take him off to the national training center, and she looked me in the eye and said, you 

might as well just keep him because we are not seeing him anyway. That is why we are the family first Corps. And that has indeed had great effect in reducing the stress on the families. 

As part of that what we have done is emphasized the maintain 

balance and have fun. What I found when I returned to the Corps 

is we lost the ability as an Army to have fun. So what I have done 

is implemented a lot of things that allow folks to have fun. We 

have reopened the club systems, we have rejuvenated family programs because I want the youngsters and their families to enjoy 

life at Fort Hood. 

The second thing we did is we took an entire city block at Fort 

Hood, Texas and made it the resiliency campus. See, I believe we 

spend too much time addressing issues with soldiers and their families after we broke them and not enough time keeping them from 

breaking, and I think that is the essence of resiliency. So at the 

resiliency campus we took a chapel, which happened to be the 

chapel my wife and I were married in 27 years earlier. We took 

this chapel and turned it into a spiritual fitness center. It is 

manned 24/7 by chaplains and counselors, so if a youngster or a 

family member has a problem late at night and they need someplace to go and somebody to talk to they can go to the spiritual fitness center. They can go there to pause and reflect, they can go 

there to meditate, they can talk to people with shared experiences, 

they can indeed grow spiritually. It is not about religion, it is about 

a spiritual foundation from which to turn to. 

We turned a gym into the wellness center, and it is not about 

how much push-ups you can do but how truly well you are. So we 

do diagnosis of the individual, of the soldier and their family, we 

determine their level of wellness and then we take them into the 

wellness center and improve their wellness. 

The primary issues with suicide in a III Corps perspective, we 

have had four completed suicides since the first of the year. It is 

about strained relationships, and it is about financial issues. So on 

the resiliency campus we put our military family life consultants 

that General Chiarelli was talking about so you have immediate 

access to counselors, and we have a national assistance center 

which allows us to improve the financial readiness of our soldiers, 

which reduces the stress on the family, so so very important. 

So this resiliency campus indeed found a life of its own, and people come there not because they got a problem, but because they 

want to avoid having a problem. It is all about getting in front of 

the problem and not reacting afterwards. 

We are all concerned at the stigma related to mental health 

issues. So the way we approach this at Fort Hood is every Friday— 

correction, every Wednesday at 3:00 I personally greet every new 

arrival to the great place. And normally that is about 300 to 400 

new soldiers and their families. And I explain to them how important they are, their self-worth, how important they are to their 
37 

families, to our organization, and make it a point to tell them how 

important they are. And then I tell the group that I have cried 

more in the last three years than I have cried my entire adult life. 

One hundred fifty-three soldiers died on the place in the battlefield 

that I placed them as I was commander of the task force as part 

of the surge, and I got to live with that the rest of my life. And 

I am personally responsible for 882 gold star families, these families who have paid the ultimate sacrifice, and that has an emotional drain. But I share with the larger audience that I am indeed 

affected and I am getting help, so if they got a problem raise your 

hand, so we can get you the right kind of help to reduce the stigma. 

The stigma is still out there, but it is something we approach on 

a daily basis. 

And the last thing, it is all about engaged leadership. I personally chair a suicide prevention review board once a month where 

every commander and command sergeant major and I review all 

the suicidal trends across the Corps from the previous month. I 

thank God and I thank engaged leadership we have only had four 

completed suicides. But three times a day my phone rings with a 

youngster who has got a suicidal gesture, an ideation or an attempt. And what we do as a group of leaders is we dissect each 

case and try to learn from those cases. We empower our leaders 

with information on how to deal with suicidal ideations. And we 

find ourselves in a situation now when a youngster who has a problem he feels free to tell his battle buddy or his leader that I got 

a problem, that I need some help. That has significantly driven 

down the completed suicides at least at Fort Hood, Texas. 

So again I think it is all about reducing stress, and we continue 

to take action at Fort Hood to reduce stress. And ma’am, with that 

I am happy to answer any questions. 

Mrs. DAVIS. Thank you very much. We will go on and come back 

to questions. Thank you. 

General Lefebvre. 

STATEMENT OF MAJ. GEN. PAUL E. LEFEBVRE, USMC, DEPUTY 

COMMANDING GENERAL, II MARINE EXPEDITIONARY 

FORCE, U.S. MARINE CORPS 

General LEFEBVRE. Thank you, ma’am, Chairwoman Davis, 

Ranking Member Wilson, distinguished members of the committee. 

On behalf of all marines and sailors and the II Marine Expeditionary Force (MEF), I would like to thank you for having us here 

today to let us talk a little bit about what we are doing down in 

the Carolina Marine Air-Ground Task Force (MAGTF). 

Just by way of reference, as the Commandant of the Marine 

Corps said, I was Commanding General at Parris Island for two 

years. So I had recruiting duty east of the Mississippi, and I also 

had recruit training. And for the last year I was the Deputy Commander for the 18th Airborne Corps, largely an Army unit in Iraq, 

and I chaired their Suicide Prevention Board. And I am currently 

serving as the Deputy for II MEF, and I am headed to a Marine 

Special Operations Command shortly. 

I also have personal knowledge of the General’s command and 

leadership philosophy as it was exhibited in Iraq, and I can tell you 

that it doesn’t get any better than what the General does in terms 
38 

of leadership. You can have all the programs you want, but it is 

the commander and what he does to make all those things happen 

that are important. And his impact in Iraq was felt long after he 

left on many, many soldiers across the theater. 

In reference to II MEF as a combat unit supporting both Iraqi 

Freedom and Enduring Freedom, we very deeply feel the death of 

every marine and sailor, whether combat loss, accidental fatality, 

or suicide. I would reinforce General Amos’ statement when he said 

that when a marine or sailor dies by suicide the needless loss of 

life is a tragedy. We take every opportunity to ensure our marines 

and sailors know how important they are to the Nation and to the 

institution. 

II Marine Expeditionary Force is grateful for your support, that 

of OSD and from our service in dealing with this issue. In our analysis of factors affecting suicide we have identified trends that may 

contribute to a tragic suicide; however, the majority of our suicides 

this year appear to be impulsive responses to a short-term issue, 

often a troubled relationship. We are trying to determine how cohesion is affected in certain units that continually regenerate for combat. 

As marines we seek to build a strong sense of commitment within our platoons, companies, battalions, and squadrons to foster the 

feeling of an extended family so our warriors know they will always 

have someone to turn to immediately when confronted with problems. It is imperative that in an era of instant communication 

where personal issues boil quickly that we are there to intervene 

and to mitigate. This task has proven to be challenging given the 

increased and extended operational tempo resulting from the war. 

Whether deployed or at home station, the day-to-day activities to 

either conduct or support requisite training keep our leaders at full 

steam and almost in perpetual motion. The challenge for our leaders is to balance the preparations and execution of war with team 

building, mentorship and the development of a war ethos for their 

subordinates while maintaining their own families and personal relationships. 

It is the sense of team among peers, unit esprit, and the approachability of leaders that provide the safety net when the individual marine lacks the resiliency to handle a flash point personal 

issue or extended period of stress. Our operational tempo has 

stretched the safety net on a number of occasions. 

Our Commandant acknowledged the effect of operational stress 

when he gained congressional approval to increase the size of the 

Marine Corps from 182,000 to 202,000. We had a 5-year period in 

which we had hoped to do that, and we actually accomplished it in 

21⁄2 years, and this year we hope to see the benefit of that buffer 

so to speak that we have established here now with the force. His 

intent was to break this 7 months deployed, 7 months home cycle— 

and as you know it is not really home, it is preparation for the next 

deployment—and to put a 14-month buffer in there which allows 

the concerned leadership that we require at the individual level to 

identify these flash point issues that often lead to a negative consequence. 

We believe a key issue in this suicide rests with smart young 

leadership. I would tell you that—I would emphasize what General 
39 

Amos said in that we have put all our marbles, so to speak, in the 

NCO basket because they are closest to this particular problem. 

And they are young themselves, as General Amos talked about, 

probably the youngest of all the force. So how does a young corporal who succeeds in combat, how do we give him the skills to 

both understand the issue and to be able to deal with it. So that 

is our focus of effort as we speak today. 

My boss, Lieutenant General Denny Hejlik, the Commanding 

General of MEF, recently addressed all lieutenants and captains 

who had been very focused on the operational aspects of this in 

order to enhance the concerned leaderships required by junior officers, in particular to understand what the signs are here within 

operational stress both in the families as well as within their marines. And our Sergeant Major has done the same with all our staff 

NCOs in the force. We will continue to create and maintain an environment where marines and sailors are cared for even though we 

maintain the tempo that I have talked of. 

Our marines and sailors must know that they are integral to the 

success of the Marine Corps and to the expeditionary force, and 

sometimes we forget that. In the heat of the moment as we prepare 

for the next training piece or the next deployment it is important 

to remind them from a resiliency standpoint what we have accomplished and what role they play in it from a self-worth perspective. 

Most importantly, we want our young marines and sailors to 

have the confidence that they can reach out and embrace the support they need from the leadership without any stigma attached. 

Our way forward is to continue integration of service level programs with local initiatives that meet our circumstances. 

The NCO program that I talked about is extremely hard hitting. 

It starts with a 30-minute video. And this video takes you through 

a marine from combat that starts to experience the stress of the 

post-stress environment, to include the financial piece, marital 

issues, and marines can see for themselves what it is to witness 

this as it occurs even when it has not happened in their own lives. 

This video also takes a marine corporal who attempted suicide and 

talks to nine of his supervisors that intervened in the suicide and 

talks to what they saw. And significantly, it includes one of our 

Navy Cross winners who actually attempted suicide also, and it 

talks to how he got to that point from a relationship standpoint, 

and it walks you back to where he started to and then how he got 

there and concludes with three family members that have experienced suicide. 

And then the Socratic method is used by NCOs with NCOs to 

talk about the video in terms of the vignette as to what the lessons 

learned. And we think this will enhance the skills at the NCO 

level. As a matter of fact, this past Friday General Hejlik with all 

the general officers in the MEF, all the leaders and the staff NCOs, 

witnessed the instruction for the purposes of making sure that we 

understood we had the best NCOs in here to be the best teachers 

for this as we really focus down at that particular level. 

Additionally, we are implementing the operational stress control 

and readiness. We talked a little bit about that in the previous session. What that does, it provides mental health professionals provide instruction to our doctors and our chaplains and our leaders 
40 

at the battalion level to give a connecting thought to these NCOs 

that we are training. So we are pushing down the capability down 

to the battalion, down actually down into the company level. That 

training is going on now and will be implemented here within the 

next 90 days. So greater awareness, as well as greater response capability. 

Lastly, I would like to conclude by saying that we are not accepting this. You have acknowledged our great effort. There is still tremendous work to be done. I very much appreciate the efforts of this 

committee to look at this and to help us. Also very much appreciate 

the sharing of ideas with our sister services here on this because 

no one has the answers. 

Again, thank you very much for the opportunity to express my 

thoughts today. Thank you. 

Mrs. DAVIS. Thank you very much. It is good to have you. 

General Lynch, if I could just start by asking a few questions. 

How has your new program, if we call it, been received, and do you 

find that there is work that is not getting done because of the 

schedule? Have the exercises of time management sunk in and are 

people utilizing them? People must be watching what you are doing 

and wondering what is going on. 

General LYNCH. You know, I went so far as to bring in the 

Franklin Covey Institute for Time Management to give classes to 

all my leaders, because what I found is we are indeed wasting time 

during the course of the day which caused them to have to work 

late at night which caused them to be away from their families. So 

I just took away that option. If you got to be home for dinner by 

6:00, you got to manage your time better. And I gave them the skill 

sets so they could manage their time better. 

It is well received across the installation. It is embarrassing to 

me the number of family members who come to me to tell me 

thank you. When I ask what are you thanking me for, they say we 

are thanking you because you gave us our husbands back. They 

should never have to do that. That is something we should do all 

the time. 

So it really is a function of effective time management, take 

away the options to work late at night, work on weekends and we 

are as prepared for war now as we were when we found ourselves 

working seven days a week. 

Mrs. DAVIS. And are you able to evaluate that? Is there something in particular that you are looking for in that evaluation that 

would be helpful for others to know? 

General LYNCH. Yes, ma’am. We continue to work all of our 

training regiment in preparation for combat operations. That is indeed what we are trying to accomplish. Number one is prepare for 

and win our Nation’s wars. So there has been no degradation in 

our capability. And since I have been the corps commander we 

have deployed multiple units, and in the deployment they are doing 

extremely well. So I know we didn’t lose anything there. 

And I do know now the stress on the families has been reduced 

because when the husband is home or the wife is home they are 

truly home. And I am seeing all indicators go down; domestic violence go down, substance abuse go down, suicide ideations, gestures, attempts go down as a result of reducing the stress. 
41 

Mrs. DAVIS. One of my colleagues, and I think it was Dr. Snyder 

who mentioned earlier that we are not just focusing on those who 

actually commit suicide, but people that are in pain, that are hurting in a whole host of ways. And I am wondering if you have a 

sense that—you mentioned that things are looking better. 

What about acting out? What about people getting into trouble 

in town? We know that there are a number of problems that a 

number of our military men and women are experiencing that may 

really be of great concern as we look at the numbers soon. What 

are you seeing? Are people not getting into trouble as much? I like 

the fact that you took everybody on a motorcycle run. I saw that. 

General LYNCH. Yes ma’am. What we found is—— 

Mrs. DAVIS. Are you tracking that, are you tracking those numbers. 

General LYNCH. Yes, ma’am, we are. I get briefed routinely, as 

all commanders do, on statistical trends. And one of the things I 

am working and looking at is crime rate on the installation and off 

the installation, and it has been significantly reduced over the 

course of the last year, to the point of about, I think it was half 

of what it was this time last year. So the kids are indeed, the kids 

being my soldiers, I refer to them as my kids because I love them 

like I love my children, the kids are indeed as a result of having 

reduced some stress and emphasizing to having fun—I mean, you 

talked about my motorcycle run. I happen to be a Harley Davidson 

aficionado. So we take these runs, but it is all about reducing 

stress. And the result of them being less stressed they are less likely to hurt themselves, hurt somebody else and do something bad, 

and we are seeing those trends. 

Mrs. DAVIS. General Lefebvre, you had mentioned working with 

the commanders and really trying to educate them as well. And I 

am just wondering if you have had much pushback? You know do— 

are you seeing that people are saying, well, you know, I am not a 

psychologist, you know, what do I need to know this stuff for. Or 

did you start out with those kind of conversations that have 

changed and trended, and what could you tell us about that? 

General LEFEBVRE. Yes, ma’am. First of all, because suicide is 

pervasive and it is not to a specific unit, military occupational specialty (MOS) or element in the MAGTF, everyone has experienced 

it. So there is no question or problem at any level of leadership inside the Marine Corps as to how big an issue this is. And I think 

the traditional pieces of let’s just be a little more concerned about 

this, those ideas went out the window a long time ago. Now it is 

how, as you asked your question earlier about frustration, how do 

we actually figure out where the causative factors are and what do 

we actually put our arms around. And commanders are asking 

those questions and they are looking for help. 

So you can proliferate programs, and yes, you are right about the 

fact that some of them may not be coordinated, but right now they 

are very interested in every asset they can put their hands on in 

order to get at aspects of the program until we get our arms 

around the larger piece. 

So there is no bad idea, so to speak. So when we come forward 

to them with a new way of looking at this, and especially when we 

emphasize at the NCO level what we are going to do, it is part and 
42 

parcel to our leadership style and it fits our culture perfectly in 

terms of where we are going to go. 

So I think the commanders are absolutely on board with that, 

and I think the forum probably is more to get a give and take with 

the commanders on better practices and ideas than it is to sell a 

particular idea to them. 

Mrs. DAVIS. What part of the culture though makes this difficult? 

General LEFEBVRE. The part of the culture is that we are all 

tough guys. But I think we are by that. And I will use how we approach boot camp. One of the members today was talking about the 

fact that he went to boot camp and he remembers what his drill 

instructor said but he doesn’t remember the soft side of things. 

Well, I wouldn’t exactly say it is the soft side of things. What I 

would say is that we have embraced this idea of values-based training. 

So now you have 80 hours where a drill instructor stacks up a 

couple of locker boxes and he gets in front of his platoon and they 

talk about sexual assault. I mean, it is not a lecture, it is a back 

and forth on what is this, it is a back and forth about stress, it is 

a back and forth about, for instance, the power of prayer and what 

part that plays inside the development of a marine. 

So it is not just about the mental and the physical. The moral 

aspect of it is now a big piece of recruit training. And you cause 

kind of some—you cause kind of a new area. So out in the fleet 

sometimes when we start to talk about these things people are, 

what are you doing in boot camp now, why are you having these 

sessions where you are talking about these issues. And the bottom 

line is that is how you recognize whose resiliency locker, so to 

speak, is low or high and who you have to focus on in the boot 

camp stressful environment in order to put some tools in that particular marine’s bag in order to allow him to be successful as he 

moves out. 

So those have been very, very positive developments, but they 

have not necessarily been part of who we have been in the past, 

but clearly where our Commandant wants us to go. 

Mrs. DAVIS. Thank you. Mr. Wilson. 

Mr. WILSON. Thank you, Madam Chairwoman, and thank both 

of you for your heartfelt explanations and pointing out of something that I believe, and that is the military service of the 

servicemembers, their families, veterans. It is like extended family. 

And I particularly—General Lynch, I appreciate your past service 

at Fort Stewart. I spent 25 summers with the Army National 

Guard at Fort Stewart, so I know the capable people who are there. 

And then also very significant, my oldest son was trained there for 

his deployment to Iraq for a year and returned to Fort Stewart before he resumed his legal career. 

Also, General Lefebvre, thank you so much for your service as 

commanding general at Parris Island. I am very grateful. That is 

part of the district that I represent. It has already been identified 

that all males east of the Mississippi River are trained at Parris 

Island. I am also very grateful all female marines in the world are 

trained at Parris Island. And I have been there to see the training, 

I have been there for the graduations to see the bearing of these 

young people. It just makes you feel so good to know how they have 
43 

faith in themselves and know what they are doing. But it is also 

even better to see the families, to see the moms, dads, the grandparents, the siblings, the other relatives who are present, and there 

is not a dry eye in the house. Everybody is just so proud of their 

military. 

And so thank both of you for providing the opportunities you do. 

General Lefebvre, as we consider this issue could you tell about 

the Marine Corps programs that are specifically focused on reducing stress on the personnel most affected by suicide? How do you 

plan to measure the success of these programs? In your estimation, 

what other resources are needed to address psychological stress in 

the Marines? 

General LEFEBVRE. The measurement piece, sir, as expressed in 

the last panel is one of the causative factors and how do we put 

a capability against it and then wait to see how we are being successful. 

The two programs that probably have the most benefit, one is the 

NCO program I just talked about. The other one is this, is the 

OSCAR program, this Operational Stress Control and Readiness 

program that we are developing with the Navy, where we are adding mental health professionals at the higher levels of command 

and providing mental health professionals at the regimental level, 

which we have already done in combat. And because there is a 

shortage of those we have taken mental health professionals and 

we are now going to train battalion commanders and normal doctors, medical doctors, and chaplains in a couple of areas. 

One is in this issue of resiliency that we talked about here today. 

And I think resiliency, mentioned by every member of the panel, 

is one of the keys, but a tough thing to define and a tough thing 

to measure in the individual servicemember. But for sure when resiliency is low they are prone to suicide. 

So the key is how will they measure what is in the tool bag so 

to speak to include what we are doing at boot camp, how we sustain that through their training and how do we refresh that in the 

fleet. 

But the OSCAR extender program that we call it will give us capability down into the battalions, actually down into the company 

level as a peer kind of a capability with specialized training. The 

goal in the long term is to provide the health professionals at that 

level, but that will take time and we don’t have time. 

So I think, ma’am, in particular your question to the previous 

panel about what the ideal is, that is apropos and one that we can 

really get our arms around because we have been looking at that 

in terms of numbers of professionals. I think when we made this 

decision to go to 202,000 and as we studied family readiness the 

Commandant did a couple of other things also. He put a family 

readiness officer in each one of our battalions. We had a family 

readiness program for an awful long time, but it was volunteer. 

And we asked our families, the senior wives in particular, to handle a lot of those responsibilities at the expense of a lot of other 

personal issues. As a matter of fact, the kinds of issues you deal 

with today are so complex that a volunteer wife would have difficulty being smart on those issues. 
44 

So this family readiness officer who is now with the reserve 

units, as well as with the active duty units, is a one-stop shopping 

as a resource into the number of programs that are there. As a 

matter of fact once referred there or once there they can sort out 

the programs for you, whether that is a family program or an individual program, has proven to be hugely successful to this point for 

units that are getting ready to deploy, and they remain at home 

station with the families while we are gone. 

So, sir, those are the programs. The measurement of those I 

think, given the NCO program, the combat operational stress program, as well as what we are doing in family readiness, I think 

over the course of the next year, as well as we have achieved this, 

about to achieve this 14-month buffer because of our increase in 

our forces, are going to pay dividends for us in our ability to spend 

more time from a leadership perspective around those who are 

most at risk. 

Mr. WILSON. Thank you very much. 

General LEFEBVRE. Thank you, sir. 

Mrs. DAVIS. Thank you. We appreciate that. You are talking 

about the family readiness counselors, and I know having met with 

key volunteers and the ombudsman how critical they are. When I 

first came into Congress and started working with HASC, and even 

though I had obviously been living in San Diego for many, many 

years I wasn’t aware of the role that they played. And I was also 

aware that they were all volunteers and they handled such complex 

issues 24 hours a day. And I really wondered how they do that. 

And without any recognition. 

We tried to change some of that, but I know that we have moved 

from that role for a number of individuals. And I was going to ask 

you whether you felt that in order to deal with the shortage that 

we have in mental health providers if there are individuals that we 

could or should be training, utilizing, that are in the services today 

that perhaps are doing very important jobs but could be doing even 

something more critical to the mission. And if you thought about 

that and where you might want to go to think about bringing more 

of those individuals, whether they are—we think of them in terms 

of practitioners at a physician assistance level or how we might do 

that in the future. 

General Lynch. 

General LYNCH. You had asked the question to the earlier panel 

what is the biggest source of frustration. My biggest source of frustration is indeed the lack of behavioral health professionals. That 

is the biggest frustration. I am short about 44 of what I am convinced I need at Fort Hood that I just don’t have. And that includes 

reaching out to the community to see what the community can do 

to help. But candidly, what I found is the Nation is short these behavioral health specialists, not just the military. So when we try 

to bring somebody on the installation we are taking away from the 

community which expands the problem. 

So what General Chiarelli talked about earlier, we are very excited about, this idea of on-line counseling. Because if the youngsters or their families can go on a computer, which is what they 

do most of the time anyway, and can access a behavioral health 

specialist and have individual counseling, that would be powerful. 
45 

It wouldn’t rob from the community but it would be a nationwide 

asset to allow us to be able to access. And what I understand from 

the Army’s perspective we will be able to do that in the fall. That 

is very important. 

What we have found is the number one issue with suicidal ideations is failed relationships, and these failed relationships are a lot 

of the function of deployments around, it just is. I mean you can’t 

continue to go away, come back, go away, come back without strain 

in a relationship. It can’t happen. You have got to focus on those 

family counselors. 

So when General Chiarelli talked about these military family life 

consultants, that is so very important. These are licensed professional counselors with at least a Master’s Degree of education in 

counseling that are now embedded in our units at the battalion 

level that allow soldiers and family members to say hey, I need 

some help, and they can have that in a confidential forum. 

We also take those military family life counselors and take them 

off the installation in a program we call Operation Store Front. So 

if somebody wants to go get help but doesn’t want to do it on the 

installation, they can do it off the installation. 

Many of the local hospitals have reached out as well with their 

licensed professional counselors to give my soldiers and their families access. 

So, ma’am, we are doing all we can do there trying to make sure 

we get the right professionals helping us address the problem. We 

try to empower our leaders with how do you deal with grief, tragedy and loss. We try to empower our leaders in how do you identify 

suicide or ideations and what do you do about it, but you really 

need to be able to turn to those professionals. 

Mrs. DAVIS. Are you finding that families who have experienced 

a suicide in the family—in most cases they would be leaving the 

base fairly within a year’s time, is that correct, or how does—what 

happens after a period of time? 

General LYNCH. We treat our fallen heroes who fell as a result 

of suicide with the same dignity and respect that we do those soldiers who fell on the field of battle, to include their families. So we 

do everything we can do to ensure the families are helped through 

these difficult times. 

I talked about the 882 gold star families that we deal with in 

central Texas. Many of those are gold star families from suicides. 

So we make sure that those families know about it. They stay on 

the installation as long as they need to up to six months, and they 

can extend that if they need to. We make sure they are given the 

same kind of resources and access to resources that those soldiers 

who fell in combat do. 

Mrs. DAVIS. And you are saying that it is six months but it can 

be extended if that would be in the best interest of the family? 

General LYNCH. Yes, ma’am. It is all about concerned, caring, 

compassionate leadership. And what we try to do is handle each 

case on a case-by-case basis and look at the situation to see what 

is appropriate. 

Mrs. DAVIS. Thank you. I certainly appreciate that. And just in 

terms of waiting times to get help and assistance, are you aware 

of whether it takes a family several weeks to have a child in, for 
46 

example, to see somebody as opposed to the servicemember who 

may be seeking help? What do those wait times look like to you? 

General LEFEBVRE. At Camp Lejeune, ma’am, we have five family counselors with a full docket. But to get in there for an additional appointment for assessment is actually pretty quick. It is 

based on how deep is the problem and what is it going to take. So 

we don’t think four is enough. We think the number is probably 

about 10 to handle just the families and the children. 

The FOCUS program that we talked about a little while ago with 

the help of UCLA is the program that we developed, and it has 

been very, very successful. What we don’t know based on the stigma that you have talked about is how many people would not come 

to this. 

But again I would go back to the 14 months now between deployments. I think commanders will be more aware of what, for a fingertip feel, what their issues are. They are embracing the counseling pieces that are required, and I think you will see more advocacy of that as we turn more attention to those pieces. 

But we suffer from the shortage that we have talked about. But 

we also have worked very closely with the Navy to increase our clinicians. They are kind of a bridge. They are not behavioral psychologists, but they know enough to help our leaders to point them 

in the right direction for help. That is the bridge to about 2011 before we start to see an increase from the Navy. 

The issue that we do see that is significant with post-traumatic 

stress disorder (PTSD) and others is continuity care. Once a young 

marine establishes a relationship, when that psychologist or psychiatrist transfers to the theater, which happens often because they 

are on rotations, it is like we talked about before just a little while 

ago about changing commanders after 90 days. You lose visibility, 

you lose confidence. So continuity care is as important as the numbers of doctors that we have to address this issue. 

Mrs. DAVIS. Thank you. Mr. Wilson, did you have any other 

questions? 

Mr. WILSON. Yes, thank you. General Lynch, you have identified 

some programs that are unique to Fort Hood that are specifically 

aimed at reducing the stress on your troops. Can you please tell us 

more about these programs, such as the Warrior Combat Stress 

Reset Program? 

I would also like to understand why you felt it necessary to initiate at Fort Hood unique programs in light of there are so many 

DOD and Army programs already in place for mental health stress 

issues. 

General LYNCH. Thank you, sir. We indeed approach the problem 

from all aspects. So we established what we call the Combat Warrior Reset Program, which allows my soldiers who indeed have difficult times, either PTSD or mild traumatic brain injury (MTBI), to 

be seen over a three-week process by dedicated professionals. And 

we use every approach to their treatment that we can, to include 

acupuncture and Reiki and massage therapy. And indeed everybody that goes into that program and comes out the other end benefits from the program. Those are the kinds of things we look at. 

But candidly, sir, what I am trying to do is spend more time addressing the problem before it becomes a problem. I don’t need to 
47 

get them into the Combat Warrior Reset Center if I can indeed 

make them more resilient. Now, not every soldier who deploys to 

combat, and your sons can attest to this, not every soldier who deploys to combat comes back with PTSD. Not all of them, they do 

not. Some of them found it to be an enriching experience. They 

were confronted with a difficult situation, they thrived in that situation, and they grew as an individual. 

So what we are trying to do in line with the Chief of Staff of the 

Army’s Comprehensive Soldier Fitness Program, which really is all 

about resiliency, emotional, physical, spiritual, family, and social 

resiliency, is have the programs on Fort Hood that I described on 

our resiliency campus. Because I want the families who are experiencing times, and they all are, they all are—you know, Sara and 

I have been married 27 years. I have been away from her four of 

the last six years. That is hard. It is hard on a marriage, on an 

established marriage. Can you imagine the strain or the difficulties 

with a newly married couple and these deployments? So have programs like Marriage to Street Retreats and a Strong Bonds Program, which allow families who are developing their relationships 

to become more strong and as a result of that more resilient prior 

to deployment. 

Mr. WILSON. I want to thank both of you, because the family support activities, I spent many years working on pre-mobilization 

legal counseling. And I have seen advances through Judge Advocate General (JAG) officers, through the family support organizations, and the Yellow Ribbon Campaign. All of these are just so 

helpful to families. And I appreciate you pointing out, too, that so 

many of our young people who have served, this will be a hallmark 

of their lives in terms of an uplifting experience to look back to and 

to let their families know about it in the future. 

And so again thank both of you for what you are doing. And 

Madam Chairwoman, thank you so much for this hearing today. 

Mrs. DAVIS. Thank you, Mr. Wilson. 

One follow-up. I just wanted to ask about the families where the 

soldier, airman have been wounded, marine, have been wounded 

and whether we are providing additional kind of support to them 

over and above what you would hope to be provided for those at 

Fort Hood. 

General LYNCH. Yes, ma’am. Engaged leaders know their subordinates and their families. And what we do is we identify those 

families that could indeed be high risk. And they could be high risk 

as a result of a wound that was incurred in combat, or they could 

be high risk because of strained relationships or financial problems. And what we do is ensure that we zoom in on those individuals and lead them to the right kind of resources so they can be 

taken care of. 

Candidly, ma’am, what I found is you can have the resources, but 

if they don’t know about them they are not going to access the resource. So engaged leaders lead their subordinates to those resources, those programs that we have. 

Mrs. DAVIS. Thank you. We certainly have many families that 

are supporting their warrior in untold ways, and I think we do 

need to provide that support to them. They are extremely resilient 
48 

in many cases, but we can’t take that for granted because they are 

working so hard to be supportive. 

Thank you so much. We really appreciate you being here. We are 

grateful for what you are doing, and we look forward to continuing 

feedback. And we hope that perhaps some of the examples that we 

have heard about here today will be followed in other places. 

Thank you very much. 

[Whereupon, at 5:57 p.m., the subcommittee was adjourned.] 
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WITNESS RESPONSES TO QUESTIONS ASKED DURING 

THE HEARING 

JULY 29, 2009 

(109) 

RESPONSE TO QUESTION SUBMITTED BY MR. JONES 

General AMOS. Headquarters Marine Corps will coordinate, upon request, to have 

a command representative from the Operating Forces give a detailed ‘‘Death Debrief ’’ to any interested Member or Members of Congress. Such a request should be 

sent to the Marine Corps Office of Legislative Affairs so that appropriate staff action 

and coordination can be made. 

In the debrief, information such as the Marine’s family history, photographs of the 

incident, and circumstances surrounding the incident will be presented. From the 

time of death, such a brief may be available to Members of Congress in as few as 

8 days; however, this timeline is entirely dependent upon the release of information 

resulting from the incident investigations. [See page 15.] 

RESPONSE TO QUESTION SUBMITTED BY MS. SHEA-PORTER 

General CHIARELLI. Of the 696 Army deaths by suicide from January 2003 until 

July 31, 2009, 114 Soldiers had been diagnosed with a substance related disorder 

(16.4%). This percentage has been fairly consistent over the past four years, ranging 

between 13.2% and 20.7%. In the past year, the Army has initiated two major programs to increase our ability to provide substance abuse counseling and treatment 

in the past year. First, the Confidential Alcohol Treatment and Education Pilot 

(CATEP) program allows Soldiers who have an alcohol or drug problem to self-refer 

into, and seek treatment from, the Army Substance Abuse Program without their 

chain of command notified. The Army will conduct the CATEP program at three installations: Schofield Barracks, Hawaii; Fort Lewis, Washington; and Fort Richardson, Alaska. The pilot program runs through February 24, 2010. Second, the Army 

has increased the authorization for Substance Abuse Counselors and increased hiring and incentive programs. The goal of both initiatives is to increase access and 

encourage participation in Army Substance Abuse Program. [See page 29.] 

RESPONSES TO QUESTION SUBMITTED BY MS. TSONGAS 

General CHIARELLI. The Army has been collecting comprehensive suicide data 

since 2001 using a formal process that documents completed suicide events. Army 

Suicide Prevention Program data analysts monitor the Defense Casualty Information Processing System, which is managed by the Army Casualty and Mortuary Affairs Operations Center and captures the cause of death. Data from the Defense 

Casualty Information Processing System and other Army information systems are 

acquired and conjoined for a focused review of Soldier data (such as age, marital 

status, job specialty, deployment, and other service information) to assist in identifying possible trends or common factors that may promote suicidal behavior. The extrapolated data allows Army Suicide Prevention Program data analysts to gather information to include Army commands, installations, and unit assignment of Soldiers 

who die by suicide. This allows further analysis of potential clustering that may be 

evident based on common elements within the command or organizational structures of units to which Soldiers are assigned and daily perform their duties. The 

analysis of data does not infer contagion of suicides in the Army. 

In addition to data analysis, the Army has ‘‘postvention’’ activities outlined in 

Army Regulation 600–63, Army Health Promotion, and Casualty assistance activities outlined in Army Regulation 600–8–1, Army Casualty Program. These activities 

are required when an individual has attempted or committed suicide. After an attempt, commanders, noncommissioned officers, and installation gatekeepers (those 

on our camps, posts and stations that interact with the general population on a 

daily basis—emergency response, chaplaincy, medical, small unit leaders) must take 

steps to secure and protect such individuals before they can harm themselves and/ 

or others. Other ‘‘postvention’’ activities also include unit-level interventions following suicides, to minimize psychological reactions to the event, prevent or minimize potential for suicide contagion, strengthen unit cohesion, and promote continued mission readiness. [See page 26.] 
110 

Admiral WALSH. The record of multiple suicides at the same Navy unit within any 

12 month period from 1999–2009 is: 

1999 4 units with 2 deaths each 

2000 2 units with 2 deaths each, 1 unit with 5 deaths 

2001 2 units with 2 deaths each 

2002 2 units with 2 deaths each 

2003 2 units with 2 deaths each 

2004 1 unit with 2 deaths 

2005 to 2006* 2 units with 2 deaths each 

2007 4 units with 2 deaths each 

2008 none 

2009 2 units with 2 deaths each 

* Deaths occurred less than 9 months apart, crossing calendar years 

With the exception of the five deaths at Service School Command Great Lakes in 

2000, there have been no instances that qualify as suicide clusters. In that instance 

the Sailors were assigned to four different training programs within the Service 

School Command. 

Although suicide clusters (multiple suicides in the same place in a short period 

of time) are rare, there is research in the field that documents an elevated lifetime 

risk of suicide for those individuals exposed to suicide in the workplace or in family 

or close friends. 

Any suicide impacts the members of a unit; consequently, prevention is key. Navy 

has trained Suicide Prevention Coordinators at each command to assist Commanding Officers in implementing a command level prevention program. Each command is required to have a written crisis response plan. Navy has a holistic prevention program that ranges from resilience building to vigilance and early intervention, crisis response, and ‘‘post-vention.’’ 

In the aftermath of a suicide loss, Navy focuses on ‘‘post-vention’’ activities as 

critically important to suicide prevention efforts, and vital to the morale, welfare 

and mission readiness of those exposed to the suicide. An assessment is conducted 

to determine the requirements for supportive interventions for the unit and its individual members. The unit then coordinates with all command and local resources, 

including Chaplains, Fleet and Family Support Counselors, and Special Psychiatric 

Rapid Intervention Teams (SPRINT) for the provision of individual and unit support, grief counseling and mental health support. [See page 26.] 

General AMOS. From January 2007 through October 2009, there were 117 suicides 

spread out across 108 different units. 8 of the 108 battalion/squadron sized units 

experienced more than one suicide within a given year. Seven of the eight had two 

suicides and one of the units had three. Most of the suicides within a battalion were 

spread out across the year by 3–8 months. Only two of the units experienced two 

suicides within the same month. 

A review of the specifics of the suicides that occurred within the same unit within 

the same month, demonstrates: 

• The suicides did not occur in the same locations 

• Battalion I: suicides occurred in Rhode Island and North Carolina; 

• Battalion II: suicides occurred in California and Texas 

• Communication with commands confirmed that their investigations concluded 

that the cases were unrelated. [See page 26.] 

General FRASER. A review of Air Force suicides from 2003 through 2008 shows 

6 incidents in which two suicides occurred on the same base, using the same means 

within a three month period. In all but one of these cases the method of suicide was 

gunshot (by far the most common means of suicide in the AF). There do not appear 

to be other links between these cases to suggest that they were ‘‘copy cat’’ suicides. 

[See page 26.] 
QUESTIONS SUBMITTED BY MEMBERS POST HEARING 

JULY 29, 2009 

(113) 

QUESTIONS SUBMITTED BY MR. WILSON 

Mr. WILSON. In a recently published article in Joint Force Quarterly, author Colonel Drew Doolin discusses military mental health services and psychological 

wellness programs that are available to military commanders today. Colonel Doolin 

asserts that although the services have several good programs aimed at helping 

commanders and troops deal with psychological stress, the services have failed to 

get the word out on each program. How does each of the services publicize these 

programs? What are you doing to make sure service members at all levels and their 

families know about your programs and know how to access these services? 

General CHIARELLI. The Army is making a significant effort at the national and 

local levels to inform Soldiers and Families about our behavioral health programs 

and to reduce the stigma associated with seeking help. We have developed a Strategic Communications Plan to publicize relevant programs and ensure Soldiers and 

their Families are aware of available resources. This plan addresses national and 

local opportunities to disseminate information to Soldiers and Families. At the national level, Army Senior Leaders discuss behavioral health programs in testimony 

before Congress, in national conferences with military and civilian audiences, and 

in media roundtables with national publications. The Army Home Page, the Army 

STAND-TO!, and other print and electronic information venues managed by Headquarters, Department of the Army, regularly highlight behavioral health programs 

and resources available to Soldiers. 

In 2007, the Army Chief of Staff directed that all Soldiers in every component of 

the Army participate in a chain teaching program on post traumatic stress disorder 

and traumatic brain injury. This chain teaching program detailed the steps Soldiers 

should take if they identified concerns about themselves or their buddies. This program has since been incorporated into the Battlemind Training Program that is required for all deploying and redeploying Soldiers and is also available for family 

members. 

At the local level, garrison, hospital, and unit commanders use a host of venues 

to publicize behavioral health programs. All newly arriving Soldiers at Army installations are required to attend newcomer’s briefings as part of their inprocessing. Installation and unit newspapers are a great source of information, as are billboards, 

flyers, and brochures. All hospital and garrison commanders conduct regular Town 

Hall meetings that are open to all Soldiers and Families. These events feature briefings, displays, and discussions concerning community programs and services. Concurrent with each of our publicity efforts for specific behavioral health programs, we 

are sending the overarching message that seeking help for behavioral health concerns is a sign of strength. 

Mr. WILSON. General Chiarelli, your testimony includes your assurance that Army 

senior leaders consider addressing the critical shortfall of uniformed health care providers a priority. However, I understand that the Army plans to increase the operating force by approximately 12,000 soldiers by the end of fiscal year 2010. At the 

same time the Army plans to decrease the generating force, which includes medical 

personnel, by approximately 6,200 by the end of fiscal year 2010. Given your testimony, would any of the 6,200 reduction be medical personnel? Along with your testimony today, the Sergeant Major of the Army testified last week before this committee that the Army needs more medical providers. How will the Army maintain 

the number of mental health personnel to meet the needs of this larger force? 

General CHIARELLI. The Army is committed to meeting the health care and behavioral health needs of all Soldiers and family members. In order to meet the health 

care needs of the growing force, the Army is increasing the number of health care 

professionals in both the operating force and the generating force. This includes increasing military billets and pursuing additional civilian personnel. 

Our of our highest priority requirements is for behavioral health providers. For 

the operating force, Army is investing over 1,000 Behavioral Health Specialists into 

Brigades across all three components. Although the Army is adjusting the generating force, our medical structure will not be decreased. In fact, as a result of the 

recently concluded Total Army Analysis review of the generating force, an additional 
114 

545 military billets have been allocated to the U.S. Army Medical Command 

(MEDCOM) to support the increase in medical workload. Assessment by specialty 

and location on how best to distribute the 545 is currently on-going. This growth 

is in addition to the previous alignment by the Army to MEDCOM of 738 additional 

military spaces in FY08 and 554 military spaces in FY09. These increases in FY08 

and FY09 included 24 psychiatrists, 19 social workers, 12 psychologists, and 100 enlisted mental health specialists. In conjunction with these increases in military billets, the MEDCOM is actively recruiting civilian and contract providers to fill all 

of the anticipated requirements to support the growing Army. Current shortfalls in 

the medical workforce include primary care physicians (family practice, pediatrics, 

and internal medicine), as well as behavioral health professionals (psychiatrists, 

psychologists, and psychiatric health nurses). 

To retain military behavioral health personnel, we are successfully employing a 

variety of special pays and bonuses targeted at psychiatrists, clinical psychologists, 

psychiatric health nurses, and social work officers. Participation among officers eligible to contract for special pays and bonuses ranges from 75% to 95%. To recruit 

military behavioral health personnel, we offer accession bonuses and participation 

in the Active Duty Health Professions Loan Repayment Program, which offers a 

maximum of $40,000 annually for fully qualified applicants. 

The Army Medical Department Center and School and Fayetteville State University developed a partnership in February, 2008, to establish the U.S. Army-Fayetteville State Master of Social Work Program. The graduate social work program was 

created as a force multiplier to offset the decrement of licensed clinical social workers available in the active duty Army inventory. The program graduated 15 social 

workers last year and has a class of 13 students this year. 

The Army has also made significant efforts to contract for or hire civilian behavioral health professionals to augment our military providers. Over the last two 

years, the Army has increased our pool of military, civilian, and contract behavioral 

health providers by 48 percent and we continue to pursue hiring actions. During 

that same timeframe, TRICARE, the Department of Defense healthcare program for 

members of the uniformed services, their families, and survivors, increased its network of behavioral health providers by over 25 percent. 

Additionally, the Army uses virtual technology to expand our current capabilities 

for providing behavioral healthcare. We currently have a number of telehealth programs and are planning to expand our capability to support care for warriors with 

traumatic brain injury and post traumatic stress via telehealth. A Virtual Behavioral Health Pilot Program was recently conducted in Hawaii to determine the effectiveness and technical requirements for virtual BH counseling. Initial results are 

highly encouraging and we plan to expand the program to additional sites. 

On August 1, 2009, TRICARE expanded its services to include two new online 

video BH programs. The two online video programs are TRICARE Assistance Program (TRIAP) and Tele-behavioral Health which have both been developed to help 

eliminate obstacles to seeking BH treatment. Both programs are available to active 

duty service members and their Families. TRIAP and Tele-behavioral Health have 

the combined capability to provide secure online Internet therapy with licensed BH 

counselors located throughout the United States. Through these programs Soldiers 

and Families anywhere in the world can access licensed BH counselors for shortterm, real-time, face-to-face confidential counseling utilizing video technology and 

software such as Skype or iChat. 

Mr. WILSON. General Colleen McGuire, who heads the Army’s Suicide Prevention 

Task Force, was quoted recently saying, ‘‘we have young leaders who have not been 

trained in the art of . . . just taking care of soldiers.’’ General Chiarelli, what is your 

assessment of her statement? How does the Army balance the time it takes to develop young leaders with the time it takes to prepare for combat? I am interested 

to hear from the other service leadership if they are faced with a similar challenge. 

General CHIARELLI. I think the Army does a very good job of developing leaders 

even as we prepare for war. However, we may be neglecting the art of garrison leadership. Our programs that care for Soldiers have not evolved to keep up with the 

constant transitions that are the hallmark of our expeditionary Army, and many of 

our young leaders who have spent the majority of their time in a combat environment may not be familiar with the programs that translate well to a garrison environment. 

We do face some challenges in getting our leaders trained on leadership skills required for taking care of our Soldiers due to the operational demands. The 

foundational education and training on the art of taking care of Soldiers is normally 

provided in formal Army schools, specifically Basic Officer Leader Course (BOLC) 

for lieutenants and warrant officers and the Warrior Leader Course for noncommis-
115 

sioned officers (NCOs). Lieutenants and warrant officers attend the BOLC prior to 

being assigned to their first units. The foundation of this training is aligned with 

the Army’s Strong Bonds, Suicide Prevention, and Battlemind for Leaders programs. 

The reality is that many of the Army’s junior NCOs are serving in leadership positions without having received formal leadership education because of the operational requirements. 

The Army is striving to balance training, education and experiences for our leaders. In the relatively short periods of time spent in Professional Military Education 

provide theory, conceptual information, doctrine, policy, and lessons learned. The actual application and mastery of leadership skills are achieved during operational assignments while preparing for combat or while deployed for combat. 

QUESTIONS SUBMITTED BY MR. LOEBSACK 

Mr. LOEBSACK. What steps are the Services taking to assure that military kids, 

including those whose parents are in the Reserve Components, have access to mental health care? 

General CHIARELLI. The Army is currently working to eliminate the barriers that 

exist for providing timely, convenient, and appropriate behavioral health (BH) services for all military children of active, Army Reserve (USAR) and Army National 

Guard (ARNG) Soldiers. Current initiatives include the Military Child and Adolescent Center of Excellence (MCA CoE), school BH programs, and the opening of Child 

and Family Assistance Centers. Although the Army is leaning forward with these 

initiatives, we recognize that gaps remain, especially for children of those in the Reserve Components (RC). 

The Army Medical Command (MEDCOM) approved the development of the MCA 

CoE, a center that focuses on interventions, programs and policy to combat the impact of being a military child with a parent deploying, wounded, or killed in action. 

MCA CoE will execute a plan that provides support for the development of direct 

BH support for Army children and their families at large deployment installations. 

The MCA CoE concept for the delivery of BH care is to: (1) provide a diversity 

of BH resources/services for Army children and Families, including school BH, integrated under a single umbrella organization; (2) facilitate the coordination of services and improve capacity and access to BH care; (3) reduce stigma associated with 

behavioral healthcare; (4) provide Outreach Community Services/Programs to promote resilience and well-being throughout the Army community; and (5) train pediatricians and family practice providers in early identification and treatment of common BH concerns. The MCA CoE will also develop a database of current standards 

of care for use by other military youth-serving professionals across the country. Emphasis will be placed on following military youth longitudinally over deployment cycles and beyond to comprehensively describe deployment impact, parental injury or 

death on children and adolescents and to discover unique protective and risk factors 

among military Families. 

The Army is also working through the MCA CoE to streamline existing BH support services for children by funding five school BH programs. The programs are 

family-centered and will provide support for children attending schools on military 

posts. The current locations are Landstuhl Army Medical Center, Germany; U.S. 

Army Medical Clinic, Vilseck, Germany; Tripler Army Medical Center, Hawaii; Walter Reed Army Medical Center, Washington, DC; and Blanchfield Army Community 

Hospital, Fort Campbell, Kentucky. Madigan Army Medical Center, Fort Lewis, 

Washington, is on track to begin a program in the coming year. The programs in 

Germany are just beginning, but the other three are already well established. 

Children of RC Soldiers may be eligible for BH services through TRICARE, the 

Department of Defense’s healthcare program for members of the uniformed services, 

their Families, and survivors. Through enrollment in TRICARE Reserve Select 

(TRS) or the Transitional Assistance Management Program (TAMP), children of RC 

Soldiers may receive BH services. 

TRS is a premium-based health plan that qualified ARNG and USAR members 

may purchase. TRS, which requires a monthly premium, offers coverage similar to 

TRICARE Standard and Extra. To qualify for TRS, RC Soldiers must be a member 

of the Selected Reserve of the Ready Reserve (participate in monthly drills). 

TAMP provides 180 days of transitional health care benefits to help uniformed 

services members and their Families transition to civilian life. Generally, TAMP 

coverage is available to ARNG and USAR service members who are separating from 

the ARNG or USAR after a period of active duty that was more than 30 consecutive 

days in support of a contingency operation. 
116 

Additionally, dependents are authorized 12 sessions of BH from the Military 

OneSource, which is provided to all dependents regardless of the Soldier’s service, 

component, or duty status. All dependent behavioral health services are contracted 

with a licensed therapist in the family member’s local community. Dependents are 

entitled to 12 sessions per concern, so if the family member is experiencing depression and later on becomes fearful of an upcoming parental deployment, he or she 

could be seen for 12 sessions per issue. 

The MCA CoE has dedicated a section in their organization to outreach in support 

of military children of ARNG and USAR Units. Short term plans are to provide educational programs to parents and school staff serving these children, on issues such 

as ‘‘The effects of Deployment on Children,’’ ‘‘Children and Reunion,’’ ‘‘Rumors During Deployment,’’ etc. Tripler Army Medical Center already has begun reaching out 

to the Guard/Reserve on the islands neighboring Oahu. The MCA CoE is also developing a video tele-health program to evaluate and treat children in remote areas. 

Efforts are being made to develop this program in the State of Washington and expand into other areas as the program develops. 

Mr. LOEBSACK. What, if any, efforts are being undertaken to address the correlating impact on children when a servicemember is determined to be suffering from 

PTSD or when they are recovering from a significant injury? 

General CHIARELLI. The Army provides inpatient and outpatient behavioral 

health (BH) care as well as medical treatment by healthcare professionals who have 

been trained to address the impact of post traumatic stress disorder (PTSD) and significant injury on military children and Families. These services are provided 

through installation medical treatment facilities (MTF). 

The Army has instituted PTSD training for health care providers so they can accurately diagnose and treat combat stress injuries as well as address the impact on 

children and Families. The Army additionally leverages local healthcare providers 

in the surrounding communities through the TRICARE Network system, which includes professionals who specialize in trauma, family, and child BH issues. 

In addition to the behavioral health programs for military children and adolescents, Walter Reed Army Medical Center Child and Adolescent Psychiatry created 

Operation Brave Families in 2003. The program aims to build resilience, value, and 

empower Families. Operation Brave Families assists military Families with communicating to children about wartime injuries and illnesses, emphasizes optimal parenting and family communication, and facilitates optimal adjustment to changes due 

to physical injuries and/or psychological conditions. 

Operation Brave Families offers a full range of services for any emotional problems children and parents may experience. Services include therapeutic art sessions, 

therapeutic play sessions, education, individual and family supportive therapy, case 

management assistance, and referrals as needed. Treatment is provided by a multidisciplinary team that includes a psychiatrist, psychologist, social worker, art therapist, and a child activity specialist. In addition, the program offers flexible and mobile services allowing staff to provide support at hospitals, lodging facilities, Fisher 

Houses, or Child and Adolescent Psychiatry clinics. A similar program has been 

modeled at Fort Sam Houston and other installations. 

Mr. LOEBSACK. What steps are the Services taking to assure that military kids, 

including those whose parents are in the Reserve Components, have access to mental health care? 

Admiral WALSH. Meeting the mental health care needs of military children is a 

priority for Navy Medicine. In order to meet this need services are provided by Military Treatment Facility (MTF) providers, TRICARE network providers, contract providers working specifically with the Reserve Components, and counselors working 

for Navy, Marine Corps and Joint Family Support programs. 

Navy MTFs work closely with the Managed Care Support Contractors to optimize 

provision of child mental health services for active duty and retired family members 

when the indicated services are not available in the MTF. Additionally, case managers and social workers are available to assist in finding network services to provide mental health care. 

There are several TRICARE/TMA mental health specific programs. Most recently, 

TRICARE Assistance Demonstration Project (TRIAP) and Tele-Mental Health programs have been developed and marketed. Under TRIAP, licensed professionals assess and deliver short-term, non-medical counseling that consists of one-on-one private, non-reportable conversations. This is a free service for beneficiaries (no billing 

for the service). 

Navy Fleet and Family Service Centers and Marine Corps Community Service 

Centers also provide professional counseling for children and families. Additionally, 

Commander Navy Installations Command, the Navy Reserve Forces Family Support 

Coordinator and the five regional Family Support Administrators work closely with 
117 

Ombudsmen at each command to ensure families are aware of these services. Together they facilitate the connection of reserve families to each other, to supportive 

military and community resources and improve community awareness of military 

families’ experiences and needs. The primary focus of these efforts is to support families living apart from military installations. The Family Support Administrators liaison with their assigned Navy Operational Support Center (NOSC) staffs to ensure 

families are supported by Navy and other services’ family support programs, including the Joint Family Support Assistance Programs (JFSAP). All of our Fleet and 

Family Support programs are designed to provide high quality service to both the 

Active and Reserve components of the Total Force. 

The Navy Reserve Psychological Health Outreach Program (PHOP) was established in 2008 to provide early identification and clinical assessment of Navy Reservists returning from deployment who are at risk for not having their stress injuries identified and treated in an expeditious manner. This program also provides 

outreach and educational activities to improve the overall psychological health of 

Navy Reservists and to identify long-term strategies to improve psychological health 

support services for the Reserve community. The PHOP facilitates access to psychological health support resources for Reservists and family members. 

Mr. LOEBSACK. What, if any, efforts are being undertaken to address the correlating impact on children when a servicemember is determined to be suffering from 

PTSD or when they are recovering from a significant injury? 

Admiral WALSH. Mental Health Providers in Navy Military Treatment Facilities 

(MTFs) address the specific needs of our wounded warriors, including those suffering from PTSD. In the Navy tertiary care centers consult teams meet regularly 

with these families. These teams consist of a health educator who assists in training 

the families of wounded service members, and a child/adolescent social worker who 

is trained to deal specifically with children. 

We also have counseling services for children by licensed professional counselors 

in our Navy Fleet and Family Service Centers (FFSC) and Marine Corps Community Service Centers. Navy Command Ombudsmen are also trained to refer families 

with concerns about the impact a parent with PTSD or other injury has on children 

to these counselors for services. 

Additionally, FFSC staff work closely with the Navy Reserve Forces Family Support Coordinator to facilitate the connection of reserve families to supportive military and community resources including the Joint Family Support Assistance Programs (JFSAP). All of our Fleet and Family Support programs are designed to provide high quality service to both the Active and Reserve components of the Total 

Force. 

Although FFSC deployment staff have always worked with families through the 

cycles of deployment, a growing awareness of the significant challenges of these deployments on military family life and child and family well-being prompted a recent 

initiative by the Department of Navy Bureau of Medicine and Surgery called 

FOCUS (Families OverComing Under Stress). FOCUS provides state-of-the-art family resiliency services to military children and families at selected installations. 

Topics including PTSD and other injuries impact on families are addressed during 

Returning Warrior Workshops to assist returning Sailors with reintegrating with 

their families and communities, and to better understand the resources available to 

them. Additionally, the Psychological Health Outreach Program (PHOP) workers ensure coordination of access to psychological health support resources for Reservists 

and their Family members. 

Finally, in an ongoing effort to fully understand the Navy and Marine Corps family, Navy Medicine has embarked in a collaborative effort with the Military Family 

Research Institute of Purdue University to assess the needs of our Navy and Marine 

Corps families and to ensure that programs, policies and practices fulfill the needs 

of all families. 

Mr. LOEBSACK. What steps are the Services taking to assure that military kids, 

including those whose parents are in the Reserve Components, have access to mental health care? 

General AMOS. Meeting the mental health care needs of military children is a priority for Navy Medicine. In order to meet this need services are provided by Military 

Treatment Facility (MTF) providers, TRICARE network providers, contract providers working specifically with the Reserve Components, and counselors working 

for Navy, Marine Corps and Joint Family Support programs. 

Navy MTFs work closely with the Managed Care Support Contractors to optimize 

provision of child mental health services for active duty and retired family members 

when the indicated services are not available in the MTF. Additionally, case managers and social workers are available to assist in finding network services to provide mental health care. 
118 

There are several TRICARE/TMA mental health specific programs. Most recently, 

TRICARE Assistance Demonstration Project (TRIAP) and Tele-Mental Health programs have been developed and marketed. Under TRIAP, licensed professionals assess and deliver short-term, non-medical counseling that consists of one-on-one private, non-reportable conversations. This is a free service for beneficiaries (no billing 

for the service). 

Navy Fleet and Family Service Centers and Marine Corps Community Service 

Centers also provide professional counseling for children and families. Additionally, 

Commander Navy Installations Command, the Navy Reserve Forces Family Support 

Coordinator and the five regional Family Support Administrators work closely with 

Ombudsmen at each command to ensure families are aware of these services. Together they facilitate the connection of reserve families to each other, to supportive 

military and community resources and improve community awareness of military 

families’ experiences and needs. The primary focus of these efforts is to support families living apart from military installations. The Family Support Administrators liaison with their assigned Navy Operational Support Center (NOSC) staffs to ensure 

families are supported by Navy and other services’ family support programs, including the Joint Family Support Assistance Programs (JFSAP). All of our Fleet and 

Family Support programs are designed to provide high quality service to both the 

Active and Reserve components of the Total Force. 

The Navy Reserve Psychological Health Outreach Program (PHOP) was established in 2008 to provide early identification and clinical assessment of Navy Reservists returning from deployment who are at risk for not having their stress injuries identified and treated in an expeditious manner. This program also provides 

outreach and educational activities to improve the overall psychological health of 

Navy Reservists and to identify long-term strategies to improve psychological health 

support services for the Reserve community. The PHOP facilitates access to psychological health support resources for Reservists and family members. 

Mr. LOEBSACK. What, if any, efforts are being undertaken to address the correlating impact on children when a servicemember is determined to be suffering from 

PTSD or when they are recovering from a significant injury? 

General AMOS. Mental Health Providers in Navy Military Treatment Facilities 

(MTFs) address the specific needs of our wounded warriors, including those suffering from PTSD. In the Navy tertiary care centers consult teams meet regularly 

with these families. These teams consist of a health educator who assists in training 

the families of wounded service members, and a child/adolescent social worker who 

is trained to deal specifically with children. 

We also have counseling services for children by licensed professional counselors 

in our Navy Fleet and Family Service Centers (FFSC) and Marine Corps Community Service Centers. Navy Command Ombudsmen are also trained to refer families 

with concerns about the impact a parent with PTSD or other injury has on children 

to these counselors for services. 

Additionally, FFSC staff work closely with the Navy Reserve Forces Family Support Coordinator to facilitate the connection of reserve families to supportive military and community resources including the Joint Family Support Assistance Programs (JFSAP). All of our Fleet and Family Support programs are designed to provide high quality service to both the Active and Reserve components of the Total 

Force. 

Although FFSC deployment staff have always worked with families through the 

cycles of deployment, a growing awareness of the significant challenges of these deployments on military family life and child and family well-being prompted a recent 

initiative by the Department of Navy Bureau of Medicine and Surgery called 

FOCUS (Families OverComing Under Stress). FOCUS provides state-of-the-art family resiliency services to military children and families at selected installations. 

Topics including PTSD and other injuries impact on families are addressed during 

Returning Warrior Workshops to assist returning Sailors with reintegrating with 

their families and communities, and to better understand the resources available to 

them. Additionally, the Psychological Health Outreach Program (PHOP) workers ensure coordination of access to psychological health support resources for Reservists 

and their Family members. 

Finally, in an ongoing effort to fully understand the Navy and Marine Corps family, Navy Medicine has embarked in a collaborative effort with the Military Family 

Research Institute of Purdue University to assess the needs of our Navy and Marine 

Corps families and to ensure that programs, policies and practices fulfill the needs 

of all families. 

Mr. LOEBSACK. What steps are the Services taking to assure that military kids, 

including those whose parents are in the Reserve Components, have access to mental health care? 
119 

General FRASER. Within the continental U.S., the vast majority of mental health 

care for Air Force family member-children is delivered within the TRICARE network. TRICARE service delivery is managed by regional contractors who determine 

the number of network providers of any given type within their region and work 

to maintain the adequacy and quality of the panel of providers. Family members 

enjoy the unique benefit of being able to seek mental health care for eight sessions 

of outpatient behavioral health care without prior approval or a referral. Active duty 

service members (including activated National Guard/Reserve members) and their 

families enrolled in TRICARE Prime or TRICARE Prime Remote can get assistance 

in setting up behavioral health appointments by calling the regional contractors’ Behavioral Health Provider Locator and Appointment Assistance Service: 

• North Region: 1–877–747–9579 (8:00 a.m.–6:00 p.m.) 

• South Region: 1–877–298–3514 (8:00 a.m.–7:00 p.m.) 

• West Region: 1–866–651–4970 (24 hours per day) 

Family members of the Reserve and Guard have these same benefits when their 

sponsor is activated and up to 90 days prior. Resources available to Reserve and 

Guard families are essentially identical to the families of active duty Airmen if their 

sponsor purchases TRICARE Reserve Select. 

There is a nation-wide shortage of qualified mental health providers for children. 

In many rural locations the situation is worse. This is why the Services’ special 

needs identification programs are so important. Once a family member is identified 

as having a need for a particular type of specialty care, those needs are reviewed 

before a family is given a new assignment. 

TRICARE has recently expanded its telemental health network and has launched 

a particularly interesting pilot program known as the TRICARE Assistance Program 

(TRIAP) web-based counseling and referral initiative, which permits eligible family 

members to receive counseling services from a licensed professional mental health 

provider and be referred to formal mental health care if such care is indicated. Parents could use such a service to discuss behavioral problems arising in their children 

to better understand the need for further care. 

Other resources available to families include counseling through Military 

OneSource, Chaplains, and Military Family Life Consultants—all of whom may 

refer the family to seek more formal mental health treatment if necessary through 

consultation with their primary care manager or by contacting a TRICARE mental 

health provider directly. 

Mr. LOEBSACK. What, if any, efforts are being undertaken to address the correlating impact on children when a service member is determined to be suffering from 

PTSD or when they are recovering from a significant injury? 

General FRASER. The Air Force offers a variety of programs and services to meet 

the needs of children of wounded warriors. 

Airman and Family Readiness Centers (A&FRCs) have many resources for families of deployed or injured Airmen and their family members. Information may be 

delivered in an individual, family or group format and may cover such issues as deployment, grief and loss, daily life issues, marriage and relationship issues and parenting. Through the A&FRCs, Military and Family Life Consultants (MFLCs) meet 

confidentially with service members, spouses, family members and children. 

The Air Reserve Component’s Yellow Ribbon Campaign provides informational 

events and activities for the members of the reserve component, their families, and 

community members to facilitate access to services supporting their health and wellbeing through the phases of the deployment cycle. 

Depending on the injury or illness, an Airman may have a Family Liaison Officer 

(Survivor Assistance Program), Recovery Care Coordinator and/or Medical Case 

Manager; these individuals frequently help the family identify issues and suggest 

care for a family member. 

The Air Force actively collaborates with its sister services and the Defense Center 

of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). One recent initiative of the DCoE has been its project with the Sesame Workshop to 

produce the ‘‘Family Connections’’ website with Sesame Street-themed resources to 

help children cope with deployments and injured parents. In addition, DoD-funded 

websites, such as afterdeployment.org, provide specific information and guidance for 

parents/caregivers to understand and help kids deal with issues related to deployment and its aftermath. 

In consultation with parents, a child’s physician (primary care manager) frequently is able to identify issues and refer the child for care when necessary. Typically, formal mental health treatment is delivered through the TRICARE network— 

families can seek up to 8 visits without a referral or the need for prior approval. 
120 

Other sources of counseling available that could benefit children of wounded Airmen include support through a chaplain, counseling provided through Military 

OneSource providers, and the TRICARE Assistance Program, offering online counseling and referral. 

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