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i 

97–192 2016

[H.A.S.C. No. 114–56] 

UPDATE ON MILITARY SUICIDE 

PREVENTION PROGRAMS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON MILITARY PERSONNEL 

OF THE

COMMITTEE ON ARMED SERVICES 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

HEARING HELD 

OCTOBER 8, 2015 
(II) 

SUBCOMMITTEE ON MILITARY PERSONNEL 

JOSEPH J. HECK, Nevada, Chairman 

WALTER B. JONES, North Carolina 

JOHN KLINE, Minnesota 

MIKE COFFMAN, Colorado 

THOMAS MACARTHUR, New Jersey, Vice 

Chair 

ELISE M. STEFANIK, New York 

PAUL COOK, California 

STEPHEN KNIGHT, California 

SUSAN A. DAVIS, California 

ROBERT A. BRADY, Pennsylvania 

NIKI TSONGAS, Massachusetts 

JACKIE SPEIER, California 

TIMOTHY J. WALZ, Minnesota 

BETO O’ROURKE, Texas 

JEANETTE JAMES, Professional Staff Member 

CRAIG GREENE, Professional Staff Member 

COLIN BOSSE, Clerk 
(III) 

C O N T E N T S 

Page 

STATEMENTS PRESENTED BY MEMBERS OF CONGRESS 

Davis, Hon. Susan A., a Representative from California, Ranking Member, 

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

Heck, Hon. Joseph J., a Representative from Nevada, Chairman, Subcommittee on Military Personnel .................................................................................... 1 

WITNESSES 

Burkhardt, RDML Ann M., USN, Director, 21st Century Sailor Office, U.S. 

Navy ...................................................................................................................... 10 

Ediger, Lt Gen Mark A., USAF, Surgeon General, U.S. Air Force ..................... 6 

Franklin, Dr. Keita, Director, Suicide Prevention Office, Office of the Secretary of Defense ..................................................................................................... 3 

McConville, LTG James C., USA, Deputy Chief of Staff, G1, U.S. Army ........... 5 

Whitman, MajGen Burke W., USMC, Director, Marine and Family Programs, 

U.S. Marine Corps ............................................................................................... 8 

APPENDIX 

PREPARED STATEMENTS: 

Burkhardt, RDML Ann M. .............................................................................. 78 

Ediger, Lt Gen Mark A. ................................................................................... 55 

Franklin, Dr. Keita ........................................................................................... 38 

Heck, Hon. Joseph J. ........................................................................................ 37 

McConville, LTG James C. .............................................................................. 45 

Whitman, MajGen Burke W. ........................................................................... 67 

DOCUMENTS SUBMITTED FOR THE RECORD: 

[There were no Documents submitted.] 

WITNESS RESPONSES TO QUESTIONS ASKED DURING THE HEARING: 

Mr. MacArthur .................................................................................................. 93 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING: 

Mr. Jones ........................................................................................................... 97 

Ms. Tsongas ...................................................................................................... 100 

(1) 

UPDATE ON MILITARY SUICIDE PREVENTION 

PROGRAMS 

HOUSE OF REPRESENTATIVES, COMMITTEE ON ARMED SERVICES, SUBCOMMITTEE ON MILITARY PERSONNEL, Washington, DC, Thursday, October 8, 2015. 

The subcommittee met, pursuant to call, at 2:00 p.m., in room 

2212, Rayburn House Office Building, Hon. Joseph J. Heck (chairman of the subcommittee) presiding. 

OPENING STATEMENT OF HON. JOSEPH J. HECK, A REPRESENTATIVE FROM NEVADA, CHAIRMAN, SUBCOMMITTEE ON 

MILITARY PERSONNEL 

Dr. HECK. I will go ahead and call the hearing to order. I just 

want to give notice that votes are expected at sometime between 

2:05 and 2:20. And so, when that happens, we will recess, go vote, 

and then come on back and finish. 

Good afternoon, everyone. 

Today, the subcommittee meets to hear testimony on the efforts 

by the Department of Defense [DOD] and the military services to 

prevent suicide by service members, family members, and civilian 

employees. 

I want to preface my statement by recognizing the tremendous 

work that both the Department of Defense and the service leadership have done to respond to the disturbing trend of suicide in our 

Armed Forces. As a military commander who has had to deal with 

suicide within the ranks, I know firsthand that this has not been 

an easy task, and I thank you all for your hard work. 

However, I do remain concerned that the recent Department of 

Defense inspector general assessment of the Department’s suicide 

prevention program identified a lack of clear policy guidance and 

synchronization of organizations responsible for executing the program. 

I am also troubled that DOD has not completed the work necessary to beginning reporting more comprehensive and inclusive 

statistics on military-related suicides, as mandated by Congress 

last year. 

So I look forward to hearing from our witnesses how the Department is addressing these concerns. 

Suicide is a difficult topic to discuss. But last year, 442 Active 

and Reserve service members took their own lives. Every one of 

them is a tragedy, every one of them has its own story, and every 

one of them demands that we not rest until we have taken action 

to change this extremely troubling statistic. 
2 

We know that suicide is a multifaceted phenomenon that is not 

unique to the military. Unfortunately, in addition to the unique 

hardships of military service, our service members are subjected to 

the same pressures that plague the rest of society: troubled relationships, substance abuse, and financial difficulties. 

Each of the military services and the Department of Defense has 

adopted strategies to reduce suicide within our troops, so I would 

like to hear from our witnesses whether those strategies are working. I will tell you that I know that at least in the Army Reserve, 

we are at 47 suicides through September 30, 2015, which is more 

than we had in all of the last calendar year. 

How do you determine whether the programs incorporate the latest research and information on suicide prevention? I am also interested to know how Congress can further help and support your 

efforts. 

With that, I want to welcome our witnesses. I look forward to 

their testimony. 

And before I introduce the panel, let me offer the ranking member, the gentlelady from California, Mrs. Davis, an opportunity to 

make her opening remarks. 

[The prepared statement of Dr. Heck can be found in the Appendix on page 37.] 

STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE 

FROM CALIFORNIA, RANKING MEMBER, SUBCOMMITTEE ON 

MILITARY PERSONNEL 

Mrs. DAVIS. Thank you, Mr. Chairman. 

And I appreciate all of you being with us today. 

I am very pleased that the subcommittee is continuing to work 

to help prevent suicides in the military. 

Since our last hearing, the Department of Defense and the services, with continued support from this committee and from the 

Congress, have worked hard to establish, to improve, and to enhance their suicide prevention programs with the goal, of course, 

of decreasing suicides in the military community and, I think we 

would all say, not only decreasing but someday looking towards a 

time when it is very rare. 

Sadly, even with these increased efforts, this issue continues to 

be a difficult one to grasp, and the number of suicides continues 

to grow. 

I am interested to hear from the Defense Suicide Prevention Office and certainly from each of the services on the changes that 

have been made to the programs over the past 2 years. What have 

we learned? What have we changed? 

In particular, I am interested in hearing more about the identification of potential indicators which may lead an individual to suicide, as well as the improvements which have been made to intervention programs providing help to those in need. 

In the past, we know that the services have struggled, we have 

all struggled, with how best to appeal to the friends and family of 

service members to encourage them to step forward before it is too 

late. I believe this is still a critical link to prevention. These are 

the people that are around the service member the most, and we 
3 

must provide them the tools necessary to identify and to intervene 

when possible. 

I certainly welcome all of you, our witnesses, and look forward 

to hearing from you on what has been done, what is currently 

being done, and where we go from here. 

Thank you, Mr. Chairman. 

Dr. HECK. Thank you, Mrs. Davis. 

We are joined today by an outstanding panel, and, given the size 

of our panel and our desire to give each witness the opportunity 

to present his or her testimony and each member an opportunity 

to ask questions, I respectfully remind the witnesses to summarize, 

to the greatest extent possible, the high points of your written testimony in 5 minutes. 

I know most of you have been here before. The lighting system 

will be green. At 1 minute left, it will go yellow. And when your 

time is up, it is at red, and I would ask you at that point to please 

finish up quickly. I assure you that your written comments and 

statements will be made part of the hearing record. 

So let me welcome our panel. Dr. Franklin, Director of the Suicide Prevention Office, Office of the Secretary of Defense. Welcome. 

I know this is the first time in your position now before the committee. Welcome. 

Lieutenant General James McConville, Deputy Chief of Staff, G1, 

for the U.S. Army; Lieutenant General Mark Ediger, Surgeon General of the Air Force; Major General Burke Whitman, Director of 

Marine and Family Programs for the U.S. Marine Corps; and Rear 

Admiral Ann Burkhardt, Director of the 21st Century Sailor Office 

for the U.S. Navy. 

Dr. Franklin, the floor is yours. 

STATEMENT OF DR. KEITA FRANKLIN, DIRECTOR, SUICIDE 

PREVENTION OFFICE, OFFICE OF THE SECRETARY OF DEFENSE 

Dr. FRANKLIN. Chairman Heck, Ranking Member Davis, distinguished members of the subcommittee, thank you for the opportunity to appear before you today to discuss the current state of the 

Department’s suicide prevention efforts. 

Suicide prevention is an issue near and dear to my heart. I am 

a daughter of a 22-year career Navy enlisted sailor, I married an 

Air Force officer, and I have spent the last 20 years of my career 

working at various levels as a social worker with military families 

around the world. I have seen firsthand the trauma and devastating effects suicide has on families, friends, units, communities 

across the military. 

Previously, as a headquarters-level policy lead in the area of suicide prevention in the Marine Corps, I worked diligently with commanders, chaplains, medical, and nonmedical helping professionals 

to reduce the number of suicides in the Corps. 

During this experience, I realized three important things: First, 

suicide is absolutely preventable. Second, suicide is such a complex 

issue that the reduction of suicide across the services is possible 

only through active and at times intensive collaboration with a 

wide variety of stakeholders. And, third, the risk and protective 
4 

factors are common across many of the challenges that service 

members face. 

When I train my staff as a licensed social worker, I always share 

how clients don’t typically present to us with just one problem. 

They come to us and other helping professionals with a wide variety of problems, including financial, legal, relationship concerns. 

Some are contemplating suicide, and we have to know the signs 

and how to get them to help. 

Therefore, I stress that it is imperative that we approach the 

problems of our clients in an integrated, vice stovepipe, fashion, engaging across interdisciplinary approaches as needed. 

It is with this view and background that I eagerly accepted the 

job as the Director of the Defense Suicide Prevention Office [DSPO] 

in February 2015. When I accepted this challenging assignment, 

the Department had just adopted the 2012 National Strategy for 

Suicide Prevention and was developing a defense strategy consistent with this national approach. This was encouraging, as these 

strategy documents are central to providing service delivery that is 

integrated in the fashion that I previously alluded to. 

Once on board, I conducted an internal assessment of the office 

responsibilities, mission, vision, functions. Parallel to that effort, I 

conducted a series of listening sessions with the services and other 

key stakeholders and partners, to include the Department of Veterans Affairs [VA]. 

And my immediate takeaway was that, despite the adoption of 

this national strategy, the DOD suicide prevention paradigm and 

DSPO’s functions were still largely organized around that 2010 

task force report. I realized the DOD strategic paradigm and 

DSPO’s organizational structure had to shift in order to execute the 

office’s responsibilities to support this new strategy and facilitate 

collaboration with so many stakeholders. 

With this understanding of necessary changes, my immediate actions were to order a closeout of the task force report recommendations, which is near completion; also, to adopt an underlying theory 

base drawn from the Institute of Medicine’s Prevention Continuum; 

and to move the Department’s strategy staffing forward, thanks to 

the constructive input from the services and the components; and 

to begin the development of a Department of Defense instruction 

that clearly spells out the policy, the responsibilities, the procedures; and, lastly, to develop an office approach and organizational 

structure that could more efficiently implement this new strategy. 

In my oversight responsibility, one of the main efforts of the office is to identify and leverage best practices across the services, 

thus ensuring rigorous science in all that we do. 

To best implement the Department’s strategy, I have leveraged 

a public health framework in organizing DSPO along five lines of 

effort, including data and surveillance, assessment, advocacy, policy, outreach and education. While each of these are explained in 

detail in my written testimony, the data and surveillance efforts 

will be critically important to inform the other lines of effort. 

During the year 2013, according to our quarterly data reports, we 

know that across the Department, including Reserve and Guard 

Components, we, sadly, experienced 474 deaths to suicide. During 

2014, we experienced 442 deaths to suicide. You will hear more 
5 

about the trends associated with these tragic losses from my service counterparts today. 

In closing, I want to inform you that the Department has recently strengthened our longstanding relationship with the VA. We 

have already collaborated on awareness of the Military Crisis Line, 

as well as a database for advanced data and analytics across both 

departments, and, finally, an innovative campaign strategy, driven 

by the research, called ‘‘The Power of 1’’ that focuses on service 

members, families, civilians, offering one small gesture or one act 

of kindness for anyone at risk. 

Beyond the VA and the services, I recognize the Department will 

not prevent suicide alone. I continue to work diligently with the 

academic sector, with the private sector, with the National Action 

Alliance and key agencies, such as the American Association of 

Suicidology, to forge the necessary long-term relationships to prevent suicide. 

And I thank you so much for inviting me, and I look forward to 

your questions today. 

[The prepared statement of Dr. Franklin can be found in the Appendix on page 38.] 

Dr. HECK. Thank you. 

General McConville. 

STATEMENT OF LTG JAMES C. McCONVILLE, USA, DEPUTY 

CHIEF OF STAFF, G1, U.S. ARMY 

General MCCONVILLE. Chairman Heck, Ranking Member Davis, 

and distinguished members of the committee, thank you for giving 

us the opportunity to speak before you on this very important topic. 

I am going to go ahead and highlight a couple of points from my 

testimony. 

When I was the commanding general of the 101st Airborne Division, a Gold Star mother who had lost one son in combat and one 

son to suicide came to the division and spoke to the spouses about 

suicides. And the one point that she wanted us to take away was 

that people don’t commit suicide, they die of suicide. 

And when you think about that, people don’t commit heart disease, they die of heart disease. There is no stigma attached to 

going to see a doctor for heart disease. There are also risk factors 

associated with heart disease, like high cholesterol, smoking, not 

exercising, and eating unhealthy food. And for our soldiers, identifying and managing these risks can help reduce the possibility of 

dying of heart disease. 

We think the same thing needs to be done with suicide. There 

are certain risk factors that we know, and we will talk a little bit 

about them, that put soldiers at high risk, and it is very important 

we identify these. And this is why I am a very big proponent of one 

of our best practices that we have put into the Army, which is embedded behavioral health at every single brigade level, so that 

when they identify the issues, they can get soldiers to the help they 

need. 

The Army had a reduction in suicides in 2014, and that was 

mainly due to the Reserve and the Guards. And, as the chairman 

said, this year we are about the same level for the Active but we 

have seen a rise in both our Guard and Reserve, and we are very 
6 

concerned about that. And we are presently doing that analysis. 

But we are making progress in combating suicide, and it is really 

a multidisciplinary, holistic approach. 

You talked about getting to soldiers. To us, it is absolutely key 

that we get the soldier’s family, their buddy, and the junior leaders 

involved in getting after suicides. We bring 100,000 soldiers into 

the Army every single year. They come from outside, and where we 

are going to identify the issues, it is the soldier’s family members 

who will be the first ones to notice when they have behavioral 

health issues, alcohol and drug abuse issues, financial problems, 

relationship problems, all those risk factors for suicide. 

And the key leader is that squad leader, that junior leader who 

is down there with these new soldiers, who can help identify the 

risk factors and get these soldiers to the behavioral health at the 

appropriate level early on before they spiral out of control. 

We are training our total force, not just soldiers but also civilians 

and family members, and all the Army’s components to get after 

not only suicide prevention but resilient skills that will make them 

strong in the face of adversity. We have increased our access to behavioral healthcare services. 

We are also fighting suicides through research. I know many of 

you are very familiar with the Army STARRS [Study to Assess 

Risk and Resilience in Servicemembers] program, and that is helping us get the best and brightest individuals after this problem. 

Historically, Army Medicine has found answers to some of the 

toughest medical problems, including yellow fever, malaria, and 

life-threatening infections. I am confident, working with these 

great partners, that they will do the same here. 

We have good policy, which we can improve. We have programs 

we can do better at. But, most importantly, we have exceptional 

leaders in the Army at all levels who are committed to taking care 

of our soldiers. 

My wife and I have three children serving in the Army. One just 

was commissioned as a social worker. And my wife expects, as all 

mothers do, for us to take care of those soldiers, their sons and 

daughters, who are serving their country during a time of war. And 

we will do that. 

I thank all of you for your continued support in sustaining a professional All-Volunteer Army, and I look forward to your questions. 

[The prepared statement of General McConville can be found in 

the Appendix on page 45.] 

Dr. HECK. Thank you. 

General Ediger. 

STATEMENT OF LT GEN MARK A. EDIGER, USAF, SURGEON 

GENERAL, U.S. AIR FORCE 

General EDIGER. Chairman Heck, Ranking Member Davis, and 

distinguished members of the committee, thank you for the opportunity to appear before you on behalf of the men and women of 

America’s Air Force. 

The United States Air Force defends our Nation with a broad 

range of capabilities made possible by an incredible force of professional airmen, which include members of the Active Component, 
7 

Air National Guard, Air Force Reserve, and civilians in government 

service. 

Secretary James, General Welsh, and leadership at every level of 

our Air Force are committed to the development of strong, resilient 

airmen and to coordinated, robust support as they confront problems inherent to life and mission. The Air Force strategy for suicide prevention focuses on resilience among airmen, coupled with 

a community-based public health approach to prevention and timely intervention with followup for those in distress. 

The Air Force leadership is very concerned about the increasing 

rate of suicides among airmen, a trend within the Active Force. 

Last year, 62 Active Duty airmen took their lives, a rate of 19 per 

100,000. To date in 2015, that trend has persisted. Suicide rates in 

the Reserve Component and among government civilians have remained relatively static, but we are committed to prevention across 

the total force. 

The Air Force Suicide Prevention Program is an integrated network of policy, process, and education that focuses on fostering 

strong, resilient airmen, providing assistance through stressful circumstances and focused support for those in distress. 

In 2015, the Air Force changed its format for annual suicide prevention training to live, small-group discussions. Special vignettes 

and discussion guides have been developed for Active Duty and Reserve Component personnel, as well as DOD civilian employees, to 

address their different demographics and circumstances. This 

training emphasizes early intervention, risk factors, and warning 

signs to enable airmen to respond using the ‘‘Ask, Care, Escort,’’ or 

ACE, model. 

The Air Force has also fielded an annual refresher course for 

frontline supervisors in career fields with the highest incidence of 

suicide. In 2014, we updated the ‘‘Airman’s Guide to Assisting Personnel in Distress’’ to help commanders and other leaders on effective intervention for an array of challenging problems. This year, 

we also released the ‘‘Air Force Family Members’ Guide to Suicide 

Prevention’’ and trained over 200 family members as resilience 

training assistants. 

Since 2012, the Air Force has embedded mental health providers 

in operational units where performance demands and operational 

stress are concerns. Mental health providers have also been placed 

in all Air Force primary care clinics, allowing quick access for airmen and their families as well as reducing concerns about stigma. 

We are on schedule to complete our 25 percent increase in Active 

Duty mental health positions by 2016. 

We know the importance of effective identification and treatment 

and controlling the impact of PTSD [post-traumatic stress disorder] 

on airmen and families. To address this, we continue to screen airmen for PTSD symptoms via pre- and post-deployment health 

assessments at various points through the deployment cycle. Effective treatment has enabled the majority of airmen diagnosed with 

PTSD to continue serving. 

In addition, in 2010, the Air Force established the Deployment 

Transition Center at Ramstein Air Base, Germany. This center offers a 4-day reintegration program for airmen returning from de-
8 

ployment that involved activities associated with post-traumatic 

stress. 

Our mental health providers are trained and current in evidencebased treatments. The Air Force is also committed to reducing suicides within the clinical setting by incorporating the latest research 

and innovative initiatives in our mental health clinics to better 

manage our highest-risk patients. 

Improvement rarely happens in a silo, so we are actively engaged 

with the Defense Suicide Prevention Office in helping to shape suicide prevention efforts across DOD through multiple committees 

and working groups. 

In April 2015, General Welsh initiated a comprehensive review 

of Air Force suicide prevention, to include an Air Force Suicide Prevention Summit, which occurred last month. Our aim is to verify 

factors underlying Air Force suicides, review the latest evidence regarding effective prevention, gain insight into the experience of 

other organizations, and refresh the Air Force strategy on identifying new actions to effectively prevent suicide. Recommendations 

from the review and summit are now being used to refresh the 

strategy and build action plans. 

The Air Force is committed at every level to develop and support 

total force airmen as resilient, mutually supportive professionals. 

We need every airman across the total force, including those in uniform and our government civilians. We will continue to work closely with our colleagues in the services, DOD, and other governmental agencies and in academia in this essential effort. 

Thank you for your attention to this important matter and your 

continued support. 

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

Appendix on page 55.] 

Dr. HECK. Okay, so that was the bell. My intention is to complete 

testimony, and then we will recess and come back for questions. 

So, General Whitman. 

STATEMENT OF MAJGEN BURKE W. WHITMAN, USMC, DIRECTOR, MARINE AND FAMILY PROGRAMS, U.S. MARINE CORPS 

General WHITMAN. Thank you, Chairman Heck, Ranking Member Davis, and distinguished members. I am grateful for the opportunity on behalf of the United States Marine Corps to update you 

on our suicide prevention efforts. 

This is an institutional priority. It is also a personal priority for 

me. I had a friend, colleague, and fellow officer in the Marines who 

took his own life in 2012. 

Whenever a Marine chooses to end his or her own life, we are 

all devastated, and we ask ourselves, why? Is there something we 

could have done? Are there actions we can take to prevent the next 

suicide? And we believe the answer is ‘‘yes.’’ We can take some actions in three different areas. We can identify the risk earlier, we 

can intervene earlier, and we can provide robust, ongoing support. 

Together, the Department of Defense and the Marine Corps have 

developed programs to help us do just that, to identify early, intervene early, and provide robust support more effectively than we 

could in the past and with initiatives even in the last couple years 

since the most recent hearing here on this topic with you. 
9 

The key to leveraging these programs is human engagement by 

leaders, by peers, and by families. Leaders at every level are 

trained, prepared, and engaged with our Marines. This includes 

each Marine’s immediate leader, whose sacred responsibility is to 

know that Marine. Peers who already know each other are also 

trained to identify and intervene early. Marines are a close-knit 

family. They tend to understand they have an inherent responsibility to look after each other. Equally important are family members, who may witness concerns before we do. Leaders, peers, and 

family members can leverage the programs and the training that 

your Department of Defense and Marine Corps developed as tools 

to help prevent the next suicide. 

Let me offer just a small sampling of some of the more recent 

program initiatives that help us identify early and intervene early 

and provide that support, and then I will tell you a brief recent 

story in which Marines leveraged those programs to save a life. 

Identifying a Marine at risk for suicide can be challenging because no single indicator can predict if someone is at risk. So we 

have taken a holistic approach to this, and we use all of our behavioral health skills to address the challenge. 

We know that Marines contemplating suicide often find themselves in a place of hopelessness, involving a mix of stress factors 

ranging from relationship problems to financial distress. So we 

train all our Marines to respond to stress in peers. To help identify 

the risk, family members and Marines are trained to help identify 

Marines and to seek help. 

To assess the risk, once we have identified some indication, we 

have introduced the evidence-based Columbia Suicide Severity Rating Scale across the entire Marine Corps, to include our behavioral 

health providers, chaplains, legal assistants, financial counselors, 

and others. 

To intervene early and provide that ongoing support, among the 

things we have done, we have added a community counseling program that enhances access to care by assisting Marines and families in navigating the many resources available for behavioral 

health issues. They can receive immediate support regardless of 

which door they have entered to get help. 

In addition, our Marine Intercept Program, MIP, interrupts the 

potential path to suicide by providing timely intervention and ongoing support, enhancing our ability to conduct ongoing risk assessment, evolve the safety plans for the at-risk Marine, and coordinate 

his or her care. 

These are but a few, and maybe we will have a chance to talk 

about some others. 

Let me quickly tell you about the story about one Marine from 

just a month ago. His trained leaders and peers had correctly identified him as being at risk for suicide due to several factors. Typically, we have 10 to 20 involved, and he was one of those. 

He entered the Marine Intercept Program, and the Marines continued to be watchful. One day, when he was not at his expected 

place of duty on time, his noncommissioned officer leader immediately launched a search in the right places because they knew 

him. They found him hanging from a rope, but they found him in 

time. He was still alive, so they revived him, they rushed him to 
10 

the hospital, and that Marine is alive today. We are taking care of 

him. He is receiving support, but he is alive. 

So we have some successes; we are making some progress. But, 

Mr. Chairman, as you said, this is difficult work. We must remain 

vigilant. We must continue with the Department to analyze the 

data regarding suicides, seek effective new approaches based on 

evidence-based research and empirical tools, continuously enhance 

our training and resources that we make available to our leaders, 

Marines, and the families toward what works. 

I thank the subcommittee for supporting this work, and I will be 

happy to answer questions later. Thank you. 

[The prepared statement of General Whitman can be found in 

the Appendix on page 67.] 

Dr. HECK. Admiral Burkhardt. 

STATEMENT OF RDML ANN M. BURKHARDT, USN, DIRECTOR, 

21ST CENTURY SAILOR OFFICE, U.S. NAVY 

Admiral BURKHARDT. Chairman Heck, Ranking Member Davis, 

and distinguished members of the subcommittee, thank you for the 

opportunity to present you information on the Navy’s suicide prevention programs. 

Every suicide is a tragedy, and a single life lost is definitely one 

too many. Sadly, in 2013, the Navy experienced a loss of 46 shipmates through suicide. Although this was a decrease of 20 suicide 

deaths from the previous year, in 2014 we saw an increase in our 

suicide total, with 68 deaths. For 2015 thus far, we have lost 44 

shipmates to suicide. 

Suicide is complex, and, as such, it is difficult to draw conclusions from numbers alone. We continue to monitor the health of the 

force and investigate every suicide and suicide attempt. The Suicide Prevention Team examines each case for pertinent information 

that might inform our prevention program. Results from these reviews consistently reveal that demographic distribution of suicide 

largely mirrors the Navy demographics, and suicides typically 

occur when sailors are experiencing some combination of multiple 

recent stressors, including intimate relationship problems, loss, recent career transitions, disciplinary or legal issues, work problems, 

and financial strain. 

The 21st Century Sailor Office stood up shortly after the 2013 

hearing, facilitating an integrated approach to total sailor fitness 

and resilience. The office encompasses diverse elements that impact sailors’ physical and psychological health. 

Promoting comprehensive wellness is one of our core strategies 

to proactively prevent destructive behaviors that can ultimately increase suicide risk. Our efforts are focused on education and awareness, prevention and intervention, sailor care, and crisis response. 

To that end, since 2013, we have launched several key initiatives. We have expanded our Operational Stress Control Mobile 

Training Teams, providing training to enable deckplate and senior 

leaders to better assess and mitigate stress in their units. In 2014, 

we mandated this training for all units 6 months prior to their 

scheduled deployment. 

We have also assigned deployed resilience counselors to our aircraft carriers and large-deck amphibious assault ships, working 
11 

alongside chaplains, behavorial psychologists, and medical professionals who proactively assist our sailors on a daily basis. 

We have also implemented several key evidence-based suicide 

prevention and intervention measures, including training on the 

use of the Columbia Suicide Severity Rating Scale and the Veterans Affairs Safety Plan to enhance risk assessment and intervention at the deck plate. 

We have also released guidance for commanders and health professionals to reduce access to commonly used lethal means of suicide through the voluntary storage of privately owned firearms. 

In 2014, we launched our ‘‘Every Sailor, Every Day’’ campaign to 

promote ongoing and active engagement, peer support, and bystander intervention so that no sailor feels alone. This campaign 

places strong emphasis on daily interaction to not only build trust 

and foster hope but enable that early recognition of warning signs 

and get sailors the help they need. 

During the 2015 Suicide Prevention Month, we introduced a new 

message to this campaign, ‘‘1 Small ACT.’’ This message encouraged simple actions to make a difference and perhaps save a life. 

It is based on the Navy’s ‘‘Ask, Care, Treat’’ bystander intervention 

model and the Navy’s supporting the DOD and Veterans Affairs 

‘‘Power of 1’’ concept. 

We have also released an improved suicide prevention general 

military training which is interactive, scenario-based, and designed 

to generate dialogue about stress navigation, suicide prevention, 

intervention, and also crisis response. 

Suicide prevention is about taking care of people. Navy’s commitment is to provide sailors and their families the tools they need to 

thrive during and beyond their Navy careers. 

Thank you, and I look forward to answering any questions you 

may have. 

[The prepared statement of Admiral Burkhardt can be found in 

the Appendix on page 78.] 

Dr. HECK. Again, I thank the panelists for keeping their testimony within 5 minutes. I think that is a record for everyone doing 

so. 

We will recess and return right after votes. I ask the members 

to return as quickly as possible. 

[Recess.] 

Dr. HECK. Okay. We will the reconvene the hearing. 

And, again, I thank the panelists for their testimony. 

We will now begin questions from the members of the committee. 

Reminding committee members that we will adhere to the 5- 

minute rule, and if there is time remaining after the first round, 

we will go with a second round of questions. 

So, Dr. Franklin, in your testimony, you talk about the rate of 

suicide among the Active and Reserve Components. And the question is, how does the DOD actually calculate the rate of suicide, 

and how do the current military suicide rates compare with the civilian rates? 

We hear a lot of emphasis, and rightfully so, on the number of 

suicides within the military, and perhaps it is because it is a much 

more closed, basically, society with a lot of oversight and oppor-
12 

tunity to intervene. But do the rates within the military differ all 

that significantly from what we see in the general population? 

Dr. FRANKLIN. Thank you so much for that question. I will go 

ahead and start with the latter part. 

Typically, I try to sway folks away from comparing the military 

rates to the civilian rates for a number of reasons, some of which 

you just mentioned. But the military as a whole, largely a healthy 

population, largely covered by health care. When you compare demographically across the civilian population, we are looking at 

folks that have no health care, perhaps they are homeless, unemployment rates. There are all sorts of factors that make the two 

populations drastically different. 

On the other hand, also, the military has additional stressors in 

some cases. I am actually looking at this a little bit further to see 

if I can find a demographically similar characteristic or population. 

What I want to make sure we don’t do is just compare a CDC [Centers for Disease Control and Prevention] data set across gender and 

age and think that we have a one-for-one comparison with the military, because we don’t. 

Dr. HECK. Right. 

Dr. FRANKLIN. So that is a sticky wicket, but certainly I can understand why folks want to ask the question, looking at whether 

or not we should look at comparisons across the university sectors 

perhaps or other types of demographics like perhaps first responders and trying to dig deeper so that I can find a good comparison 

group. 

But the other question that you asked me was about the rate calculation. The rate calculation recently changed, and we are looking 

at the total force. We work within the Defense Suicide—I am sorry, 

the Defense Manpower Data Center to get the denominator. And 

then, from there, we will take the total number of suicides, and it 

is just a math equation where we will divide the two. And that is 

how we calculate the rate. 

Dr. HECK. So you say the rate recently changed. How was it calculated previously? 

Dr. FRANKLIN. Before, we would separate it out. And so now we 

are looking at more of the total force. 

Dr. HECK. Okay. All right. Thank you. 

And, General McConville, I appreciated your analogy and the 

fact that you used the phrase ‘‘die from suicide’’ not ‘‘commit suicide,’’ and the analogy you made with heart disease. And you mentioned one of the issues that we find is the stigma associated with 

seeking behavioral health assistance and folks concerned that 

somehow if their chain of command learns about it, you know, it 

is going to impact their eval [evaluation], may impact their future 

promotions. 

So I would ask one of the panelists, what is being done within 

your service to try to remove the stigma of reaching out for help 

so that we can get ahead of this problem as opposed to being reactive? 

General MCCONVILLE. Well, sir, thank you for that question, because, as a former commander, that is why we started to think 

about it in a different way. We have to change the culture of how 

we look at suicides, because it is just like heart disease. 
13 

And so what I found very helpful and what, really, the Army as 

an institution is propagating is, if you have problems with mental 

health, it is the same thing as having some type of heart disease, 

and you need to go to the right doctor. 

So you identify those type of issues and, again, I talked to you 

about being a proponent for the embedded behavioral health. Having that as close to the point of need that we can get behavioral 

health is really very, very important. And the way that works in 

a division, that brigade combat team has a multidisciplinary team 

that actually sits there that does physical fitness with the unit that 

is there. So if a soldier starts to have problems, we can get them 

in early on. 

I use the analogy even with heart disease, if you wait and I am 

not a doctor, so, the doctors here, you know, don’t—I make it up 

anyways. But, you know, if you wait till you are 95 percent, you 

know, clogged and you go to the doctor, they may not be able to 

help you. But if you get them early on when you are starting to 

have high cholesterol and you are starting with these risk factors 

and you get them to see the doctor, they get you on the appropriate 

diet, they can get you to stop smoking, you can do those type 

things. We need to do the same thing with suicide if someone is 

starting to have a problem. 

And the ranking brought that up, about the family members is 

absolutely key. They are the ones that know. I have looked at a lot 

of suicides over the years, and people go, ‘‘No one knew.’’ Well, 

someone did know. And, usually, when you peel it back and you 

take a look at it, there was a buddy that knew or a family member 

knew. And if we got it early on, we could have got the help they 

needed, and we might have saved a life. 

Dr. HECK. All right. My time is about to expire, so I will come 

back on the second round and follow up. 

Mrs. Davis. 

Mrs. DAVIS. Thank you, Mr. Chairman. 

And I actually was going to ask all of you about perhaps one incident or story that you go back to, you know, every day when you 

come to work, thinking about either a success story or one that was 

tragic. And I think, you know, several of you mentioned that, but 

I guess I would wonder what that is. 

It is always helpful to have a family member at a hearing like 

this or someone who has sort of really been there. And I have a 

feeling that you have lived through that through the folks, but I 

wondered if you wanted to share that and what it has done in 

terms of your own drive to make sure that we are able to address 

this. 

General MCCONVILLE. I will go ahead and start. 

I guess, you know, I have many examples, having commanded a 

very large organization in combat over the last couple years. But 

one of the things that we did at Fort Campbell is we used to do 

a Mother’s Day brunch for all the Gold Star Mothers and family 

members the week before Mother’s Day, and we invite all the Gold 

Star family members. And it was interesting who used to come as 

part of our survivors outreach. And we had people come that had 

lost their sons and daughters to suicide. 
14 

And one man, in particular, came. And it is amazing, the pain 

that that father was going through, the fact that he had lost his 

son to suicide. And he came to Fort Campbell because there was 

a good program there. His son wasn’t even in the division, but we 

had this great survivor outreach person, Suzy Yates, that took incredible care of these families, and he came to that brunch. 

And you could see the pain. And it is a very, very different pain, 

what parents go through with a suicide, than, you know, soldiers, 

I have lost soldiers in combat, I have lost soldiers to accidents, I 

have lost them—but that suicide, it has an—first of all, it is the 

end of the world for the parents. And it is a gaping hole to units 

when you see what happens when you have a suicide in the unit, 

because everybody wants to wonder what we could have done. 

Mrs. DAVIS. Uh-huh. 

General MCCONVILLE. And so you can feel my passion about this 

stuff. And, you know, I have thought through this stuff, and it is 

getting after what we do to take care of soldiers. So, every day I 

wake up, we have a sacred obligation to take care of the sons and 

daughters that parents sent us, and the last thing we want to do 

is to have a son or daughter die of suicide. And that is a sacred 

obligation for us. 

Mrs. DAVIS. Uh-huh. 

General EDIGER. The story I always think back to is, early in my 

career, when I was a squadron flight surgeon for a fighter squadron in the Air Force, we lost a lieutenant young fighter pilot to suicide, married, with a child on the way. And the thing that struck 

me about that was that it was really a somewhat impulsive act, in 

that case, in that he was confronted with an acute situation, a 

problem that was really, when you looked at it, completely solvable. 

And then I saw the rippling effect of that tragedy as it went out 

to the family, and a child that was born without a father. And that 

really struck me, that we really have a responsibility to help particularly our youngest members in the military arrive at a more 

functional approach to problems and how they approach problems, 

solve problems, and that we need to do a better job of connecting 

them with sources of help in terms of just their basic life skills so 

that their approach to problems like that don’t turn into a tragedy. 

Mrs. DAVIS. Uh-huh. 

General WHITMAN. Mr. Chairman, you know, the Marine Corps 

tracks and studies every one of the suicides and attempts and ideations that we have. And we study them and pull from them what 

we can. 

Each of us, I am sure, has our own personal most devastating 

story. Mine would be the friend I lost in 2012. There is no question 

he was a very close friend. 

But we look at all these. We looked at them in 8-day reports. 

And the entire institution does. The assistant commandant of the 

Marine Corps gets those reports; we review them together. If someone has survived, if it is an attempt or an ideation, the commanders get involved through our Marine Intercept Program and 

evaluate what the problem is. We pull data out of that, as well. 

And then, finally, we have a regular institutional effort, an Executive Force Preservation Board that is led by our assistant com-
15 

mandant, that looks at all the cases in aggregate and tries to pull 

the lessons that we can from those to prevent the next one. 

Mrs. DAVIS. Uh-huh. 

Admiral BURKHARDT. For me, I am passionate about people, and 

I strongly believe that every life is worth living. And it is really sad 

when I see the SITREPs [situation reports] that come in and I 

think about those lives that we have lost and the family members 

and the units impacted. 

And the Navy is committed to helping our young people and all 

our service men and women and their families understand how to 

better identify those risks and refer people to help and make sure 

that everyone has a chance to live life fully and really thrive in our 

environment. 

Mrs. DAVIS. Okay. Thank you. 

Dr. HECK. Ms. Tsongas. 

Ms. TSONGAS. Thank you, Mr. Heck. 

Thank you all for being here. I can tell you that this is an issue 

that really strikes home with my constituents, as they read the 

alarming statistics and stories or if they have been personally impacted by a family member or friend who served in the military. 

So I appreciate all the work that each of the services has done and 

that the DOD has done, as well. 

But I really want to ask a question about, and you have all certainly given great testimony to the efforts that the services are 

doing, investing in. But I really want to address the issue of how 

you all are working together with each other and with the DOD. 

So, on September 30, 2015, the DOD Office of the Inspector General issued a report that states that, quote, ‘‘DOD lacked a clearly 

defined governance structure and alignment of responsibilities for 

the Defense Suicide Prevention Program,’’ unquote. And that report 

also states that the DOD, quote, ‘‘did not standardize best practices 

across the Department, and the services did not take advantage of 

each other’s knowledge and experience,’’ unquote. 

And I know that this is often not unique to suicide prevention. 

We hear that often in other contexts, as well, that you work within 

your own service and not always across services. 

So I would like first Dr. Franklin to address what changes are 

being made to address these issues. And, also, if each of you could 

comment upon how you share best practices and work across the 

services. 

So let’s start with you, Dr. Franklin. 

Dr. FRANKLIN. Sure. Certainly. Thank you so much for the question. 

Make no mistake, the DOD IG [Inspector General] absolutely 

cited a number of the things that you spoke about. The policy, the 

evidence-based practices, the research—all of it needs to be coordinated, and we absolutely needed a strategic approach. 

I will tell you, I think the Department was largely operating in 

a reactive mode early on in the suicide arena as a result of the Department of Defense task force. And so, by ‘‘reactive,’’ I mean they 

were chasing down those task force recommendations, 76 of them, 

and they were trying to get current. 

Upon completion of that, like many programs, it was an opportunity to take a pause and look at the program and look at the na-
16 

tional landscape in the area of suicide prevention and then determine our own strategy, moving away from task force recommendation mode to a science-based approach based on our current needs 

and the state of the program. 

So when I arrived in the office and I did a series of listening sessions with the services, we right away changed our practices. I 

couldn’t be more pleased to tell you that the services meet on a 

quarterly basis. Their suicide prevention program managers are— 

we have had two of those meetings so far. They are 2-day meetings. 

They share a number of best practices. I could give you examples. 

And you heard in some of their testimony where some of them are 

implementing similar tools like the Columbia Suicide Severity 

Scale or the VA safety planning. They learned that from each 

other. And those are exciting opportunities, and I absolutely see 

that as the future of the office. 

I am a social scientist by trade, and I think that we need to leverage the research and we need to work together. And I am eager 

to see the future of this team when we can have more time and 

place to execute many of these evidence-based approaches. 

Ms. TSONGAS. Can each of you give an example of where you 

learned a best practice from perhaps the DOD or from each other? 

General MCCONVILLE. Well, I know there is coordination with— 

from where I sit, I know that we meet at the program manager 

level. 

What I am surprised to see as you listen to the testimony is how 

the concepts, especially when I look at my Marine colleague here, 

you know, we are pretty much moving towards getting after the 

problem the same way. We understand in combat-type units that 

these new soldiers coming in that are most susceptible, getting the 

leadership, getting the families—we have shared the STARRS 

studies that we have worked with that show, which we have all 

spent a lot of money on, what type of indicators. And as I listen 

to testimony, I see many of our colleagues using that same type information. And as we pass the information back and forth, for me, 

it kind of gives an idea that, hey, we are all getting after the same 

thing. 

I did an exchange with the Japanese, which is kind of interesting. We talked about sharing suicide information. Their concept 

is very similar to what we are trying to do. They have a one company, one floor concept. And it gets around to this whole relationship, which my Marine Corps colleague talked about, is how we 

make sure people are taking care of each other and identifying 

those risk factors so—I see the risk factors the same across each 

and every one of us. 

Thank you. 

Ms. TSONGAS. General. 

General EDIGER. A couple of examples I will add is, we are sharing the data from our research. And I know we have learned a lot 

from watching and studying the Army STARRS data in terms of 

resilience and the ability to measure that and predict certain outcomes. 

I mentioned our Suicide Prevention Summit in the Air Force that 

occurred 3 weeks ago. And Dr. Franklin was a prominent participant in that, but, also, the Marines were there and gave some ex-
17 

cellent presentations in terms of their programs and actually, we 

are borrowing significantly from what the Marines are doing and 

what we are implementing now. 

Ms. TSONGAS. I have run out of time, but thank you. 

Dr. HECK. Mr. MacArthur. 

Mr. MACARTHUR. Thank you, Mr. Chairman. 

I am sorry I missed your opening remarks. I was at another 

hearing. But I read the memo, the advance memo, and I just had 

a few things that maybe you have covered already, I don’t know. 

First, there is nothing more tragic than young people—often, 

these are the people we want to be the next greatest generation. 

And we see so much that they have to live for, and, obviously, 

sometimes they don’t. 

You mentioned, Dr. Franklin, that it is a closed system, the military. I think that was your word, or maybe that was the chairman’s words. But you suggested you can’t really compare military 

suicide rates with civilian rates. I think the chairman called it a 

closed system, but same idea. 

So I am interested in comparisons within that system. And the 

years of numbers that I see here cover 4 years. And I just wondered, if you apply this new methodology of calculating the rate 

and I gathered it is currently done against total force. I am not 

sure what you looked at previously; you could tell me that. 

But if you applied this current methodology going back 10 or 15 

years—have you done that? And what does it show about the 

trending of suicide within the military? Is it going up? Down? Staying the same? Give me some sense of the magnitude of direction. 

Dr. FRANKLIN. Sure. Certainly. Thank you so much for the question. 

I would need to get back to you on whether or not we took the 

current methodology and traced it back 10 or 15 years. The difference between the two methodologies are that one looks at the 

total force and the others sort of separate it out. But that is certainly something that we could do and get back to you. 

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

page 93.] 

Dr. FRANKLIN. Overall, when I look at the numbers, I see a lot 

of fluctuation. There are times where you will see that it will spike, 

and you will try to study it and understand it. It is a 1-year spike 

or a 2-year spike. And then you will see where it has dipped slightly or it has gone up in a way that it is not statistically significant 

yet. And so it is just this up-and-down fluctuation over time. 

Either way, it is too many. We say one is too many and continue 

to study the data, not only in the context of the quantitative numbers, but, also, some of my colleagues today talked about the qualitative stories. Studying the full review of each and every one of 

these cases is critically important. They are not just a number. We 

must know the names, the faces, and the stories, the risks, the protective factors, what was behind each and every one of them. 

Mr. MACARTHUR. I would appreciate it if you could back get back 

to us. I think it could be helpful to look at trends over time, because perhaps there are some factors that are at play, with conflicts that they are in or different things, where you see elevated 

or depressed rates of suicide. 
18 

Dr. FRANKLIN. Yes, yes, certainly. Over time, we talk a lot about 

relationship issues being at the heart of a lot of this, but financial 

struggles, legal struggles, and also just this notion of, particularly 

within the military environment, sort of a falling from glory or no 

longer feeling a sense of belongingness with the unit or with the 

military. But, certainly, continuing to study those risk factors. 

And I would also turn it over to—my Army colleague may have 

more to say here about the identified trends specific to the Army. 

General MCCONVILLE. Yes, sir. I could talk a little—and, again, 

I can’t break down the numbers. I just have the statistics really for 

the Army as we look at different types of mortality, whether it is 

accidents, natural, suicide, or homicide. 

But, basically, what we see is, in the Army, compared to the civilian population, is in 2005 we were below the numbers. We were 

basically at a rate of about 13, and the U.S. was running about 18. 

And then, as we went from 2005 to 2012, it began to grow. And 

during that period of time, the Army actually crossed the civilian 

average. Now it has come back down to where we are a little higher, but, again, I am not a statistician, but they would say that is 

within the normal. 

So when we look at the death rate within the Army, what we 

find is, as far as accidents, it is much lower than our civilian 

counterparts. We talk about natural, much lower than our civilian 

counterparts. Suicides, a little higher, but, you know, again, the 

statisticians say that is about the same. It was statistically higher 

in 2012. And then, for homicides, it is much lower than the rate. 

So that is kind of how it breaks out. And I am not smart enough 

on the analysis of how they got all those numbers. 

Mr. MACARTHUR. I yield back. 

Dr. HECK. Mr. O’Rourke. 

Mr. O’ROURKE. Thank you, Mr. Chairman. 

I wanted to follow up on some questions asked by my colleagues 

Ms. Tsongas and Mr. MacArthur. 

One of the conclusions of the inspector general’s report is that we 

don’t have good or consistent measures for success. And so I would 

love to get your advice, Dr. Franklin, for this oversight committee 

on how we can best gauge the job that you are doing and that the 

different branches are doing in preventing suicide. 

Dr. FRANKLIN. Thank you. Thank you so much for the question. 

And measuring suicide is difficult, but it is not impossible. And 

we absolutely owe you that, and we need to do that. 

When I arrived in the office, we started a refreshed effort in the 

context of our measures-of-effectiveness work. Early on, I think we 

were trying to bite off more than we could chew and attach measures of effectiveness to every single program out there. And now we 

have streamlined our approach, and we are looking at key indicators that we can collect from the chaplains, from the medical community, and then directly from the services that get after it. 

It is a much more streamlined, simple approach. We have developed a series of logic models to study the outcomes of the Suicide 

Prevention Program as a whole vice the individual parts and pieces 

that make it up. So I am certainly pleased to share those models 

with you. 
19 

It is definitely an important issue. Measures of effectiveness 

should be part of everything we do, and we shouldn’t think of it 

as an afterthought but, rather, part of the front end of programming. 

Mr. O’ROURKE. One of the things that I think is cited as a success story in the IG report—and you mentioned it, I believe, in 

your opening testimony—is the data that you are collecting now, 

and you implied data across service and then as the service member transitions out and becomes a veteran. 

And you mentioned the analytics that you are doing, the advanced analytics that you are doing on that data. Can you give us 

an idea of what it is that you are measuring? 

And I appreciate the focus on ensuring that we are sharing best 

practices across service branches. How are we sharing with the VA 

and vice versa? 

Because I think all of us here are also very concerned with veteran suicides, as well. And so, you know, whether it is the risk factors that General McConville brought up earlier that are identifiable, I want to know if those are being shared with VA providers 

and clinicians and what kind of impact we are having there. 

Dr. FRANKLIN. Yes. Yes. Two-part question. 

The first, I think you are getting after this Suicide Data Repository. This is a massive database, a data set that pulls together 

about 22 other data sets, drawn off of the CDC and the National 

Death Index data. 

It is a joint partnership between the Department of Defense and 

the VA. So we both put into it, and we can both pull out of it. And 

so far, we have developed a charter and had a series of meetings 

to discuss the art of the possible on the data and analytics, and it 

is very exciting. We do not have any results from it yet, but the 

framework is in place, and a number of discussions have been held, 

particularly in the context of predictive analytics. 

Mr. O’ROURKE. Can you go deeper into that? And perhaps anyone else who is with you at the panel. Are you seeing correlations 

with combat, with specific kinds of combat, specific experiences 

within combat correlated to higher likelihood of suicide attempt? 

Dr. FRANKLIN. Those are precisely the things that we are going 

to begin looking at. The database was just stood up. We have only 

recently put the business rules in place and put in a series of processes for folks to access the data, to begin to look at the research 

questions and going through proper IRB [Institutional Review 

Board] procedures and those sorts of things. So it is in its early 

stages, but there is quite a bit of excitement about the potential future of it. 

So far, what we have also done is discussed opening up to academic sector and letting folks know our research needs and our 

gaps so that folks can tap into the database and help us study 

these very issues. 

I wish I had more for you in the context of specifics on the analytics, and I hope to at another time, potentially even another hearing. 

Mr. O’ROURKE. I look forward to that. 

And, General McConville, you mentioned identifying risk factors 

and then acting upon those. Any that I just mentioned right now, 
20 

are those correlated? Are those risk factors that you are looking at, 

combat service, particular kinds of combat service? 

General MCCONVILLE. We have. 

And the value of the massive STARRS study was it is really not 

as combat-related as some would think. And, you know, as we went 

through this, the folks that are most likely to commit or most likely 

to die of suicide are those that have zero or one deployments. It is 

not the multiple deployers, which we were kind of—you know, that 

is counterintuitive to what a lot of us thought. And that was, 

again, you know, a very—and we are continuing to look at that. It 

doesn’t mean that one deployment does not affect you, but it does 

get back to those that may have some type of behavior health 

issues going into the military. That is very, very important. 

And as we move to a complex behavior module, it is more than 

one effect. The fact that someone goes through a divorce does not 

mean they are going to die of suicide. The fact that someone has 

a drinking problem does not mean—all those. But it is getting 

those compact factors coming together and then understanding how 

they affect—because they affect all very differently. 

The thing we are trying to get to is really trying to measure resilience. And it is not like on the positive side. You know, when we 

bring soldiers in, resilience or grit is something we are trying to define in our screening process. So if when someone comes in—we 

know what a resilient person is. We have always focused on physically fit, but we are also focusing on mentally fit, and we are also 

focusing on character. Because those are the attributes that we are 

trying to bring into the service. 

And then, once we get them in, is to give them the type training 

they need when they are brand-new soldiers in initial training and 

during that first period of time. Because what we see is, if we look 

at suicide attempts and what our studies have shown us, actually, 

it is female soldiers that are most likely, first-term soldiers, to attempt suicide. Brand-new soldiers—male soldiers are most likely to 

die of suicide during their first term. 

So that first term is very, very important, the first couple years 

when a soldier comes in, because we really haven’t fully brought 

them into the culture of the military. And this goes for a lot of 

things, with sexual harassment, sexual assault. All those things 

tend to happen at a higher percentage in that 1- or 2-, first-year 

soldier. And that is why we are really focusing on this ‘‘Not in My 

Squad’’ campaign that we are going after. 

Mr. O’ROURKE. Thank you for your answers. I am going to have 

to yield back to the chairman. 

I appreciate the indulgence. 

Dr. HECK. Mr. Coffman. 

Mr. COFFMAN. Thank you, Mr. Chairman. 

One, first of all, I want to commend the Army, and I don’t know 

if the other services are doing it too, in terms of recruiting and now 

trying to develop methodologies to determine who is more resilient 

than others, who is more likely to fall victim to the stressors of 

training, of combat training, of deployment, of all the things in the 

military. And so I think that is very important, if we could mitigate 

problems through the intake process in terms of who comes in. 
21 

One thing I wanted to ask all of you is that, what is different, 

if I look at my service in the first Gulf war and my service in the 

Iraq war later on, in 2005–2006 in Iraq, that in the first Gulf war, 

you were just checked out. It was probably the last war where 

there wasn’t the Internet, where you just—you know, it was snail 

mail. You checked out. You went there, you came back. You didn’t 

have communications with your family until post-conflict, then occasionally on a land line, on a phone. 

But in the Iraq war, where you have—and Afghanistan too— 

where you have forward operating base and you have soldiers, Marines, and sometimes airmen and sailors going outside the wire, 

coming back in, getting in real-time with their families, being told, 

you know, we are having these problems and these problems. And 

so, all of a sudden, they have the compounding effect of being concerned about what is going on at home in real-time and being deployed in a combat zone. 

How much are those stressors factors in suicide rates? And the 

fact that we have fewer deployed troops today, does that bring it 

down? Although we have a lot of deployed troops, just not in a combat zone, but all over the world. 

Who can comment on that? 

General MCCONVILLE. Sir, I can comment on it. 

Really, I think you bring up a great point. And as I look and try 

to put this in perspective with the strategy that we have, is, you 

know, when we were going to the Gulf war and we were doing that 

before, there was no contact. Now, the soldier is sitting there, he 

or she is Skyping with their significant other. And, I mean, I could 

give you some horror stories of some of the things that happened 

while people are Skyping and things that have been said. 

So that creates a tremendous amount of stress on our soldiers. 

Because we look at some of the factors, we are saying, okay, so relationships is a problem, financial is a problem. Well, they have a 

direct access to that soldier to do that. So that is a significant concern as we go forward. 

And, again, that is why we want to build the resilience, both in 

the soldiers but also the families. And one thing that we really 

haven’t talked about is our resilience training for families. And 

right now we are training master resilience trainers. Spouses have 

taken that on. They are more ecstatic, and they are excited about 

that. That is making a difference, so much so that we are standing 

up a program for our teens too, because they want it. And, again, 

anyone that has, as you know, had military kids traveling around, 

and with the stress of the military—very, very important for our 

folks. 

Mr. COFFMAN. Good. 

General EDIGER. This is one of the prime factors that led us to 

start training family members as resilience training assistants. Because the connectivity back home, while comforting in many cases, 

it can also share the stress from what is happening in the operational environment. And so we recognize the importance of having 

Key Spouse programs and actually incorporating resilience training 

into the Key Spouse program, which led us to do that. 

I think in terms of the members who are actually deployed, we 

have actually found that our suicide rates among airmen during 
22 

the time they are deployed are far lower. And we think that is because of the sense of responsibility to their fellow airmen, and they 

are part of a team, and they understand that they have a responsibility to be there for their team. And so, during the actual deployment, we have found that the rates of suicide attempts are far 

lower. 

General WHITMAN. Three parts of your question, I think. 

Is there a link to combat and deployment? We have not found 

any in the Marine Corps, similar to the Army experience and the 

Air Force experience. It is a factor, but it is one of many. And, typically, suicide is related to 10 to 20 of those, in any given case. 

Sometimes it is, but it more often than not in the past year, it 

wasn’t, deployment or combat. 

We are looking at screening very hard. Part of our Marine Corps 

Recruiting Command effort, a very deliberate effort to look at what 

screening would be the most effective up front before a Marine 

comes in. And we use a Marine total fitness model to look at body, 

mind, and spirit, and social. 

And, finally, we are also training families through a new Conquering Stress with Strength program that we initiated this past 

year. It is fairly new, but it has been well received. And we expect 

to expand that across the Marine Corps. 

Admiral BURKHARDT. The Navy has similar results, where we 

have not found that deployments has been significantly related to 

death by suicide. 

Mr. COFFMAN. Okay. 

Thank you, Mr. Chairman. I yield back. 

Dr. HECK. Mr. Walz. 

Mr. WALZ. Thank you, Chairman and Ranking Member. 

I want to thank each of you for the work you have done. It is 

gratifying to me to see the commitment is here. And I know, going 

out and talking to folks over the years and having worn the uniform within the last 10 years, this is not a box to check, obviously, 

for the services. This is a commitment that is deeply engrained in 

the culture. And for that, I am incredibly grateful. 

It is a very difficult task to take on. It is one we understand we 

have a moral responsibility to, but it is a readiness responsibility, 

as we all know. This is a force multiplier, keeping people healthy. 

And I think the resiliency training—I would make the case that, 

once again, you are probably outstripping the private sector. And 

this issue of mental health parity is still a troubling thing, a stigma in the private sector. We have worked very hard to get insurance to pay for it, in some cases, until very recently. 

So I understand the challenges. And I also think you know, all 

of us here, that it is amazing to me, and people want to fix this 

badly, and they want a fairly easy fix. And I remember we worked 

really hard in the VA earlier this year when we passed the Clay 

Hunt bill. And I was gratified to see that happen. But I said, if you 

needed a stark reminder of this, in my hometown of Mankato, Minnesota, the day we passed it, the next day on the paper, the top 

half of the paper said, ‘‘Clay Hunt Bill Passes Congress.’’ The bottom half of the front page was a young man walked into the Minnesota State University, Mankato, library and died by suicide, gunshot wound, on that very same day. 
23 

And so it reminds me that this is a deep dive. We are in it for 

the long haul. There are many factors. The research is catching up 

or starting to. And I am grateful for where you are going. 

And I think that leads, to me, I am not going to ask in detail. 

This is just my hunch on this. I think the spirit that I have seen 

this be taken on is real, it is happening. And so when I see the IG 

was talking about unsynchronized, I think that is pretty much a 

condemnation of our entire mental health system, if you will. And 

so I am not sure if there is any question to ask there, if you agree 

with where they are at or if there is something we can do. I read 

that and am—and perhaps we should be more concerned, but it 

strikes me as perhaps this is deeper. I don’t know. 

Maybe starting with you, Dr. Franklin. And, also, I am grateful 

for your office proactively reaching out soon after you were in your 

job and working with us. Because we are unsynchronized with the 

VA, if you will, and you are working to try and make that happen. 

Dr. FRANKLIN. Yes. Thank you so much. Good question. 

And the unique part of this challenge at the DOD level is putting 

the standards in place, making sure we have the best research and 

opportunities for the services to work together. And the Department really serves in a facilitator role, in some regards, bringing 

some synergy to the table so that the services learn from one another. 

But, at the same time, I couldn’t agree with you more, in the context of the services needing to have service-unique and -specific 

programming where relevant, provided that it meets the standard 

and that it is the best and the best that we know from the science. 

So honoring the service uniqueness. Having worked as a social 

worker for the Army and the Air Force and at the headquarters 

level for the Marine Corps, I can tell you that they are quite similar but also quite different, as you probably well know. 

Mr. WALZ. Yeah. And I hear it listening to folks talk. And I think 

that is important. So I think, you know, it is important for us to 

publicly address that. I appreciate the IG pointing this out, but I 

think there is more to this than what the report said. 

So the next thing is part of that and I heard each of you say this, 

and, General McConville, you mentioned this, this peer-to-peer 

piece or whatever. We did best practices on Clay Hunt and showed 

there is a lot of success there. We are kind of looking outside the 

governmental things, different organizations, one I am partial to, 

Ride for Recovery, and some of these, of how do we use these with 

evidence-based programs that are making a difference? How do we 

synchronize across these? Because they have their own issues inside the world of the Army, the Marines, and so forth. 

And I don’t know if any of you want to tackle that or maybe this 

is to you again, Dr. Franklin of, how do we use those external resources? 

Dr. FRANKLIN. External resources, in some sense, even from the 

VA and also from just, sort of—— 

Mr. WALZ. Yeah. 

Dr. FRANKLIN [continuing]. What I say, outside-the-gates resources. Certainly, we have come up with a number of good ideas 

by looking at best practices with other population groups. Whether 
24 

we study police officers or firefighters, there are evidence-based 

practices that can be applied right inside the DOD. 

And part of that is hearing about them, learning about them. I 

have taken a number of briefs myself on these practices, trying to 

stay current. At our quarterly council meeting, we bring in experts 

from outside industry. Most recently, the American Association of 

Suicidology came in and briefed. The Coast Guard has come in and 

briefed a number of best practices. 

And then, from there, the relationships are in place for folks to 

gain more information and further discovery and determine how 

that particular practice might fit within their service. 

Mr. WALZ. Well, I am glad to hear that. Because I think what 

I hope you need to know is in the VA, we talked about this—this 

is all of our issues, all Americans. 

Dr. FRANKLIN. Yes. 

Mr. WALZ. We need to pull in every resource. And you are doing 

all you can, but if there are things we can do, we need to make 

that as available as possible. 

So thank you, Chairman. 

Dr. HECK. Thank you. 

Dr. Franklin, let me ask this. And I know you are new into the 

position, and I appreciate you with your office call that you had a 

few weeks back. We talked a little bit about metrics and the effectiveness and measures. 

But the question I have for you specifically now is: Last year, 

Congress required DOD to develop a policy to collect data on suicide attempts involving members of the Armed Forces and deaths 

of military family members that are reported as suicides. It is my 

understanding that the policy is still being developed. So when can 

we expect to see that policy? 

Dr. FRANKLIN. You are absolutely right; the policy is in progress, 

and it should be done by now. I agree with you. And if folks on the 

panel are frustrated, as am I. We need to move this policy along 

sooner rather than later. It is an important policy, and looking at 

the family member data piece intuitively makes sense. It is the 

right thing to do. 

I wish I could give you an exact date, but just know that it is 

one of the top priorities on my list right now, and I am working 

it hard, as is our entire P&R [Personnel and Readiness] leadership 

team. 

Dr. HECK. Can you ballpark it, maybe not an exact date? 

Dr. FRANKLIN. I would say February 2016. And my leg [legislative] affairs person behind me is probably not appreciating me giving that date, but I am trying to get it done sooner—— 

Dr. HECK. All right. 

Dr. FRANKLIN [continuing]. Sooner rather than later. And, definitely, like I say, I couldn’t agree with you more. 

The good news about this policy is that all the services have met; 

they have agreed upon a standardized approach. Actually, the 

Army led that group. I couldn’t have been more pleased with them 

for that. 

And so, methodologically, the process has been staffed and looked 

at and studied. And I feel confident that when you get the data 

there will be an increased level of fidelity, in part because of the 
25 

length of time that it has taken to put the plan together. But, 

again, it needs to move. 

Dr. HECK. Great. I appreciate you making that a priority. 

You know, all of you talked about the importance of the first-line 

leader, the squad leader, and being the person to identify at the 

lowest possible level somebody who may be at risk. And I certainly 

agree. 

And I know it is very hard to prove the negative, to prove the 

thing that didn’t happen, but how are you measuring whether or 

not the programs you have that are training the frontline leaders 

are actually effective in decreasing suicide attempts? 

I can tell you that, again, in personal experience, I had a squad 

leader, had been through all the training, the ACE [Ask, Care, Escort] training, it was actually a master resilience trainer—and was 

out with one of his squad members on a Friday night. Two hours 

later, after he dropped that squad member off, the squad member 

died of suicide. 

And so the question is, how do we know that the programs that 

we have are actually effective in giving the tools necessary to those 

first-line leaders? 

And I am going to start with Admiral Burkhardt, because we 

have been starting this way, and you have been awfully quiet. So 

we will start this way and go in reverse order. 

Admiral BURKHARDT. Yes. Thank you, sir. 

I think one of the things we have noticed with our bystander 

intervention is helping sailors know that it is ‘‘Every Sailor, Every 

Day’’ and that they have responsibility to step up and step in. And 

that has resonated with that peer-to-peer training and the dialogue 

and the methodology that we have been rolling out, our training 

and our awareness. The sailors are engaged, and they want to 

make a difference. 

I think the struggle is connecting the dots. So a lot of different— 

whether it is a family member or the unit or one of the programs 

that the member has been engaging, like financial counseling or if 

they have been going through administrative or legal separation 

processing or transitions from duty stations, is that we have a way 

to make sure that there are warm handoffs between programs and 

also that we are keeping in touch with that sailor to recognize the 

change. 

Where I have seen a lot of difference between the suicide ideations and—that the sailors are sharing with their shipmates, and 

the shipmates are bringing it to attention and referring the sailor 

to the proper resource. And I see that quite often in the reports I 

receive, that it is happening, whether that referral is to a shipmate 

or to the chain of command or it is a family member that is bringing it to the attention of the chain of command or the chaplain. 

And the chaplain—we are really focused on a strategy to make 

the confidentiality apply to the service member and making a concentrated effort to say that also applies to the family member. And 

it can make a difference where the family member may have a perceived or real perception that if they bring something forward to 

the Navy that they could be hurting the member’s career. 

Dr. HECK. Thank you. 

Admiral BURKHARDT. Yes, sir. 
26 

Dr. HECK. General Whitman. 

General WHITMAN. Yes, sir. It is hard to prove a negative, of 

course, but we, too, track each individual story. I mentioned one in 

my opening report. And we do have a number of those, where we 

can at least see that, in that case, at that moment, we saved a life. 

We have a more robust now training, annual training program 

for our Marines called Marine Awareness and Prevention Integrated Training. Every Marine goes through this every year, and 

it includes elements of identifying risk factors, triggering events, 

warning signs, protective factors. I have tested this when I have 

gone to visit units, and Marines can read back to me what they 

have learned. 

So, again, anecdotally, I think it is making a difference. They 

know. And you can trace back that training to some of these individual cases for peers and for the direct leaders with those Marines. 

Dr. HECK. Great. Thank you. My time has expired. 

Ms. Speier. 

Ms. SPEIER. Mr. Chairman, thank you. And thank you for holding this very important hearing. 

And thank all of you for being here. 

I have been rattling around in my head the New York Times 

Magazine story just a few weeks ago. I mean, I just can’t get the 

pictures of some of those tragic stories out of my mind. And I hope 

all of you, I see the Rear Admiral is nodding her head; she has 

read it. I don’t know if all of you have read it. If you have it, I really commend you to read it. Because while it talks about the suicide 

rates among veterans, it raises a lot of questions. 

And one of the earlier questions by one of my colleagues was 

about whether we are tracking combat versus stateside and the 

like. And I get the impression that you don’t see any difference in 

terms of the suicide rate between those that actually serve in active combat and those who are not in a combat setting. They raise 

that question in that article. 

And I don’t know, I guess the question is, do you track that? 

Dr. FRANKLIN. Absolutely. This is tracked through the DODSER 

[Department of Defense Suicide Event Report], Suicide Event Reporting, tool. It is tracked whether the—— 

Ms. SPEIER. And you see no difference, basically. 

Dr. FRANKLIN. There was recently an article published in the 

New England Journal of Medicine. The title of the article is something to the effect of ‘‘Deployment is not a singular risk factor 

when it comes to suicide.’’ 

The issue is you often have to unpack that variable of deployment. Not only have they deployed, how many times? What was 

the length of their deployment? What was their level of combat exposure while they were on that deployment? And what was their 

preexisting trauma perhaps that they have experienced before they 

even went into the war zone? So it starts to get complicated very 

quickly. Also, what protective factors did they have in place if they 

had had preexisting trauma or not? 

So I struggle when we try to narrow it down to just two simple 

variables: deployment, suicide. It is really not that simple. The 

issue around suicide that a lot of the folks on the panel—— 
27 

Ms. SPEIER. So, excuse me a minute, Doctor. 

Dr. FRANKLIN. Yes. 

Ms. SPEIER. I have limited time. 

Dr. FRANKLIN. Yes. 

Ms. SPEIER. So do we think that possibly multiple deployments 

may have an impact on the higher incidence of suicide? You don’t 

know that either? 

Dr. FRANKLIN. It is not what the data is telling us. 

Ms. SPEIER. Okay. I—— 

Dr. FRANKLIN. No, ma’am. 

Ms. SPEIER. That is fine. Okay. 

Let me ask this question. In that same article, there was a reference to one vet who went to seek help, spoke to a counselor, and 

the counselor said to him, ‘‘You have to think about this as a 

breakup, like a breakup with a woman, and you have to think of 

it in those terms and move on with your life.’’ And I thought to myself, we have serious problems if we have healthcare professionals 

providing services to persons with mental health issues talking to 

them in those kinds of terms. 

So it raises the question, what are the qualifications of those who 

are counseling persons that have mental health issues who are Active Duty military? 

General EDIGER. I can speak to that. 

So, across all three services, we have common standards in terms 

of the credentials that are required in order to gain—— 

Ms. SPEIER. And they are? 

General EDIGER [continuing]. Privileges. 

Well, for licensed clinical social workers, there is a licensure in 

one of the States of the Union. And they must be certified as a licensed clinical social worker. 

As far as psychologists, we privilege them at the Ph.D. level, for 

our clinical psychologists across the three services. 

And, of course, psychiatrists, residency-trained in a program approved by the ACGME [Accredited Council for Graduate Medical 

Education], which is the—— 

Ms. SPEIER. Right. 

General EDIGER [continuing]. Organization in the U.S. that does 

that. 

Ms. SPEIER. So a clinic social worker could, in fact, be counseling 

someone who is suicidal. 

General EDIGER. Yes. Yes. And they are trained to do that. 

Ms. SPEIER. Okay. 

So have we, kind of, reviewed the qualifications of those who provide those services and see success versus non-success? I mean, 

maybe that is not something we can do, but it certainly would be 

interesting to see if there is a certain level of educational attainment and experience that is most effective in assisting someone 

who has suicidal tendencies. 

General EDIGER. And so, in the Military Health System, we have 

a scope of practice that is specifically defined for each individual 

provider and that is tailored to their certification and their specialty. And so each commander of each medical unit specifically 

privileges the provider to provide certain elements of mental health 

care. 
28 

And so a licensed clinical social worker knows full well what 

privileges they hold and what services they are qualified and 

cleared to perform. And then, if they recognize that a patient needs 

care that goes beyond their scope of practice, then they refer them 

to a higher level of care, to a clinical psychologist or a psychiatrist 

as the case may be, or perhaps refer them for residential or inpatient care. 

And so this is all monitored through a quality assurance process 

that is defined in a DOD instruction. 

Ms. SPEIER. Mr. Chairman, could I have one more question? 

Dr. HECK. We are going around for a second round, so hopefully 

we will get to you. 

Mrs. Davis. 

Mrs. DAVIS. Go ahead. 

Dr. HECK. Okay. Mrs. Davis will yield. 

Ms. SPEIER. Thank you. I thank you for yielding. 

I have one question, one comment. 

The use of psychotropic drugs with persons that have suicidal 

tendencies I am sure is used a great deal. Have you tracked those 

who have committed suicide as to whether or not they have taken 

their lives with drugs or by use of firearms? 

And what has that told you? What have you learned from that? 

General EDIGER. We do. 

In regards to firearms, at the DOD level, we actually have statistics, and that is the most frequent means of committing suicide 

among service members across all three services. And that is true 

of males nationally in the U.S., as well. 

In regards to mental health care, we do actually track, and we 

know which of the patients, which of the service members that 

commit suicide were under mental health care within 90 days, in 

our case, of the time they committed suicide. Each of those cases 

is individually reviewed. 

And we have a lot of service members that receive mental health 

care month to month. I know in the Air Force we have 230,000 

mental health visits a year across it. And, of course, the rate at 

which those mental health patients commit suicide is well below, 

you know, .01 percent. 

But everyone that does commit suicide who was under some kind 

of mental health care, both Army, Navy, and Air Force, is reviewed 

to determine if there is something we can learn from that. 

And I can tell you, in many cases, those patients had encounters 

with mental health, but, actually, even though at every visit we 

have a standard that we require a suicidal risk assessment, in 

many cases those patients never expressed an intent or a desire to 

commit suicide during their mental health visit. 

Ms. SPEIER. I thank the gentlelady for yielding, and I yield back. 

Mrs. DAVIS. Thank you. 

You all talked about the resilience and trying to build that in 

with families. And I have some dear friends, and it is kind of an 

amazing case that has been followed by a lot of people because 

their son had enough going for him to write a very extensive suicide note. And one of the issues for them was whether or not there 

would have been the ability for someone to contact them that their 

son was having such difficulty. 
29 

We have many safeguards in terms of confidentiality, and I respect all of those. But are there some tools, in working with this 

and I was trying to go through, as well, with the IG’s report. I 

didn’t see them making any specific recommendations. Obviously, 

we are concerned about confidentiality on a number of different 

levels. But families want to be there for their loved one, and often 

they have no idea. 

Are there some ways that you are seeing that that can perhaps 

be someone would have the ability to sign off on permission? And 

I would see this even as early as the recruitment phase, that while 

you are educating families and parents and the service member— 

I don’t know. How do we do that? Because I think we would prevent more problems if families had the knowledge. 

Dr. FRANKLIN. Yes. And thank you, Rep. Davis, for sending that 

family to me. I had a wonderful afternoon with them, and I really 

appreciated the opportunity that you provided in terms of hooking 

us up. And I appreciated the special time that I had with them to 

hear their unique story. 

And I could see their story transferrable across multiple other 

stories, and so I was thankful that they highlighted it and brought 

it forward, because I think that could be a practice. And I gave 

them my commitment to look into that further, this notion of a listserv or perhaps some education and outreach to parents of young 

service members that would educate the parents on just military 

life in general. 

Being a part of this culture for my entire life, there are some 

things we take for granted about the culture that we know because 

we have always known them. And that family and many others 

like them could greatly benefit just from some education and some 

awareness in a way that doesn’t impact the confidentiality that you 

mention. 

Thank you so much. 

Mrs. DAVIS. Thank you. 

Dr. HECK. Mr. MacArthur. 

Mr. MACARTHUR. I recognize your primary focus is on prevention, as it should be, and I respect you for that. I have a question 

for General McConville, and it has more to do with the impact of 

these suicides on others and its effect on military readiness. 

And you noted earlier that there is a higher suicide rate among 

those with fewer deployments, which is surprising, I guess, to me. 

And you suggested the possibility, maybe even the likelihood, that 

this is related to preexisting conditions when people enter service. 

And I wondered, are your findings making their way to the recruitment process? Things likes resiliency, are you looking at indicators and putting that into recruitment? Or is it too unformed yet, 

the conclusions, for that to have happened? 

General MCCONVILLE. Thank you for the question, sir. 

Where we are right now is this notion of measuring resiliency, 

because we want to prevent suicides, but what we really want to 

do is we want to build these incredibly high-quality soldiers that 

can go out on the battlefield and do the things that we need to do 

for the country. 

So what we use, we have the Army Research Institute that 

works for us. It is social scientists; that is what they do for a living. 
30 

And what we are trying to do is take terms like ‘‘resilience’’ and 

say, okay, how do you actually test someone? 

We have tests that we do right now when soldiers come in. They 

take, other than the standard-type test, we call it TAPAS [Tailored 

Adaptive Personality Assessment System], where we try to get an 

idea of how sound they are. But we are trying to refine that 

science. 

Mr. MACARTHUR. But does that imply, because I am inferring 

that you have concluded that lack of resilience is a possible precondition, something that predisposes somebody to taking their 

own life. 

General MCCONVILLE. Well, what we have found, at least from 

the Army perspective, is, we were doing what I would call a lot of 

diving catches and my Marine colleague talked about that, is how 

we, all of a sudden, had a soldier in serious and we basically saved 

his life. We have lots of stories, Marines, all of us have. 

So that is one part of it. But what you want to do is kind of move 

away from that. What we are trying to do is move the whole force, 

really, away from what the red area. I call the diving catch the red 

area. We move to a yellow area, where we start to manage and 

identify these transitions or these high-risk factors that we are 

training our solders to do. 

And we move them even further, where they are really in a resilience phase, where we build soldiers who can handle stress, who 

can handle adversity. If they have behavioral-health-type issues, 

they are getting that early on, just like if you had knee injuries or 

physical-type injuries. 

Mr. MACARTHUR. Yeah. And my question is take your knee injury. There is a certain degree of physical incapacity that would 

render someone unfit for military duty. 

General MCCONVILLE. Right. 

Mr. MACARTHUR. Are you taking some of these findings regarding resilience and other things that I think you are suggesting may 

be precursors or things that cause somebody to be more tending towards that, are they coming into the recruitment process? Are you 

looking at resiliency or brittleness, maybe the opposite, in personality testing to see whether someone raises a red flag at the recruitment? 

Or is it, again, too unfounded yet and would actually be discriminatory? I am trying to get a sense of whether you have closed the 

loop on the recruitment side. 

General MCCONVILLE. Yeah. What we are trying to do is we are 

trying to find that sweet spot. Because we don’t want for folks that 

have sought treatment, to say, ‘‘Hey, you can’t serve.’’ You know, 

we are trying to find—I mean, just like some of the types of injury. 

We want to give everyone the opportunity to serve that can meet 

the standards and is mentally fit enough to do that. So we don’t 

want to have an arbitrary, if you have had some type of behavioral 

health counseling, if you saw a high school counselor. 

So the challenge we have right now and I have asked my, I am 

not a scientist. I am a helicopter pilot by trade. But what we are 

trying to do is get the science to help us do that, where it is a fairtype assessment where we can screen and look at that. 
31 

Part of the STARRS study was to try to find that. We are not 

there yet in science. And we would like to get there because we 

think that would be helpful for everyone involved, if we could 

screen to a level where we identify—like we could do with a lot of 

the physical-type injuries. 

Mr. MACARTHUR. I would just add, in my few remaining seconds, 

I am not faulting you for that. I think it could be a slippery slope, 

but I am interested in, as we come to conclusive findings, where 

they make their way into our practices in the military. I think that 

would be helpful. 

I yield back. 

Dr. HECK. Mr. O’Rourke. 

Mr. O’ROURKE. Mr. Chairman, I just want to thank those who 

testified today. 

I learned a lot at today’s hearing. And some of the facts that you 

gave us were counterintuitive to my assumptions about where we 

should be looking and where we see risk. 

But I do think, Dr. Franklin, that we do need to see the analysis 

that you talked about, and we do need to better understand the 

measures for success and hold ourselves and you accountable for 

that going forward. 

And I am very interested in understanding how we apply what 

we learned here or within the Department of Defense to taking 

care of veterans who may be at higher risk for death by suicide. 

So thank you all for what you are doing. 

Thank you, Mr. Chairman. 

Dr. HECK. Mr. Walz. 

Mr. WALZ. I am good. 

Dr. HECK. Ms. Speier? Okay. 

Again, I thank you all very much for being here today and offering your testimony. We all stand ready to assist you in whatever 

way possible as we try to erase this scourge of suicide within our 

military. 

This hearing is adjourned. 

[Whereupon, at 4:00 p.m., the subcommittee was adjourned.] 

A P P E N D I X 

OCTOBER 8, 2015 

PREPARED STATEMENTS SUBMITTED FOR THE RECORD 

OCTOBER 8, 2015 

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WITNESS RESPONSES TO QUESTIONS ASKED DURING 

THE HEARING 

OCTOBER 8, 2015 

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RESPONSE TO QUESTION SUBMITTED BY MR. MacARTHUR 

Dr. FRANKLIN. Prior to our implementation of the current rate methodology in 

March of 2014, we used a method that was based on duty status. The previous 

method did not distinguish the Active Component from the Reserve Component, represented the number of Reserve and National Guard Service members in the force 

at 11% of the Active Duty population, and combined fiscal and calendar year data. 

The current methodology provides leadership with a clearer distinction between Active and Reserve Components, and we are able to determine that the Reserve Component appears to be tracking at a higher rate than the Active Component. 

We have applied the current rate calculation methodology to our data going back 

11 years (2003–2013) for the Active Component, and 4 years (2010–2013) for the Reserve Component. Once we applied the new method to the past years for the Active 

Component, we did learn that the new Active Component rates followed yearly 

trends similar to the previous methodology which was based on duty status. We do 

not have the data needed to calculate the rate retroactively prior to 2010 for the 

Reserve Component. 

Applying the new method and examining the Active Component data from the 

Armed Forces Medical Examiner (2003–2013), the suicide rate increased from 2003 

(10.8 per 100,000) until it peaked in 2012 (22.7 per 100,000). In 2013, the Active 

Component suicide rate declined to 18.7 per 100,000. We have not yet published a 

2014 rate. 

Applying the new rate calculation method and examining the data from the Reserve Component, there was an initial decrease from 23.5 per 100,000 in 2010 to 

21.8 per 100,000 in 2011. Since 2011, the rate steadily increased to 26.4 per 100,000 

in 2013. In the current methodology, Reserve Component rate includes members of 

the National Guard and Reserve regardless of their duty status. [See page 17.] 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING 

OCTOBER 8, 2015 

(97) 

QUESTIONS SUBMITTED BY MR. JONES 

Mr. JONES. What is the Department of Defense and the services doing to determine what information sharing would be most helpful to help prevent suicides? 

Dr. FRANKLIN. The Department of Defense has two governance structures to guide 

suicide prevention efforts and share best practices. The first is the Suicide Prevention Risk and Reduction Committee (SPARRC) which meets on a quarterly basis. 

The SPARRC serves as a collaborative forum of subject matter experts to facilitate 

the flow of information between the Defense Suicide Prevention Office (DPSO), Military Departments, and other stakeholders for the exchange of best practices and lessons learned. It also advises the Director, DSPO on suicide prevention issues; identifies policy and program changes required to improve suicide-related programs; submits recommendations to the Director, DSPO for approval; and facilitates and implements action items approved by the Suicide Prevention General Officer Steering 

Committee (SPGOSC). The SPARRC also facilitates collaboration between federal 

organizations such as the Department of Veterans Affairs, Department of Health 

and Human Services, including the Substance Abuse and Mental Health Administration, Centers for Disease Control and Prevention, and National Institute of Mental Health. 

The second governance is the SPGOSC which serves as an advisory body to the 

Under Secretary of Defense for Personnel and Readiness (USD(P&R)). The SPGOSC 

facilitates the review, assessment, integration, standardization, implementation, and 

resourcing of suicide prevention policies and programs. It also addresses present, 

emerging, and future suicide prevention needs, and evidence-based practices for 

military and civilian personnel that have DOD-wide applicability and provide recommendations to the USD(P&R) via the DSPO. 

DSPO most recently attended last month’s Air Force summit on suicide prevention to share evidence-based best practices to help inform the Air Force’s suicide 

prevention, intervention and postvention efforts. The Army, Navy, and Marine 

Corps also had representatives at the Summit to share best practices. It is through 

on-going engagement with the Services and other stakeholders that we will continue 

to share best practices to guide the Department’s suicide prevention efforts. 

Mr. JONES. As I understand it, military members and veterans all access the same 

call center when they call in to a DOD/VA suicide prevention hotline. The person 

providing the immediate counseling must have as much information as possible to 

help prevent a suicide and get the military member or veteran the help they need. 

All information is vital to include medications, number of deployments, martial status, children, etc, anything that will help the counselor connect with the caller. Is 

this type of information readily available to the counselor and if not why not? 

Dr. FRANKLIN. Veterans/Military Crisis Line (VCL/MCL) staff has read-only access to callers’ relevant information that aids in thorough suicide assessment and 

dispatch of emergency services, if needed. Staff can view the Department of Veterans Affairs (VA) medical records for registered Veterans and Guard or Reserve 

members; staff use Joint Legacy Viewer (JLV) to view the Department of Defense’s 

medical records for Active Duty Service members and Guard or Reserve members 

who are not registered with VA. Except in an emergency for which VCL/MCL staff 

must dispatch emergency response, staff ask for a caller’s permission to access medical record information, and will respect the caller’s request for privacy and not access records if denied permission. There are no other limitations on information 

VCL/MCL staff can legally ask callers. Information that is particularly relevant to 

the VCL/MCL mission and routinely reviewed via access of records during calls includes: 

• Past suicide attempts, recent assessments of suicidality and safety plan for suicide prevention 

• Past and current lists of medications and the conditions for which they were 

prescribed 

• Branch of service, dates of service, and combat status 

• Demographic information including address, age, social security number, and 

race 
98 

Æ The Social Security Number (SSN) is a primary field used to search within 

both VA medical records and Joint Legacy Viewer (JLV) in order to identify 

the correct patient record. Both systems can be searched using only the last 

4 of the SSN and, if multiple results are returned, the name or other demographic information can be used to confirm the correct record is viewed • Next of kin information • Recent medical or mental health care and upcoming appointments 

Mr. JONES. What is the Department of Defense and the services doing to determine what information sharing would be most helpful to help prevent suicides? 

General MCCONVILLE. Suicide prevention efforts between the Military Services 

are now more integrated compared to recent years as a result of the collaborative 

approach under the Defense Suicide Prevention Office (DSPO). The DSPO established the Suicide Prevention Risk Reduction Council (SPARRC) for the purpose of 

collaboration, communication, and documentation of suicide prevention best practices across the Department. The DSPO General Officer Steering Committee was 

also established with participation across the Department to provide oversight and 

guidance for governance and execution of the Defense Strategy for Suicide Prevention. 

To further our collaboration and information sharing efforts across the four Services, the Army established a Service Suicide Prevention Program Manager (SPPM). 

SPPM conducts a monthly teleconference to review ways to bolster our holistic prevention efforts across multiple prevention portfolios. We frequently review and share 

policy guidance, data sharing, tools, and training curriculum, and have worked 

closely on intervening techniques with the Navy and Resilience Training with the 

Air Force. From the Medical perspective, the Army Director of Psychological Health 

conducts a weekly meeting with participation across all Services to discuss potential 

Office of the Secretary of Defense, Mental Health policy changes. 

Mr. JONES. As I understand it, military members and veterans all access the same 

call center when they call in to a DOD/VA suicide prevention hotline. The person 

providing the immediate counseling must have as much information as possible to 

help prevent a suicide and get the military member or veteran the help they need. 

All information is vital to include medications, number of deployments, martial status, children, etc, anything that will help the counselor connect with the caller. Is 

this type of information readily available to the counselor and if not why not? 

General MCCONVILLE. Yes, the Veterans/Military Crisis Line (VCL/MCL) staffs 

have access to each caller’s relevant information to aid in thorough suicide assessment and dispatch of emergency services, if needed. Data sources available include 

the Department of Veterans Affairs (VA) medical records for registered Veterans 

and use Joint Legacy Viewer (JLV) to view the Department of Defense’s medical 

records for Active Duty Service Members. Except in an emergency, for which VCL/ 

MCL staff must dispatch emergency response, staff must ask for each caller’s permission to access medical record information, and must respect callers request for 

privacy and not access records if denied permission. Typical access of records during 

calls includes: Past suicide attempts, recent assessments of suicidality and safety 

plan for suicide prevention, Past and current lists of medications and the conditions 

for which they were prescribed, Branch of service, dates of service, and combat status, Demographic information including address, age, social security number, and 

race, Next of kin information, and Recent medical or mental health care and upcoming appointments. 

Mr. JONES. What is the Department of Defense and the services doing to determine what information sharing would be most helpful to help prevent suicides? 

General EDIGER. Suicide prevention efforts within the Services have become increasingly integrated and standardized in recent years under the guidance and support of the Defense Suicide Prevention Office (DSPO). The DOD Suicide Event Report (DODSER) tool is the standard mechanism for the Services to report suicides 

and suicide attempts of Service members. The DODSER contains approximately 150 

data fields that can be further analyzed at the Service and DSPO levels. Service 

Suicide Prevention Program Managers hold a monthly teleconference to coordinate 

their efforts and share information. Also, the Quarterly Suicide Prevention and Risk 

Reduction Council meetings provide opportunities for the Services to meet together 

with DSPO and a quarterly Tri-Service Suicide Prevention General Officer Steering 

Committee ensures senior leader engagement and interservice coordination. In September 2015, AF Suicide Prevention Summit brought the military Services and 

DSPO together to participate in forging recommendations to enhance suicide prevention efforts in the AF. Attendees included a wide cross-section of AF leaders and 

key stakeholders and brought them together with esteemed experts from agencies 

such as National Institute of Mental Health and Centers for Disease Control and 

Prevention, as well as academia. This positive shift in terms of the climate of col-
99 

laboration has promoted alignment between the U.S. national strategy for Suicide 

Prevention, the DOD strategy and the individual Service strategies. The current 

status of information sharing represents a significant improvement in recent years 

and further integration and standardization of data collection, reporting and analysis are progressing consistently. From the clinical; while military healthcare providers have limitations in what they can share based on regulations such as HIPAA, 

they are required to inform commanders if there is a concern of harm to self or others, potential harm to the mission or duty impairment. Commanders and supervisors are encouraged to share information if they are concerned about a member. 

Medical information is shared and available in real time to all medical personnel 

across the military services through the AHLTA system, which is also available in 

the deployed setting and linked with VA data systems to facilitate Service member 

transitions. The AF has initiated systematic multidisciplinary reviews of suicides, 

while DSPO is working on developing an analytic framework for reviewing suicides 

to further capitalize on the opportunity to capture and share such information 

across Services and DOD. This data will be a critical next step in advancing our 

understanding of suicides in the military and informing our next wave of prevention 

and intervention efforts. 

Mr. JONES. As I understand it, military members and veterans all access the same 

call center when they call in to a DOD/VA suicide prevention hotline. The person 

providing the immediate counseling must have as much information as possible to 

help prevent a suicide and get the military member or veteran the help they need. 

All information is vital to include medications, number of deployments, martial status, children, etc, anything that will help the counselor connect with the caller. Is 

this type of information readily available to the counselor and if not why not? 

General EDIGER. Hotlines such as the DOD/VA Crisis Line follow a crisis response 

model that minimizes stigma and promotes autonomy for the user providing 24/7 

access and allowing them to share only the information they are comfortable with. 

Callers may opt to use the service in lieu of traditional counseling or medical care 

and having control over disclosure of their medical and personal information may 

be crucial to allowing them to establish rapport. Crisis line counselors have access 

to the CAPRI system which contains medical information for those enrolled in the 

VA system, but must obtain the caller’s consent and personal information before accessing the system. DOD/VA Crisis Line counselor can connect the member to counseling or medical care through a local crisis coordinator in their geographic region. 

These local coordinators can refer to military, VA or civilian resources for support, 

information or counseling and can alert command or civilian authorities for an 

emergency response if warranted. Each of the military services has medical liaisons 

to the Crisis Line to ensure seamless support and a rapid exchange of information 

to facilitate appropriate medical or mental health care referrals. By occupying a 

unique niche outside of established medical and mental health services the Crisis 

Line provides an additional option for veterans and Service members in distress. 

Mr. JONES. What is the Department of Defense and the services doing to determine what information sharing would be most helpful to help prevent suicides? 

General WHITMAN. The Marine Corps continues to address information sharing as 

a key element of preventing suicide, including what information is most helpful. We 

currently have several ongoing initiatives highlighting the importance of the availability of information. For example, we participate in quarterly Suicide Prevention 

and Risk Reduction and General Officer Steering Committee meetings in collaboration with the Department of Defense Suicide Prevention Office (DSPO) and sister 

services in an effort to determine best practices to prevent suicide. The Marine 

Corps recently completed an initiative to improve Commanders access to health information by training Commanders and behavioral health providers on confidentiality rules and effective coordination of care. 

Mr. JONES. As I understand it, military members and veterans all access the same 

call center when they call in to a DOD/VA suicide prevention hotline. The person 

providing the immediate counseling must have as much information as possible to 

help prevent a suicide and get the military member or veteran the help they need. 

All information is vital to include medications, number of deployments, martial status, children, etc, anything that will help the counselor connect with the caller. Is 

this type of information readily available to the counselor and if not why not? 

General WHITMAN. For specific information on the DOD/VA suicide prevention 

hotline, we defer to DSPO and VA. In general terms, when a call center responder 

speaks with a service member or veteran in crisis, s/he gathers information directly 

from the caller to appropriately respond to the crisis. This may include the caller’s 

geographic location, service status, suicide-related intent, environmental safety, access to lethal means, and any active medical emergencies impacting the crisis. If the 

service member or veteran has contacted the call center previously, that information 
100 

is also available. Ultimately, a call center responder’s ability to connect with a service member or veteran calling in crisis is fostered more by appropriate training and 

the ability to quickly build rapport. 

Mr. JONES. What is the Department of Defense and the services doing to determine what information sharing would be most helpful to help prevent suicides? 

Admiral BURKHARDT. Navy meets regularly with the other Services, in multiple 

venues that occur at various levels, from action officer to flag officer, to collaboratively identify and share best practices for suicide prevention across the Department of Defense (DOD). Additionally, the Armed Services collaborate with the Defense Suicide Prevention Office (DSPO), which collects evidenced-based best practices from the Services and civilian entities, and disseminates them throughout 

DOD. 

Mr. JONES. As I understand it, military members and veterans all access the same 

call center when they call in to a DOD/VA suicide prevention hotline. The person 

providing the immediate counseling must have as much information as possible to 

help prevent a suicide and get the military member or veteran the help they need. 

All information is vital to include medications, number of deployments, martial status, children, etc, anything that will help the counselor connect with the caller. Is 

this type of information readily available to the counselor and if not why not? 

Admiral BURKHARDT. The suicide prevention hotline is a Department of Veterans 

Affairs initiative in collaboration with the National Suicide Prevention Lifeline. The 

hotline operates 24 hours a day, seven days a week, and is staffed by trained mental 

health professionals prepared to deal with immediate crisis. As with all mental 

health professionals, VA hotline mental health professionals must rely on information provided by the person seeking their services. Callers must have the option of 

remaining anonymous, if they so choose, or they can disclose their identities to allow 

the staff to access VA medical records real-time during the call. 

QUESTIONS SUBMITTED BY MS. TSONGAS 

Ms. TSONGAS. What actions has DOD leadership taken to respond to the Inspection General on the observations and recommendations from the November 14, 

2014, DOD Suicide Prevention Assessment? When do you expect DOD will have a 

response to all the findings and recommendations? 

Dr. FRANKLIN. The Department agreed to implement the recommendations and is 

working to modify policy for the Department of Defense Suicide Event Report submission process. The Under Secretary of Defense for Personnel and Readiness published a memorandum to the DOD components which provided interim guidance in 

support of the recommendations contained in the report. At this time, many of the 

recommendations from the DOD Suicide Prevention Assessment have been addressed. 

In addition, the Defense Suicide Prevention Office is working diligently with the 

Services to incorporate the recommendations into an upcoming Department of Defense Instruction (DODI), which is currently in development. We estimate completion of this DODI in 2016. 

Ms. TSONGAS. What steps has leadership taken to allow medical record sharing 

with the VA’s Military Crisis Line and service member’s health records? Especially 

since the IG identified a substantial and specific danger to public health and safety 

with regards to the DOD appropriately transmitting relevant service records to the 

VA. 

Dr. FRANKLIN. This recommendation is complete. The Veterans Crisis Line/Military Crisis Line staff received access to the Joint Legacy Viewer on July 31, 2015, 

to access Department of Defense medical records, and this capability has resulted 

in more timely access to crisis intervention services. 

Ms. TSONGAS. Where is the DOD with the milestones they established with regards to the recommendations from the (DODIG–2015–016) report? Was DOD able 

to meet any of their established milestones? If milestones were missed has OSD established new milestones? 

Dr. FRANKLIN. The Department has achieved a number of milestones with regard 

to the observations and recommendations from the DODIG–2015–016 report. 

Refinement to the under/technical assistance has been completed, after a complete 

help text overhaul of the DODSER survey deployed in 2015. 

After action reviews are an ongoing process that began in 2015 with the task of 

engaging in weekly After Action Reviews with actual DODSER users. The findings 

of these reviews have been presented quarterly to the Defense Suicide Prevention 

Office and the Service Suicide Prevention Program Managers. 
101 

Quality Assurance reviews are an ongoing process involving monthly data quality 

reviews of submitted DODSERs where ‘‘missing’’ or ‘‘unknown’’ responses are selected. Frequently occurring errors or missed data will be discussed with the Services’ DODSER Program Managers so that findings from the Quality Assurance Review can be incorporated into feedback and guidance to their DODSER form 

completers. Items that are commonly ‘‘unknown’’ will be compared against the feedback from the After Action Reviews in Recommendation 3.c. to identify questions 

that are likely to cause confusion or that are difficult to answer. 

The DODSER has been modified and the software development aspect of these 

recommendations has been completed and is currently being reviewed by an internal quality assurance team for overall compatibility with the system. This review 

will be completed in November 2015, at which point the software changes will be 

ready for deployment. We anticipate deploying these changes alongside the other 

Annual Changes on January 1, 2016, in compliance with the IG deadline. 

With regards to trend data, official action related to this is pending the development of policy, per the IG recommendations, because of Protected Health Information/Personally Identifiable Information privacy concerns regarding the provision of 

raw, identified DODSER data to Installation Commanders. However, the DODSER 

software and web-interface already contain an automated reporting tool through 

which users can specify variables of interest and create a customized, de-identified 

data report containing counts and percentages. Additionally, if installations need 

identified data, there are processes that exist within the Defense Health Agency system to get approvals for sharing identified data. 

Ms. TSONGAS. The November 14, 2014, DOD IG report identified shortcomings in 

the DOD Suicide Event Report (DODSER). How do the DOD, DSPO, and all services plan to fix these problems before implementation of a new policy that includes 

the Guard and Reserves? 

Dr. FRANKLIN. The Department has made significant progress on efforts to address shortcomings identified in the November 2014 DOD IG Report, to be completed by the IG deadline of January 1, 2016. 

The DODSER has been modified to allow for ‘‘No Known History of XXX’’ responses and to require an explanation for ‘‘don’t know/data unavailable.’’ The software development aspect of these recommendations has been completed and is being 

reviewed by a quality assurance team for overall Information Technology compatibility with the system. This change will be deployed alongside the other, Service 

Requested, Annual Changes set for January 1, 2016. 

The refinement of the user/technical assistance has been completed. The completely revised help text was deployed on January 1, 2015, and has been available 

to users since that date. 

The Department is conducting ongoing, weekly after action reviews with DODSER 

users as well as monthly Data Quality Reviews on 10% of a given month’s submitted reports. Frequently occurring errors or missed data are discussed with the 

Services’ DODSER Program Managers so that findings from the Quality Assurance 

Review can be incorporated into feedback and guidance to their DODSER form 

completers. Items that are commonly ‘‘unknown’’ will be compared against the feedback from the After Action Reviews in Recommendation 3.c. to identify questions 

that are likely to cause confusion or that are difficult to answer. 

Official action related to software updates to allow unit and installation trend reports is pending the development of policy because of Protected Health Information/ 

Personally Identifiable Information privacy concerns regarding the provision of raw, 

identified DODSER data to Installation Commanders. However, the DODSER software and web-interface already contain an automated reporting tool through which 

users can specify variables of interest and create a customized, de-identified report 

containing counts and percentages. Additionally, if installations need identified 

data, there are processes that exist within the Defense Health Agency system to get 

approvals for sharing identified data. 

Æ