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i 

80–193 2013

[H.A.S.C. No. 113–23] 

UPDATE ON MILITARY SUICIDE 

PREVENTION PROGRAMS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON MILITARY PERSONNEL 

OF THE

COMMITTEE ON ARMED SERVICES 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

HEARING HELD 

MARCH 21, 2013 
(II) 

SUBCOMMITTEE ON MILITARY PERSONNEL 

JOE WILSON, South Carolina, Chairman 

WALTER B. JONES, North Carolina 

JOSEPH J. HECK, Nevada 

AUSTIN SCOTT, Georgia 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

CHRISTOPHER P. GIBSON, New York 

KRISTI L. NOEM, South Dakota 

SUSAN A. DAVIS, California 

ROBERT A. BRADY, Pennsylvania 

MADELEINE Z. BORDALLO, Guam 

DAVID LOEBSACK, Iowa 

NIKI TSONGAS, Massachusetts 

CAROL SHEA-PORTER, New Hampshire 

JEANETTE JAMES, Professional Staff Member 

DEBRA WADA, Professional Staff Member 

COLIN BOSSE, Staff Assistant 
(III) 

C O N T E N T S 

CHRONOLOGICAL LIST OF HEARINGS 

2013 

Page 

HEARING: 

Thursday, March 21, 2013, Update on Military Suicide Prevention Programs . 1 

APPENDIX: 

Thursday, March 21, 2013 ...................................................................................... 33 

THURSDAY, MARCH 21, 2013 

UPDATE ON MILITARY SUICIDE PREVENTION PROGRAMS 

STATEMENTS PRESENTED BY MEMBERS OF CONGRESS 

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

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

Wilson, Hon. Joe, a Representative from South Carolina, Chairman, Subcommittee on Military Personnel ........................................................................ 1 

WITNESSES 

Bromberg, LTG Howard B., USA, Deputy Chief of Staff, G–1, U.S. Army ........ 5 

Garrick, Jacqueline, Acting Director, Defense Suicide Prevention Office ........... 3 

Hedelund, BGen Robert F., USMC, Director, Marine and Family Programs, 

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

Jones, Lt Gen Darrell D., USAF, Deputy Chief of Staff for Manpower and 

Personnel, U.S. Air Force .................................................................................... 7 

Reed, Dr. Jerry, Ph.D., MSW, Vice President and Director, Center for the 

Study and Prevention of Injury, Violence and Suicide, Suicide Prevention 

Resource Center ................................................................................................... 9 

Van Buskirk, VADM Scott R., USN, Deputy Chief of Naval Operations, Manpower, Personnel, Training, and Education, U.S. Navy ................................... 7 

APPENDIX 

PREPARED STATEMENTS: 

Bromberg, LTG Howard B. .............................................................................. 55 

Davis, Hon. Susan A. ....................................................................................... 38 

Garrick, Jacqueline .......................................................................................... 41 

Hedelund, BGen Robert F. ............................................................................... 88 

Holt, Hon. Rush, a Representative from New Jersey .................................... 39 

Jones, Lt Gen Darrell D. .................................................................................. 79 

Reed, Dr. Jerry ................................................................................................. 98 

Van Buskirk, VADM Scott R. .......................................................................... 67 

Wilson, Hon. Joe ............................................................................................... 37 

DOCUMENTS SUBMITTED FOR THE RECORD: 

[There were no Documents submitted.] 

WITNESS RESPONSES TO QUESTIONS ASKED DURING THE HEARING: 

Mrs. Davis ......................................................................................................... 111 

Dr. Heck ............................................................................................................ 111 
Page

IV 

WITNESS RESPONSES TO QUESTIONS ASKED DURING THE HEARING—Continued 

Mrs. Noem ......................................................................................................... 111 

Mr. Scott ............................................................................................................ 111 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING: 

Ms. Shea-Porter ................................................................................................ 115 
(1) 

UPDATE ON MILITARY SUICIDE PREVENTION 

PROGRAMS 

HOUSE OF REPRESENTATIVES, COMMITTEE ON ARMED SERVICES, SUBCOMMITTEE ON MILITARY PERSONNEL, Washington, DC, Thursday, March 21, 2013. 

The subcommittee met, pursuant to call, at 10:02 a.m., in room 

2118, Rayburn House Office Building, Hon. Joe Wilson (chairman 

of the subcommittee) presiding. 

OPENING STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM SOUTH CAROLINA, CHAIRMAN, SUBCOMMITTEE 

ON MILITARY PERSONNEL 

Mr. WILSON. I would like to welcome everyone to a meeting of 

the Military Personnel Subcommittee on the very important issue 

of military suicide prevention programs. Today the subcommittee 

meets to hear testimony on the efforts by the Department of Defense and the military services to prevent suicide by service members, military families, and civilian employees. 

I want to preface my statement by recognizing the tremendous 

work the Department of Defense and the service leadership has 

done to respond to the disturbing trend of suicide in our Armed 

Forces. This has not been an easy task and I thank you for your 

hard work. 

Suicide by members of our Armed Forces is particularly distressing to me because I consider military service an opportunity 

for a person to achieve their highest ability of fulfilling life. I also 

consider military service as a family, where we want the best for 

each other and we care about each other. 

I want service members to know they are talented people who 

are important and appreciated by the American people. They can 

overcome challenges. 

Suicide is a difficult topic to discuss. Last year 350 service members took their own lives. Each one of them is a tragedy. 

Every one of them has a deeply personal story. We cannot rest 

until we have created every opportunity to change such an awful 

statistic. 

Suicide is a multifaceted phenomenon that is not unique to the 

military. Unfortunately, in addition to the hardships of military 

service, our service members are subject to the same pressures that 

challenge the rest of society. They are exposed to the same 

stressors that may lead to suicide by their civilian counterparts. 

I am deeply concerned about the uncertainty of sequestration 

and the coming budget challenges, how that will affect our service 

members and their families. Each of the military services in the 
2 

Department of Defense has adopted strategies to reduce suicide by 

our troops. 

I would like to hear from our witnesses whether those strategies 

are working. How do you determine whether your programs incorporate the latest research and information on suicide prevention? 

I am also interested to know how Congress can further help and 

support your efforts. Lastly, I am interested in learning how our 

civilian experts are tackling the problems across the Nation and 

how private organizations, like Hidden Wounds of Columbia, are 

assisting and making a difference. 

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

to your testimony. 

Before I introduce our panel, let me offer Congresswoman Susan 

Davis from San Diego an opportunity as ranking member to make 

her opening remarks 

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

STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE 

FROM CALIFORNIA, RANKING MEMBER, SUBCOMMITTEE ON 

MILITARY PERSONNEL 

Mrs. DAVIS. Thank you, Mr. Chairman. 

And welcome to all of you. Thank you so much for being here and 

sharing your expertise with us. 

I am pleased that the subcommittee is continuing its attention 

on suicides in the military. It has been nearly a year and a half 

since our last hearing, and during this time we have only seen increased numbers of service members taking their own lives. And 

behind each statistic we know there are families with shattered 

lives. 

While Congress has pushed forward a number of initiatives to 

support the Services and the Department of Defense in their efforts 

to develop policies and programs to reduce and prevent suicides in 

the force, we know that these numbers continue to grow. 

And yet, we also know that military service members are not 

alone. Over 38,000 individuals die by suicide every year. 

In 2010, suicide was the 10th leading cause of death in the 

United States and the fourth leading cause of death for adults between the ages of 18 and 65. While suicide among young individuals from 15 to 25 years continues to be a concern, the rate of suicide among older Americans is even higher. 

It is important that we share what we learn in the military and 

what is learned by others in our country if we are to be successful 

in addressing this societal issue. The establishment of the Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces in the Duncan Hunter National Defense 

Authorization Act of Fiscal Year 2009 was a start, only a start. 

The task force made 76 recommendations, and I am interested 

in where the Department and the Services are in implementing 

these recommendations. Have we walked back all the cases that we 

are aware of and understanding the dynamics involved in all of 

those? 
3 

Have we completed all of these recommendations? And if so, 

what metrics are being used to track success? What other efforts 

can be undertaken to address suicide in the military? 

I welcome all of you, our witnesses, and look forward to hearing 

from you about what has been done, what is being done, and where 

do we go from here in our efforts. 

Thank you, Mr. Chairman. 

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

Mr. WILSON. Thank you, Mrs. Davis. 

I ask unanimous consent to include into the record a statement 

from Congressman Rush Holt of New Jersey. 

[The prepared statement of Mr. Holt can be found in the Appendix on page 39.] 

Mr. WILSON. Without objection, so ordered. 

We are joined today by an outstanding panel. Given the size of 

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

present his or her testimony and each member an opportunity to 

question the witnesses, I would respectfully remind the witnesses 

to summarize, to the greatest extent possible, the high points of 

your written testimony in 3 minutes. I assure you that your written comments and statements will be made part of the record. 

Let me welcome our panel: Jacqueline Garrick, Acting Director, 

Defense Suicide Prevention Office; Lieutenant General Howard B. 

Bromberg, U.S. Army, Deputy Chief of Staff, G–1, U.S. Army; Vice 

Admiral Scott R. Van Buskirk, Director, Military Personnel, Plans 

and Policy, U.S. Navy; Lieutenant General Darrell D. Jones, Deputy Chief of Staff for Manpower and Personnel, U.S. Air Force; 

Brigadier General Robert F. Hedelund, Director, Marine and Family Programs, U.S. Marine Corps. 

And, General, thank you for being here today. This is your first 

appearance before this committee. 

Jerry Reed, Ph.D., Vice President and Director, Center for the 

Study and Prevention of Injury, Violence and Suicide, the Suicide 

Prevention Resource Center. 

We will proceed, beginning with Ms. Garrick, with opening statements, and it is imminent that we will be having votes. We will, 

at a prudent time, suspend and then return. 

And, Ms. Garrick. 

STATEMENT OF JACQUELINE GARRICK, ACTING DIRECTOR, 

DEFENSE SUICIDE PREVENTION OFFICE 

Ms. GARRICK. Thank you, sir. Of concern for DOD [Department 

of Defense] is the rate of suicide among its forces, which rose in 

the past decade from 10.3 to 18.3 per 100,000. 

While we saw leveling in 2010 and 2011, the suicide rate for 

2012 is expected to increase. DOD has closely tracked every suicide 

and attempt published in the DODSER [Department of Defense 

Suicide Event Report] since 2008. 

Therefore, we know the majority of our suicides were completed 

by Caucasian males below 29, enlisted, and high-school educated. 

In some cases, relationship, legal or financial issues were present. 

Service members primarily used firearms and died at home. They 

did not communicate their intent, nor did they have known behav-
4 

ioral health histories. Less than half had deployed and few were involved in combat. 

Nonfatal suicide attempters were similar to those who died. However, those used primarily drugs and had at least one documented 

behavioral health disorder. 

A DOD task force report made 76 recommendations, with the 

first establishing the Defense Suicide Prevention Office to oversee 

all strategic development, implementation, standardization, and 

evaluation of DOD’s suicide and resilience activities. 

NDAA 13 [National Defense Authorization Act for Fiscal Year 

2013] codified this office, which enhances its authority to implement the remainder of the legislation. 

A general officer steering committee established priority groups 

on data, stigma, lethal means, investigations, research, and evaluations, and the Department has made significant strides. 

The Defense Suicide Prevention Program Directive will set policy 

and assign responsibilities. DOD and V.A. [U.S. Department of Veterans Affairs], along with CDC [Centers for Disease Control and 

Prevention], created a suicide repository going back to 1979, so that 

now the DOD can affirm military service for the CDC, enhancing 

its ability to track Guard and Reserve and service member deaths 

overseas. This will enhance our research, longitudinal studies, and 

population health surveillance. 

DSPO [Defense Suicide Prevention Office] program evaluation 

approach tracks requirements, funding, and will unite efficiency 

measures with effectiveness for continuous process improvement 

reporting on shortfalls and duplications. We are evaluating training to develop core competencies for peer, command, clinical, and 

pastoral requirements. 

A critical aspect of preventing suicide is eliminating stigma that 

prevents service members or families from seeking help. DOD and 

V.A. are implementing President Obama’s executive order and have 

a 12-month help-seeking ‘‘Stand By Them’’ campaign to encourage 

service members, veterans, and their families to contact the military crisis line by phone or online. 

We are expanding it in Europe and we are expanding it to Japan 

and Korea. It is at larger bases in Afghanistan, and where it is not 

available we have trained medics to initiate a peer support call 

line, similar to the Guard’s Vets4Warriors program. 

Since service members often believe that seeking care is careerending, training is key. In reality, denials and revocations involving mental health are less than 1 percent. Therefore, service members must understand that seeking help is a sign of strength and 

it does not jeopardize their clearances. 

Postvention has implications for prevention and reducing suicide 

contagion. A postvention guide was published for Reserve Component commanders, and we do a debriefing with TAPS [Tragedy Assistance Program for Survivors] on factors leading up to a service 

member’s death, as reported by the families. And this dialogue 

builds a frame of reference that the DODSER alone does not provide. 

DOD is clarifying the NDAA 13, which authorizes mental health 

professionals and commanders to inquire about privately owned 

firearms, ammunition, and other weapons, and we have developed 
5 

a family safety curriculum with Yellow Ribbon and the Uniformed 

Services University, and have distributed over 75,000 gun locks. 

Since we know suicide and attempts are associated with prescriptions, DOD started a drug take-back study, allowing beneficiaries 

to return unused medications in compliance with DEA [Drug Enforcement Agency] rules. 

We continue to improve access to quality of care, with behavioral 

health providers being embedded at the unit level, and we will continue to evaluate that. 

DOD has developed a research plan and created teams to translate findings from studies into policies and practices. We have responded to the NDAA 12 by creating a community action team, 

partnering with nonprofits, universities, and others to assess practices and share lessons learned in family and peer support. 

We have expanded Partners in Care, a chaplain program in 

which faith-based organizations provide support to the Guard and 

Reserve. And we are exploring therapeutic sentencing techniques 

for military justice proceedings, as used in Veterans Treatment 

Courts. 

We have worked with the Action Alliance on the National Suicide 

Prevention Strategy, and we have partnered with the Department 

of Veterans Affairs on the Veterans Crisis Line, making sure that 

material is at preseparation counseling and is incorporated into 

transition briefings. 

So in closing, DOD fervently believes that every one life lost to 

suicide is one too many and prevention is everybody’s responsibility. No stone is being left unturned, and this is a complex issue. 

The challenges are great. However, this fight will take enormous 

collective action and the implementation of proven and effective initiatives. 

DOD remains optimistic that it will find better solutions that 

will save more lives. 

Thank you, sir. 

[The prepared statement of Ms. Garrick can be found in the Appendix on page 41.] 

Mr. WILSON. And thank you, Ms. Garrick. 

And, General Bromberg, we will proceed. And the moment you 

get through, the buzzers indicate it is a vote, and so we will then 

suspend. 

STATEMENT OF LTG HOWARD B. BROMBERG, USA, DEPUTY 

CHIEF OF STAFF, G–1, U.S. ARMY 

General BROMBERG. Yes, sir. 

General Wilson, Ranking Member Davis, distinguished members 

of the subcommittee, on behalf of our Army, thank you for continued strong support and demonstrated commitment to our soldiers, 

civilians, and families. 

As you know, our Nation has been at war for nearly 12 years. 

Our soldiers, families, and civilians remain the strength of our Nation and have demonstrated unprecedented strength, performance, 

and resilience. And while physical injuries may be easier to see, 

there are many invisible wounds, such as depression, anxiety, posttraumatic stress, that also take a significant toll on our service 

members. 
6 

Army leaders at all levels are committed to eliminating the negative stigma associated with seeking help; building physical, emotional, and psychological resilience in our soldiers and families and 

civilians; and ensuring that anyone who may be struggling gets the 

help he or she needs. 

Tragically, though, the Army has had 324 potential suicides during 2012, the highest annual total on record. Of those, 183 deaths 

occurred within the Active Component and Reserve Component on 

Active Duty. The Reserve Component not on Active Duty, a total 

of 141, is the second highest on record. 

While most Army suicides continue to be among junior enlisted 

soldiers, the number of suicides by noncommissioned officers has 

increased each of the last 3 years. And almost one-third of our 

Army suicides have no deployment history and almost 18 percent 

have never been mobilized from the Reserve Component. 

By far, most Army suicides are in the 21- to 30-year-old age 

range, and that trend has held since 2010. 

And, as already mentioned, suicide is not solely a military problem. It is a rising national issue. And while it is difficult, we must 

use extreme caution when directly comparing the Army population 

with the general population. 

The 2010 national suicide rate is slightly higher than the Army 

Active Duty rate for 2010 and 2011. This very general comparison 

strongly supports the idea that suicidal behavior is an urgent national problem that affects all Americans across all dimensions of 

society, including those who have chosen to serve the Nation by 

serving in the Army. 

And we believe we have an historic opportunity to understand 

the lessons of the last 12 years and make our force even stronger. 

And the Army is now moving forward with our Ready and Resilient 

Campaign plan. This campaign is focused on making resilience a 

part of our culture and integrates and synchronizes multiple efforts 

and programs designed to improve the readiness and the strength 

and resilience of the Army team. 

I assure the members of this committee there is no greater priority for myself and other senior leaders of the United States Army 

than the safety and well-being of our soldiers. 

Suicide does remain a complex issue. It is a hard enemy, both 

for the Army and the Nation. The loss of any life is tragic, and it 

is imperative that we make a holistic approach to addressing this 

complex challenge. 

Mr. Chairman, Representative Davis, members of the committee, 

thank you and I look forward to your questions. 

[The prepared statement of General Bromberg can be found in 

the Appendix on page 55.] 

Mr. WILSON. General, thank you very much. 

And we will suspend and we will begin immediately with Admiral Van Buskirk. 

Thank you. 

[Recess.] 

Mr. WILSON. The Subcommittee on Military Personnel update on 

military suicide prevention programs shall resume. 

And, Vice Admiral Van Buskirk. 
7 

STATEMENT OF VADM SCOTT R. VAN BUSKIRK, USN, DEPUTY 

CHIEF OF NAVAL OPERATIONS, MANPOWER, PERSONNEL, 

TRAINING, AND EDUCATION, U.S. NAVY 

Admiral VAN BUSKIRK. Chairman Wilson, Ranking Member 

Davis, distinguished members of the committee, thank you for 

holding this hearing and affording the Navy the opportunity to provide an update on our suicide prevention and resiliency programs. 

Sadly, last year the Navy experienced 65 suicides in our Active 

and Reserve forces, an increase of six over the previous year. We 

have already suffered the loss of 13 shipmates this year. 

We clearly have more to do. Suicide prevention remains a top 

priority of the Navy leadership, and we remain committed to doing 

everything possible to save lives. 

We continue to vigilantly monitor the health of the force and investigate every suicide and all suicide-related behavior. We take 

what we learn from our investigations and adapt our education, 

programs, and prevention strategies. 

Operational Stress Control is a centerpiece of our strategy. It is 

the way we inculcate our new accessions, the way we deliver our 

training to the fleet and to our leaders. It is a method we use to 

increase the awareness and strengthen our resilience. 

Our Operational Stress Control Program provides an integrated 

structure of health promotion. It focuses on building resilience, addressing problems early, and promoting a healthy and supportive 

command climate. We continue to evaluate the response to this 

critical asset. 

Our Navy leaders recognize that they are the key to 

destigmatizing help-seeking behaviors. The unity of effort at the 

deckplates is where we strengthen our sailors. 

The deckplates is where we identify and mitigate the signs of 

stress and help our sailors cope and acquire necessary treatment 

for stress injuries. By teaching sailors better problem-solving skills 

and coping mechanism for stress we will make our force a much 

more resilient one. We will continue to do everything possible to 

support sailors so that they know their lives are valued and are 

truly worth living. 

Thank you, and I look forward to your questions. 

[The prepared statement of Admiral Van Buskirk can be found 

in the Appendix on page 67.] 

Mr. WILSON. Thank you very much, Admiral. 

General Jones. 

STATEMENT OF LT GEN DARRELL D. JONES, USAF, DEPUTY 

CHIEF OF STAFF FOR MANPOWER AND PERSONNEL, U.S. AIR 

FORCE 

General JONES. Chairman Wilson, Congresswoman Davis, and 

distinguished members of the committee, thank you for allowing 

me to testify before you today on behalf of the Chief of Staff of the 

United States Air Force and all airmen stationed around the world. 

Air Force leaders at all levels are committed to suicide prevention through our wingman culture. Suicide prevention is not the 

purview of the personnel or the medical community. It belongs to 

commanders and leaders at all level. This is the overarching 

premise on which the Community Action Information Board was 
8 

built and the cornerstone of the Air Force Suicide Prevention Program. Evidence shows this is the necessary framework for effective 

intervention across the force. 

Suicide prevention is a contact sport. It starts with leadership involvement, from the chief of staff to the newest first-line supervisor. 

In a wingman culture, airmen look out for their fellow airmen. 

We teach them to identify risk factors and warning signs for suicide and to take appropriate action once these indicators are identified. 

We realize we must continue to reevaluate and enhance our prevention efforts. And, with this in mind, we have taken on several 

initiatives across the Air Force. 

We require front-line supervisor training for our most at-risk career fields and one-on-one training for this program. We are also 

increasing our mental health provider staff by 335 people of additional trained professionals through fiscal year 2016. And we are 

revising our Air Force Guide to Managing Suicidal Behavior, which 

has proven to be an effective clinical tool over the past 10 years. 

Within the Air Force, we have not experienced a link between 

suicides and deployment. The most significant risk factors for suicide in the Air Force continue to be problematic relationships, legal 

or administrative issues, work-related problems, or a combination 

of these factors. 

We continue to research how we can better identify those at risk 

to achieve the earliest possible intervention. One such study explores how social media impacts their relationships, help-seeking 

behavior, and emotional well-being. We are also conducting several 

research projects examining the role of life events and social 

stressors in the suicides of our military members. 

We continue to collaborate with the Defense Suicide Prevention 

Office, our sister services, and the Department of Veterans Affairs. 

Our goal is to leverage our internal resources, combining our experiences and best practices to improve suicide prevention across the 

force. 

We need every airman as we face the difficult challenges ahead. 

All leaders are responsible for promoting our wingman culture and 

removing any barriers to a healthy force. 

Thank you for your attention to our efforts and for your support 

in these endeavors to keep all of our airmen healthy and ready. I 

look forward to answering your questions. 

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

Appendix on page 79.] 

Mr. WILSON. Thank you very much, General Jones. 

And we now proceed to General Hedelund 

STATEMENT OF BGEN ROBERT F. HEDELUND, USMC, DIRECTOR, MARINE AND FAMILY PROGRAMS, U.S. MARINE CORPS 

General HEDELUND. Chairman Wilson, Ranking Member Davis, 

and distinguished members of the committee, it is my privilege to 

appear before you today and I would like to thank you for allowing 

me to testify on behalf of Lieutenant General Milstead. 
9 

Like our Commandant, we both are engaged and committed to 

tackling the complex problem of suicide amongst our marines. It is 

an all-hands effort to us. 

As our Commandant has said, one suicide is one too many. Each 

suicide has far-reaching impact on families, friends, and fellow marines. 

Regardless of the total number, every single suicide is a profound 

tragedy. Whether we have one or many, we will expend whatever 

effort is required to gain ground and get ahead of this problem. 

As we all know, discovering, and ultimately understanding, what 

leads one to suicide is elusive. It is very difficult to identify one 

trend or factor as a key to unlocking the secret to suicide for our 

population. 

However, through our data, tracking, and research, we have 

found that the primary stressors and risk factors associated with 

marine suicides and attempts are legal and disciplinary problems, 

relationship problems, behavioral health diagnoses, financial problems, and substance abuse, or a combination thereof. 

Regardless, we are committed to exploring every potential solution, using every resource we have available, and making the right 

investments toward saving marine lives. We deeply believe that 

preventing suicide requires engaged leaders who are alert to those 

at risk and take action to help marines before they reach crisis. 

We take care of our own. Thus, we are committed to breaking the 

stigma that may still exist in pockets around our Corps for those 

who seek help. We never leave a marine behind on the battlefield 

and we won’t leave a marine behind at home. 

We thank you for bringing attention to this national problem, 

and I look forward to your questions. 

Thank you. 

[The prepared statement of General Hedelund can be found in 

the Appendix on page 88.] 

Mr. WILSON. Thank you, General Hedelund. 

And we now will conclude testimony with Dr. Jerry Reed 

STATEMENT OF DR. JERRY REED, PH.D., MSW, VICE PRESIDENT AND DIRECTOR, CENTER FOR THE STUDY AND PREVENTION OF INJURY, VIOLENCE AND SUICIDE, SUICIDE 

PREVENTION RESOURCE CENTER 

Mr. REED. Good morning, Chairman Wilson, Ranking Member 

Davis, and members of the subcommittee. 

My name is Jerry Reed and I serve as the director of the national 

Suicide Prevention Resource Center and as co-director of the Injury 

Control Research Center for Suicide Prevention. 

Suicide is not just a challenge for the defense or veteran communities. It is an American challenge that calls us all to action. Every 

suicide is a tragedy. 

In the United States, suicide is the 10th leading cause of death, 

claiming more than 38,000 lives in 2010. By comparison, homicide 

was the 16th leading cause of death, claiming more than 16,000 

lives, or fewer than half the deaths than by suicide. 

There is no single cause for suicide, no single solution, and no 

single agency, department, or person can fight this battle alone. We 

all have a role to play. 
10 

While suicide touches all ages across the lifespan, in the general 

population it is the third leading cause of death for those 15 to 24 

years old and the second leading cause of death for those 25 to 34 

years old. Suicide rates generally increase with age. 

A few similarities between the military and the general population are: more men die by suicide than women, firearms are used 

in both populations and the outcome is often lethal, and substance 

use is often a factor in both attempts and completions. 

Intuitively, we would expect the military to have lower rates because service members are screened for mental illness and drug 

abuse on entry into Active Duty, they are healthier than the general population, they are fully employed and fully insured, they are 

routinely screened for drug use, and they have access to mental 

health care. Yet, rates in the military have been rising over the 

past 10 years and this is cause for concern. 

What we don’t know is why rates are rising and what can be 

done to reverse this trend. We need to more fully understand the 

role of combat, deployment, and exposure to traumatic events on 

suicide risk. We also need to explore why rates are higher among 

junior enlisted personnel, some of whom have not been exposed to 

combat, and to better understand the process of help-seeking in our 

military. 

From what we know nationally, some of what has been shown to 

yield positive results include: following a comprehensive approach, 

combining several initiatives that target different behaviors, populations and settings. Examples of this that have been or are being 

pursued in DOD are the Air Force Suicide Prevention Program or 

the No Preventable Soldier Deaths Campaign at Fort Bliss. 

We know that no one program or intervention by itself will suffice. We need to ensure a cohesive approach is taken. 

The National Registry for Evidence-Based Programs and the 

Best Practices Registry include over 100 programs, materials, and 

practices that science and experience show can prevent suicidal behaviors and reduce risk. 

Following a public health approach, we need to look at the data, 

develop a comprehensive strategy, implement interventions, measure their effects, and evaluate outcomes. 

In my closing comments, I would like to offer the subcommittee 

a few recommendations to consider as we move forward: Follow a 

battle plan that is comprehensive and incorporates both public 

health and mental health perspectives. We will not simply treat 

ourselves out of this challenge. 

Our current battle plan is the recently released National Strategy for Suicide Prevention. It is a comprehensive document and 

guides our national effort. 

We also should take steps to successfully integrate DOD and the 

V.A. activities where possible, and efforts with those going on with 

the Action Alliance for Suicide Prevention, chaired by former Senator Gordon Smith and Secretary of the Army John McHugh. 

This public-private partnership, launched in 2010 by Secretaries 

Gates and Sebelius, holds great promise for suicide prevention. The 

alliance has set a goal to save 20,000 lives over 5 years, and we 

are serious about advancing steps that will move us in this direction. 
11 

We should explore ways to ensure that those at risk for suicide 

do not have access to lethal means, ensure seamless care for those 

transitioning from Active service to veteran status and from Active 

service to inactive Guard or Reserve status, and ensure service 

members know how and where to receive help. And we should also 

build upon success stories and implement, evaluate, and most importantly, scale up when we see initiatives that are making a difference. 

When we implement a program that works, we need to ensure 

it is sustained over time. And we need to think from both an individual perspective, focused on the service member in need, and 

from a systems perspective, ensuring that every door a service 

member enters is the right door and that there is continuity in the 

care provided between systems. 

Finally, we need to change the way we talk about suicide by including stories of hope and resilience through public awareness 

campaigns, such as DOD’s Real Warriors and V.A.’s Make the Connection. 

It is important to remember that suicide prevention is a relatively new field of study. And as we have observed from working 

on other public health issues, the effects of prevention require us 

to be patient, deliberate, and most importantly, to stay the course. 

Thank you for the opportunity to join you this morning. We need 

to approach this battle with the collective attitude of one team with 

one fight. It is important to remember that our military comes from 

the general community and will someday return to the general 

community. 

The more we can do together, the better for those we wish to 

serve. By working together I am confident that we can and will 

save lives. 

Thank you. 

[The prepared statement of Dr. Reed can be found in the Appendix on page 98.] 

Mr. WILSON. Thank you very much, Dr. Reed. 

And we now will proceed to each member of the subcommittee 

asking questions for 5 minutes. The time will be determined by 

Jeanette James, our professional staff personnel. And she herself 

is a retired Army nurse, and she has been so helpful being a resource to this subcommittee and to the committee at large. 

As we begin, from Ms. Garrick and for our service personnel who 

are here, as a 31-year veteran of the Reserves and Guard myself, 

as the proud dad of three members of the Army National Guard, 

I really appreciate Guard service and Reserve service, and we have 

really relied on the Guard and Reserve as never before, successfully, with overseas operations. But when our Guard members return they don’t have the 24/7 support of military facilities; equally, 

they have the stress of military, but also civilian stress. 

Beginning with Ms. Garrick, what programs are there that could 

and do apply to Guard members? 

Ms. GARRICK. We have several programs that we are looking at 

with the Guard. The one I mentioned, the Partners in Care project, 

leverages the faith-based communities and is a chaplain program 

specifically, so that is very helpful in terms of providing some very 

specific boots on the ground. 
12 

And then, of course, our Yellow Ribbon Reintegration Programs 

are very important, very vital to the pre-, during, and post-deployment phases of the Guard and Reserve deployments. We also have 

a postvention guide that we have worked on for Reserve component 

commanders, if there is—had been a death in their unit, that they 

have the tools and the techniques that they need to be able to respond to a suicide in the unit. 

We are doing a Safe at Home program, specifically, that would 

roll out under Yellow Ribbon. We have distributed about 75,000 

gun locks; most of those have been through the Guard. And I think 

our Vets4Warriors, the call center that utilizes a peer support 

model, has been very helpful. 

So those are some of the programs that I have seen that I think 

have been working really well with the Guard and Reserve. 

Mr. WILSON. Thank you. 

General Bromberg. 

General BROMBERG. Yes, sir. All our programs in the Army, we 

are mirroring those at the—trying to mirror those at the State and 

local level through both the United States Army Reserve command 

and also through the National Guard. The increased capacity for 

behavioral health touch points and services available to our 

Guards, or it has already mentioned the Vet4Warriors peer lines 

is very good. 

Additionally, the United States Army Reserve has reached out to 

the employer network as well, to link up returning veterans with 

employers to solve that challenge, which I think is very key. Because we have seen, as I looked at eight recent suicides in the National Guard across the Nation were all linked—one of the causes 

was—we think was linked to unemployment. So how can we employ that employer network back? 

Additionally, Health Promotion & Risk Reduction Councils that 

we do on the Active side, we are mirroring those at the State and 

local level also with additional capacity, so they can look inside 

their units. 

And as you know, sir, the challenge of connecting to a guardsman who is not seen every day by a leadership or a chain of command is something we have asked the Guard and Reserve to get 

after as well. 

But, again, a complete mirroring of our programs. 

Mr. WILSON. Thank you. 

Admiral Van Buskirk. 

Admiral VAN BUSKIRK. Yes, sir. In addition to all of our operational stress control programs, which are available to our reservists, we specifically have a Navy and Marine Force Reserve Psychological Health Outreach Program that specifically targets our Reserve Components, both in the Navy and the Marines. 

These are 55 specific individuals that we embed with our reservists and that are part of a team that have the behavioral health 

specialists with them to meet the needs of those personnel who 

may need to seek their professional help, and also for those people 

to be able to recognize where help is needed. 

In addition to that, we have our Returning Warriors Program, 

where our—all of our people who are returning—mobilized who are 

returning back to the States from the deployment go through re-
13 

turning warrior workshops, where additionally we have health professionals embedded to help our people cope—not just our personnel, but their families as well, because it isn’t just about the individuals, it is about the families being able to cope with the stress 

that our personnel have endured. 

Mr. WILSON. Thank you. 

And, General Jones. 

General JONES. Sir, I echo the challenges that we have with 

Guard and Reserve members as they come home and disperse back 

into the community. But we are trying to mirror many of the same 

programs we have found success with on the Active Duty side. The 

Community Action Information Board in the Guard and the Reserves followed suit, establishing a wing director of psychological 

health to help monitor these programs and just check on how our 

airmen are doing when they get back home. 

The Guard and Reserve, over the last few years in the—on the 

Guard side of the house since 2007, have averaged about 161⁄2 suicides a year. On the Reserve side it was somewhat less, about 71⁄2. But it is positive to report that on the Reserve side, the numbers 

significantly dropped between 2011 and 2012. On the Guard side, 

we saw a slight spike in 2012, but since 2013, so far this year we 

have had zero suicides in the Guard or the Reserve, which we are 

very excited about that. And we know that is just a temporary 

trend but we want to see how long we can keep that going to help 

our airmen. 

Mr. WILSON. Very encouraging. 

Concluding with General Hedelund 

General HEDELUND. Yes, sir, thank you. 

Many of the relationships that have already been mentioned, the 

Marine Corps maintains with its Reserve community as well. And 

I think that in this current environment where we are deploying 

fewer Reserve units in full, but we continue to deploy Reserves as 

individuals; we have to ensure that we are making that transition 

to services for them in a more individual way. 

We, too, take advantage of the Yellow Ribbon Program, of course, 

and we have a Reserve Component that is investing in additional 

behavioral health specialists to put in key places around the country to address needs in the Reserve community. 

But every directive, MARADMIN [Marine Administrative Message], or initiative that goes forward, you will see at the bottom of 

it, ‘‘this applies to the total force.’’ So every requirement, all the 

training, education, et cetera, that Active Duty marines are required to fulfill, those commanders and marines that are in the Reserve force are also required to fulfill. So the same support that we 

give to our Active Duty we provide to our reservists, although delivery sometimes varies. 

Mr. WILSON. Well, thank you all. And as part of the military 

family I particularly want to thank you. 

And we now proceed to Congresswoman Susan Davis, the ranking member. 

Mrs. DAVIS. Thank you. Thank you, Mr. Chairman. 

We all know that there are a multitude of programs that have 

been in existence for some time and are relatively new. I wonder 

if you could talk more about how we are evaluating them. 
14 

This is difficult because you can’t necessarily evaluate a nonevent either. If in fact we have people who are not moving to suicide as a result of programs, which we hope is what exactly is happening, but we know in many cases it is not. 

Could you talk more about that and about the tools that are 

being used? And how are really knowing that they are evaluating 

what we need to know? 

Ms. GARRICK. Yes, ma’am. As you recall, the task force report 

made some recommendations about doing some program evaluation, so that is one of the priority areas that we are concentrating 

on. 

So we have developed what we call a capacity analysis program 

evaluation approach, where we have taken actually the national 

strategy, the task force recommendations, the NDAA 12 and 13. So 

we have outlined all the strategies and then we have looked at the 

programs and we have started to line up—and we work very closely with the Services; they are providing us with the data and the 

inputs on what their programs are, what they look like, so that we 

can start beginning to flesh out what are the programs, what strategic objective are they supporting, and then what are some of the 

costs that bounce up against those programs. 

And then when we look at the strategy we can see, so where are 

the gaps and overlaps? 

Mrs. DAVIS. Ms. Garrick, do you have a sense of a timeline, because we have been with this for a while? Obviously, you can gather data for a pretty long time and we don’t—you don’t always know 

what is going to happen a few years down the line. 

I am just wondering at what point we will have a comfort level 

that, in fact, there are some programs that actually aren’t doing 

what we would like them to do and that we are able to shift some 

of those resources or, you know, activities that are different and 

that are making a difference. 

Ms. GARRICK. Correct. So we started this process of just beginning the—pulling the inventory together about 4 or 5 months ago, 

and we have made quite a bit of progress in what that inventory 

is, and we have developed sort of a rough order of magnitude on 

what have we covered down on. And I am hoping by the end of this 

fiscal year, all things considered, that we will actually be able to 

start reporting out on what we are seeing in terms of some gaps 

and overlaps. 

And we couple that with an effort we have with the Department 

of Veterans Affairs on developing a surveillance database. That is 

where we have taken the DOD data from DMDC [Defense Manpower Data Center], the V.A. data, and the CDC data and we put 

surveillance data together so we can start looking at the—what do 

we know about suicides, what are some of the risk factors, how can 

we do better longitudinal studies, how can we do better population 

health surveillance like Mr. Reed described. 

So marrying up some of those initiatives—again, it is a big-picture perspective. 

Mrs. DAVIS. Yes. It sounds like that in some ways we have identified some age groups, and also the fact that a firearm has been 

used in many of the cases. Is it clear that there are more firearms 

used in military or not? 
15 

I thought, Dr. Reed, you suggested that that is not necessarily—— 

Mr. REED [continuing]. Population is about 50 percent of the 

completed suicides in the civilian population are completed with a 

firearm; in the military I think it is closer to 60 percent. 

Mrs. DAVIS. Sixty percent, okay. I thought that I had heard that 

it was more than that. 

Would that be considered a metric, then? I mean, if we think 

about metrics and what we are looking for, what—how do you describe that for the general public? 

General BROMBERG. Ma’am, if I could add—— 

Mrs. DAVIS. General Bromberg. 

General BROMBERG [continuing]. One of the things that we have 

studied with our Ready and Resilient Campaign plan, one of our 

major lines of effort is getting exactly at what you are talking 

about. So, we have already peeled out like 122 programs to start 

delving into them. 

One of the areas we are looking heavily into right now is does 

resiliency training or other events like—with our Strong Bonds 

campaigns and training that deals with reducing stressors in relationships—does that training have a direct effect? So can I take the 

Strong Bonds training and see if I have a decrease in domestic 

abuse or relationship issues. And we are starting to gather that 

data now over this course of the year. 

Additionally, what we are looking at with the resiliency training, 

ma’am, is for those soldiers that have had resiliency training, is 

there a reduce in gestures, attempts, and ideations. We have one 

unit we have already looked at, and over the last 18 months we 

are starting to see a turn. 

Mrs. DAVIS. May I just really quickly turn to General Hedelund 

for a second? 

At Pendleton I believe they are doing a program and they have 

had—actually, they haven’t had the suicides in this particular unit. 

It is a pilot. Are you aware of that? 

General HEDELUND. I would have to check and get you more information on that, ma’am. 

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

page 111.] 

Mrs. DAVIS. All right. 

General HEDELUND. But I would like to echo that it is an area 

where we do need to get in and make sure that we have got the 

evidence-based approach going. 

Mrs. DAVIS. Thank you. 

General HEDELUND. Thank you. 

Mr. WILSON. Thank you, Mrs. Davis. 

And we now proceed by order of appearance to Congressman 

Austin Scott, of Georgia. 

Mr. SCOTT. Thank you, Mr. Chairman. 

And thank you all for being here. It is certainly an issue that I 

think is a big concern not only to the members of the committee 

and the military, but to Americans in general. 

And I guess two quick questions I have, and then to get to one 

more specific. 
16 

Ms. Garrick, are there any differences among the trends in the 

different branches? And is there a correlation behind the men and 

women who are attempting suicide and the V.A. backlog? 

Ms. GARRICK. I think overall and in general what we see with— 

among all the Services are, the big driving forces are these young 

white males, junior enlisted, with relationship, financial, and legal 

issues. And I think that is why a lot of the programs I think speak 

to targeting that. That is why the resilience piece is so important 

is to help these young people adjust to the military. 

We have seen about the same amount with deployments versus 

nondeployments, combat, noncombat. So we know that there are 

other driving forces and factors that come into play. 

So we look at those populations, we look at the differences between some of those issues and try to target programs that are 

very specific. The Services have all blended programs that meet 

their unique needs as—in their unique environments, whether it is 

aboard a ship, or in theater in Afghanistan. We have seen some 

programs that we have done there, as well. I mean, I got to spend 

some time with the Combat Operational Stress Control Team in 

Kandahar and did some training with them very specific on peer 

support and crisis-line work. 

So we are trying to be very specific in what we are targeting. 

And then, in terms of the DES [Disability Evaluation System] 

issue, I don’t know that we see a higher number of suicides among 

those going through a disability process, although we do know that 

pain and pain management can be a risk for those who have died 

by suicide. So there is some correlations there. 

Mr. SCOTT. Thank you for that. I would be interested, as time 

permits—I know you have a lot of programs—to know, essentially, 

what percentage of our men and women that do commit this are 

caught up in a V.A. backlog. 

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

page 111.] 

Ms. GARRICK. Yes. 

Mr. SCOTT. Because that can lead to a tremendous amount of additional stress, as well as the financial conditions that caused the 

problems. 

And so, Dr. Reed, I think I will focus my next question to you, 

as the doctor. And one of the issues that is brought up again and 

again is the stigma that is affiliated with the need for assistance 

and even seeking treatment. That makes it hard for people sometimes to actually reach out to others. I know that we are training 

people on the warning signs and the seriousness of the issues, 

which, I think, is wonderful. 

And I guess my question is going to get back to the use of a specific therapy with regard to animals, whether it be dogs or some 

other type of domestic animal that the person is able to establish 

a friendship with. 

But I want to focus on that area, specifically on equestrian facilities. I have got one in my area, Hopes and Dreams Riding Facility. 

It is in Quitman. 

They have a lot of men and women in. They seem to have had 

a tremendous amount of success with regard to working with people. 
17 

And my question is, is there ongoing research with regard to that 

particular therapy? What are the successes there? And how do we, 

if it is working—because it does appear to be working from what 

I see, and again, what I see—how do we get more people involved 

in those treatment methods that, quite honestly, are at very little 

cost to us? 

Mr. REED. When we were asked by Congress to set up the National Suicide Prevention Resource Center back in 2002 one of the 

things we were asked to do specifically was to create a Best Practices Registry to begin to serve as a clearinghouse for that which 

is being done that works. 

Today, as I mentioned in my testimony, there are over 100 programs that are listed in the registry. What we need to see happen—I have been to some of the equestrian programs myself; I was 

out in a tribal community and saw just the benefits of that program for people who might have a difficult time connecting in other 

ways. 

And I think what we have to accept with suicide prevention is,as 

I mentioned, it is a relatively new field—there is not one solution. 

It is not necessarily a therapy session in a therapist’s office, but it 

could be an alternative therapy. It could be approaching a connectedness issue through animals or through other kinds of ways to engage a person. 

Because part of the challenge is people who struggle with 

thoughts of suicide don’t feel connected to the larger community. 

And if we can enhance that connectedness through programs such 

as you have mentioned, and then encourage the program developer 

to submit that program to the Best Practices Registry for review 

and hopeful inclusion, we then make it a whole lot more able to 

be disseminated to the Nation at large to be able to replicate that 

program if it has got evidence behind it that shows effectiveness. 

Mr. SCOTT. Well, thank you for that answer, Dr. Reed. And I 

guess the one thing that I would, you know—the review process 

and the other things, I think, if we could expedite them I think 

that would be a big help. 

Thank you, gentlemen, for being here, and ma’am. 

Mr. WILSON. Thank you, Congressman Scott. 

Now we proceed to Congresswoman Niki Tsongas, of Massachusetts. 

Ms. TSONGAS. Thank you, Mr. Chairman. 

And thank you all for being here. I commend the work that you 

all have done, the really focused effort you are bringing to this. 

And, you know, we all hope going forward we are going to see great 

progress on this because it is an issue of such deep concern to all 

of us here, as well as those across the country who hear about the 

great increase in the numbers of suicides. 

But I am concerned that in our current budgetary constraints, in 

particular sequestration, that this could really undermine all your 

good efforts and exacerbate the—this particular epidemic. My concern is two-pronged: one, because the strained resources will inevitably force our men and women in uniform to take on more responsibility than ever—in other words, all the pressures of the workplace. 
18 

You have looked at, sort of, the legal issues, I mean, that they 

tend to have relationship issues, financial issues, legal issues—but 

just the demands of the workplace. We have heard about the multiple deployments, but in reality there are more suicides taking 

place in people who are not deployed. So is there something in the 

workplace itself and the demands of the workplace that are exacerbating and causing increased stress? 

As one of our witnesses at a recent Oversight and Investigations 

Subcommittee hearing on the QDR [Quadrennial Defense Review] 

noted, they said, ‘‘You can’t, in reality, do more with less.’’ And as 

we have less, you are asking often very young people to do quite 

a bit more. 

Second, I am also worried that the budgetary environment could 

potentially impede all your prevention efforts from being researched, because a lot of research is certainly going on or fully implemented. So I would welcome all of your comments on just, you 

know, the stresses in the workplace, how the various cuts coming 

about one way or the other may, in fact, exacerbate those stresses, 

and whether or not you see any kind of correlation or are concerned at all as we have to continue to make these cuts. And then 

second of all, are you worried that it will also have an impact on 

your—all the other efforts you have put in place? 

Ms. GARRICK. Well, ma’am, clearly yes. If we furlough our civilian workforce it means that the military will be picking up some 

of that workload, so there will be that stress. That stress is ongoing 

already. We are starting to figure out how we are going to manage 

that as best we can but it is definitely a concern for everybody 

across the spectrum, across the Department. 

There are some recognition that the workplace stress is certainly 

a piece of what happens in the nondeployed environment, that we 

have been at war for 10 years. There is an operational tempo that 

we are all very conscientious about and that leadership needs to be 

able to train and mentor junior officers and bring people on board 

in such a way that helps facilitate a resiliency and mentor them 

through their careers. And that doesn’t always happen when you 

have the high operational tempo that we have right now. 

So I think your points are well taken and are definitely issues 

that we are all grappling with and challenges that we will have to 

face and overcome as we move forward through sequestration, continuing resolutions. I mean, I know you have had many of our senior leaders here discussing those very issues, and clearly, I think 

there will be ripple effects throughout the Department if sequestration actually goes into effect. 

General BROMBERG. Ma’am, with respect to the budget, we are 

all concerned. But as far as behavioral health and support goes, 

that is one of our primary areas that we will do everything we can 

not to furlough in the behavioral health department. And we are 

going to ask for those exceptions not to do that, to keep that workforce steady so we don’t lose that progress. 

With respect to the overall workplace stressors, I think the relationship stressors and those other things you have heard about, alcohol abuse and other things, are just as important as the stress 

in the workplace. And so working through our Resiliency Campaign, as we continue to train master resilience trainers to teach 
19 

people how to deal with the adversities is really key to what we 

have to do during this time period. And that is one of our major 

focuses. 

Ms. TSONGAS. So the adversities of the workplace as well as the 

adversities of that which you confront outside the workplace. 

General BROMBERG. Disappointments in your family relationships, disappointments if you get in trouble with the law. How do 

you work your way through that and not get into what they call 

the ‘‘spiral of negative thinking,’’ the spiral of going down, down, 

down—how you can help pull yourself out along—and having the 

leadership engaged with that. 

The master resiliency trainers are starting to take effect as put 

those across all our formations to include families and civilians. 

Ms. TSONGAS. Quickly. I have a few more seconds. 

Admiral VAN BUSKIRK. Yes, ma’am. 

Just, I was in Norfolk 2 days ago doing all-hands calls, one for 

about 1,200 people, one for about 500—and men and women in uniform, both in the Navy and the Marine Corps. To answer your 

question, yes. The pressure of the budgetary atmosphere that we 

are in, the stress, it was significant in terms of the uncertainty 

that our people are feeling that is being added to the already environment where OPTEMPO [Operations Tempo], PERSTEMPO 

[Personnel Tempo] are part of the norm in terms of what they are 

dealing with on a daily basis. 

So we have added to that uncertainty with sequestration and the 

continuing resolution debate that we have been having here and 

the uncertainty that goes with that. 

But from a program standpoint, we remain committed to our programs and we are working to maintain those fully functional. 

There will be some areas that have more strain than others, but 

for the behavior health programs that we have, to—keep those 

fully functional, and we have made those a priority. 

Ms. TSONGAS. Thank you. 

I think I have run out of time, so thank you, though. 

Mr. WILSON. Thank you, Ms. Tsongas. 

We now proceed to Congresswoman Kristi Noem of South Dakota 

Mrs. NOEM. Thank you, Mr. Chairman. 

And thank all the witnesses for being here. 

This is a tough issue for any family that has lost someone that 

has taken their own life. And I have a constituent back in South 

Dakota that is dealing with this, a loss of a son. And, you know, 

it is a grief that no parent should have to go through. 

So I want to thank you for all your work in this area, but obviously we have a long ways to go. 

Some of my questions—and, frankly, I have some concerns, and 

I will direct them at Lieutenant General Bromberg because this 

young man served in the Army, but after a soldier reaches out for 

help, what exactly happens at that point? 

General BROMBERG. Yes, ma’am. 

If the soldier reaches out for help, depends how he reaches out 

for help. Does he go to a chaplain, does he go to a peer, or does 

he go to behavioral health? So there are multiple pathways, what 

we call multiple touch points. 
20 

If you start with the unit, training the unit on ask, care, and escort training that teaches the peers to say—ask questions, care 

about the individual, and escort them to behavioral health. And if 

they are in the behavioral health network, of course, they go into 

seeing the behavioral health specialist, and they are treated as 

they are needed to repair them and get them back to their full capacity. If they go to a chaplain, they can still be referred to that 

way. 

So there are several pathways that the soldier can go down. 

Mrs. NOEM. Well, what can happen if the soldier is in counseling 

then, yet they are soon to be deployed. How is that balanced with 

their mission that they have in front of them? 

General BROMBERG. There are many avenues. For example, if 

they are in counseling there is a decision made is if the soldier 

should even deploy. And any soldier that is put on any type of 

medication, the psychotropic medication, we automatically don’t deploy them for at least 90 days to see the effects of the medication. 

If the soldier can deal with a mild medication and still deploy, 

that is a chain of command and a medical decision to make. But 

there is a 90-day period right there. 

Mrs. NOEM. So if they are deployed then they are under the supervision of their commanding officer? 

General BROMBERG. And the medical facilities that are forward—— 

Mrs. NOEM. Medical facility would be—I have that information—— 

General BROMBERG. Yes, ma’am. 

That is tracked in his medical record and it should go forward. 

I am sure we are not absolutely 100 percent perfect and we have 

had problems over the past 12 years, but we have improved that 

to include putting behavioral health forward. So we have behavioral health teams with our forward-deployed organization, which 

is a step we are doing to standardize that across the Army out 

through 2016. Because putting behavioral health with the units at 

the point of action is very key. We have learned that over these 

last several years. 

Mrs. NOEM. You know, I understand that after a suicide occurs 

that there is an after-action review that it happens with the family. 

Is there contact with the family during this review? 

General BROMBERG. Yes, ma’am. The first is the unit does an 

after-action review as well as we do after-action reviews all the 

way up to the Department level. In fact, we meet monthly; the Vice 

Chief of Staff of the Army hosts a suicide review group with all 

senior commanders where we look at general trends and cases. And 

there is also information provided to the family. 

Mrs. NOEM. But during that review is the family contacted? I 

mean, that is the concern that I have with this individual situation 

is this family was not contacted during that investigation whatsoever. 

They were certainly given the advantage of having an after-action review, but I would think if they were really going to understand what happened in that individual situation that there would 

have to be some kind of communication with the family during the 

investigation. 
21 

General BROMBERG. Yes, ma’am. If you like I can get that followon information. We can, you know, dig into the details of this case. 

Each one is different. We will normally finish our investigation 

first. But I will be happy to take that on. 

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

page 111.] 

Mrs. NOEM. Yes, I would really appreciate that, because I think 

that is a key missing link. And what I am concerned about is that 

while we are very action-oriented in our military in our national 

defense, that I don’t want us to approach these situations such as 

checking the box, that we have completed what we feel are requirements, that we need to have the adaptability, the flexibility to care 

about the individual to take the action that is necessary, because 

these are crisis situations and just checking the box isn’t going to 

get us the kind of results that we really need and deserve for our 

service men and women. 

Thank you. 

I yield back, Mr. Chairman. 

Mr. WILSON. Thank you very much, Mrs. Noem. 

And we now proceed to Dr. Brad Wenstrup of Ohio 

Dr. WENSTRUP. Thank you, Mr. Chairman. 

And I applaud all the work that you are doing. I have done some 

temporary duty at Fort Lewis dealing with suicide prevention. I am 

familiar with the difficulties in trying to assess and try to prevent 

and then to try to treat. And I know that your assignment is difficult. 

Of course, we are always looking for numbers; we are always 

looking to try and figure out where are the common trends, and 

you have identified some of them already, such as legal, financial, 

and domestic problems. 

I know you compare with the civilian numbers, but do we compare, say, 30 and under, of the civilian population? As you mentioned, so many within the military are 29 or younger, so I was curious if we compared in that way and what kind of results you 

have seen there. Is it pretty similar to the general population? 

Ms. GARRICK. Yes, sir. I think Dr. Reed addressed some of that 

as well. We see a lot of similarities between ourselves and suicide 

in the civilian population. It is pretty much a mirroring demographic, with young white males with these types of issues and 

problems. I think there are some studies they have done with college students that look very similar to our population. 

Dr. WENSTRUP. So we can’t really conclude that this trend within 

the military is military specific, that that may not be the issue; it 

may be more societal rather than just military, right, Dr. Reed? 

Mr. REED. Great point. And I think that is one thing we really 

have to tease out. The rate of suicides for 18- to 25-year-olds in the 

general population is high. It is the third leading cause of death. 

So the question really is, what percent of the suicides that are 

happening in the military in the same demographic are similar, in 

terms of their cause, to the general population, or perhaps unique 

to the experience of being in the military? 

When you look at another group, the same age group—the college-age student—this population has half the suicide rate of their 

peers that don’t attend college. So what is it that is protecting col-
22 

lege-age 18- to 25-year-olds that is not protecting the general population, or perhaps some of those that are in the military? 

These are questions we really have to look at, because it may not 

be a military-specific explanation for the 18- to 25-year-old suicide 

rate. It may be more of the fact that these are young people whose 

brains are still developing. Problem solving skills, coping skills, 

impulsivity are factors that affect all 18- to 25-year-olds. And 

maybe we need to look from that perspective as well as we try to 

address the problem. 

Dr. WENSTRUP. Thank you. And so it seems, as often is the case 

with military research, it tends to benefit the entire country, and 

I think that this will be a case of that. 

The preventive side is often very difficult, obviously. I look at like 

the ACE [Ask, Care, Escort] program with the Army. 

Is there any way of measuring how many saves we have had? 

General BROMBERG. Sir, we are just starting to do that now. Earlier example, we looked at one infantry division where they have 

done now 24 months of resiliency training, and we were tracking 

the gestures, attempts, and ideations, and to see how many peerto-peer interventions there were. 

And the initial results are—is that while the gestures have remained generally about the same, the number of peer-to-peer interventions has increased dramatically, and therefore the number of 

cases having to go to behavioral health have really reduced. But we 

are in the really early stages of doing that and we are trying to 

link that training to outcome. 

Admiral VAN BUSKIRK. I think I would like—just like to add on 

to that, and that is, sir, that we can’t exclusively look at just suicides and suicide-related behavior. I think one of the good things 

that is happening as we have all investing in our behavioral health 

specialists and embedding those people in our units. We look at all 

of the other things that are related to stress and see how that is 

being managed. Are incidents of alcohol abuse going down? Domestic abuse was mentioned earlier. 

So there are these other areas that are also related to stress, to 

where we see the benefits of when we get the professionals in 

there, we reduce the stigma. When it is a total leadership, down 

to the deckplate level, we see success in these areas and start to 

see the needles move, I think, in terms of the other behaviors that 

might be associated with stress, which might be indicators of a potential suicide-related behavior later on or an event. 

Dr. WENSTRUP. I appreciate you taking on this difficult challenge 

and thank you for being here today. 

And I yield back my time. 

Mr. WILSON. Thank you, Dr. Wenstrup. 

And we now proceed to Congressman Chris Gibson, of New York. 

Mr. GIBSON. Thank you, Chairman. 

And I thank the ranking member, as well, for calling this hearing, and all the panelists for your service commitment to our country. 

I am encouraged, actually, by the dialogue here in this hearing, 

and find particularly interesting some of the responses. 

Dr. Reed, the recent one you just gave with my colleague here, 

looking at the data, trying to understand it, how difficult this is 
23 

that we are just not going to be able to point to—we are not going 

to know, you know, by precise numbers. 

But I think the focus on resiliency will come through. And over 

time I think we will see a very positive impact on this. 

I want to also mention that Mr. Scott, he brought up equine, and 

we have a couple of programs going on in our district in upstate 

New York with initial very favorable reviews. So I am encouraged 

by that and we are going to continue to work that. 

Former commander, 3 years ago a brigade commander in the 

82nd—and, you know, can appreciate firsthand how serious our 

commanders and sergeant majors, first sergeants, are taking this 

issue and all the emphasis that is put in in a period of enormous 

stress coming through over a decade of war, the budget situation, 

the drawdown. All of these pressures, exogenous and impacting. 

And yet we have a leadership very focused on making a positive 

difference. Greatly appreciate it. 

Ms. Garrick, like you, my wife, Mary Jo, is a licensed clinical social worker. She is part of a congressional spouse’s group trying to 

make a difference on this very issue, and they are partnered with 

the American Foundation for Suicide Prevention. And, you know, 

I think they are doing important work. 

I went to an event recently in Albany where General Graham 

and his wife Carol were there. I just can’t say enough positive 

about this event. It was well attended. It was focused on education, 

on warning signs, actions that could be taken. 

So to follow up with the Chairman, you know, having firsthand 

experience in terms of the Active Component and seeing how engaged we are, my question really is a followup on the Reserve Component and veterans side of this, because as concerning as the data 

is for our service men and women, we know the veterans’ situation 

is worse. 

And I think you are already making a positive impact on the 

work that you are doing in the DOD. And so, you know, coming 

away from this event last week, I thought that the American Foundation for Suicide Prevention is really engaged and making a difference on this. And so I am interested to know what partnerships 

we have with the DOD and what is your review of that and your 

intentions going forward? 

Ms. GARRICK. Yes, we have established a community action team 

approach, as described by, actually it was Admiral Mullen when he 

wrote the ‘‘Sea of Goodwill.’’ So we took that concept and we have 

started to have these community action roundtable discussions 

where we bring in from the community organizations like the Tragedy Assistance Program for Survivors, the suicide association you 

have just mentioned. Dr. Reed and I talk quite a bit and I work 

very closely with the Department of Veterans Affairs. 

Our last roundtable we held we had several university participation—Harvard, UCLA, the universities in North Carolina and 

South Carolina were both on the phone, Penn State. So we had 

some really great university dialogue on looking at peer support 

and curriculum for peer counselors. 

So we are doing a lot of these kinds of outreach efforts. And my 

partnership with the Department of Veterans Affairs truly does 

allow us to leverage looking at building a joint data repository 
24 

across the Department with HHS [Department of Health and 

Human Services], the CDC data as well. And I think a really important step forward is that the DOD will now confirm for CDC 

Guard Reserve deaths, so that will really help us understand the 

reach into the States and what that looks like at the local level. 

So those kinds of partnerships, they may—it may take us a 

while, but those things are certainly the steps that I see that we 

needed to take and I think are going to be very helpful in moving 

us forward and understanding this from a perspective that Dr. 

Reed described. 

Mr. GIBSON. Well, I appreciate that comment. And just to put a 

finer point on the Albany area, it is about 3 hours or so from Fort 

Drum, and about 2 hours from West Point. But the population— 

about 15 percent of the population, veterans. So this is why this 

event was so critically important, because they were educating the 

social workers and some of the volunteers who are at the V.A.— 

the Stratton V.A.—and also support some of the Active Duty and 

the National Guard that are in the Albany area, whether it be on 

recruiting, ROTC, or the 42nd Infantry Division right there in New 

York. 

So I am going to be working with the committee and see if there 

is maybe more we can do on this partnership, but I appreciate everything that everyone is doing. 

Thank you, and I yield back. 

Mr. WILSON. And thank you, Mr. Gibson. And thank you for your 

family’s commitment and service. 

We now proceed to Congresswoman Carol Shea-Porter, of New 

Hampshire. 

Ms. SHEA-PORTER. Thank you very much, Mr. Chairman. 

And thank you all for being here and the great work that you 

are doing. 

I have to say, it is frustrating. I wish that we had one name 

across the military spectrum. I am reading about all these various 

programs, and through the years while I have had the privilege of 

serving here there have been different titles—all, you know, working to serve this purpose and try to help enlisted men and women 

and officers as well. But the complexity of just the titles and the 

program has to throw a lot of the intended recipients. 

So my first question is, how many people are you aware of, no 

matter how hard you try for your outreach, how many victims or 

their families have said they didn’t know where to turn? 

Ms. Garrick. 

Ms. GARRICK. Yes, I don’t know that I have an exact number of 

how many, but I have certainly heard that as well. And that is 

why, again, part of what we have done, and all of the Services in 

their statements noted that we have tried to craft one message for 

moving forward, and that is if you need help, get it. Treatment 

works. 

And when we work with the military crisis line we have an ‘‘It’s 

Your Call’’ campaign, and then this year we launched the ‘‘Stand 

By Them’’ campaign, which is a V.A.–DOD single-message, single 

point of contact, 1–800 number. And if you type—if you call the 

number it is the same number as the SAMHSA [Substance Abuse 

and Mental Health Services Administration] suicide hotline num-
25 

ber so that regardless of whether you press one or don’t press one 

you are getting funneled into the same help with the same protocols in place, so that our service members and their families are 

using the same services that veterans and their families have 

available to them so that there is that pull-through. 

And that is why it is so important that at transition we are going 

to be able to provide them that information, as well. So as they 

move forward, the message never changes. It is the ‘‘It’s Your Call,’’ 

the ‘‘Stand By Them’’ campaign, and the same 1–800 number. 

Ms. SHEA-PORTER. But do we keep any statistics? Is the question 

asked: Did you know where to turn? Did you know this service was 

available? Because my interaction with service men and women 

and veterans, and certainly we know this from the Vietnam era for 

all the outreach, you know, that somehow or another there was 

still a curtain there—were not aware of it. And I know that our 

V.A. in Manchester, New Hampshire, has been reaching out and 

going to where veterans actually are, trying to draw them into the 

system so they can have access to needed benefits. 

So there is still some kind of a curtain there, and is there any 

way that we are measuring how effective we are? Are we asking, 

did you know where to turn? Did the family know once they were 

aware things weren’t right? Because I think that is an important 

part, to make sure that we are actually reaching them. 

Ms. GARRICK. Yes, I think going back to the previous question 

from Congressman Gibson, that is why these community action 

teams and that approach is so important. Because we can’t do this 

alone, we really do need our community members involved and engaged so that that message is getting out there, that our veterans 

service organizations know how to facilitate a rescue, they know 

how to call the 800 number, how to go online, how to do the 

texting, the chatting, so that all that is out there. 

We just did do a study with the Guard and Reserve, actually, on 

suicide prevention and resilience. We asked support professionals 

and commanders, so what resources are you aware of? What do you 

use? What do you like? What don’t you like? So that we could get 

a better understanding of that exact issue. 

Ms. SHEA-PORTER. But again, you know, does it actually arrive 

through the individual’s curtain and do they know that? And so I 

have a very simple suggestion. I thought, everybody has to go to 

the grocery store. You know, we don’t have to go look for resources 

to help ourselves or our family members. Maybe we know to do 

that; maybe we don’t. But everybody has to go to the grocery store. 

Can we put the number on grocery bags? Can we ask various 

companies and all of the great corporations and small family businesses to put this telephone number on grocery bags to—because 

there is still some kind of problem there where they are just not 

all aware of the resources there. 

So for all the great work you are doing, if there are individuals 

that are not tied into VSOs [Veterans Service Organizations], if 

they are not tied into various organizations, if they think in their 

minds that it is better not to be connected to the military or to the 

Veterans Administration for whatever reason, how do we still reach 

those who have not reached out and we have not noticed yet? 

Ms. GARRICK. No, and I think that is a great suggestion. 
26 

Ms. SHEA-PORTER. So I yield back. 

Ms. GARRICK. We have had some conversation about doing that 

with the commissaries. 

Ms. SHEA-PORTER. Right, so I—but past the commissaries, because a lot of them will not be using commissaries. I think this is 

going to call for the effort, and it has already been developed for 

a long time, I know, but continuing to make sure that our business 

community and our nonprofits as well as those who are in the military and veterans community can work together to put this out 

there. 

Because these programs are there, they are wonderful, but some 

people still do not access them. 

So thank you, and I yield back. 

Mr. WILSON. Thank you, Ms. Shea-Porter. 

We now proceed to Dr. Joe Heck, of Nevada. 

Dr. HECK. Thank you, Mr. Chairman. 

Thank you all for what you are doing and for being here. I am 

sorry that I missed your testimony. I had another hearing to attend, but I did read through your written statements prior to 

today. 

First, I want to thank Ms. Garrick for bringing up the TAPS program and forging a community partnership with them, not just for 

the Services that they provide to the family members but for looking at the information that they glean from the family members 

during their debriefings and how that may help us identify future 

risk. I was just at their anniversary dinner a couple nights ago, so 

an incredible program and I am glad that you are involved with 

them. 

I approach the issue, I think, a little bit differently, as a military 

health care provider and as a brigade commander who over the last 

2 years has had one successful and two threatened suicides within 

my command. So it is a real issue for me that hits home. 

You know, when the Army launched its health promotion, risk 

reduction, and suicide prevention campaign in 2009 and it stood up 

the task force, the Army Reserve participated and came up with 

four pillars that they were going to concentrate their efforts on, 

and I want to talk about two of them. One was reducing the stigma 

associated with asking for help, which has been addressed somewhat here today, and the second was providing resources to geographically dispersed personnel. 

I tell you, fortunately, for the two threatened suicides that we 

had, it was fortunate that those individuals were located within the 

community where the unit was based. Again, you know, being geographically dispersed in the Reserves can mean a lot, and in my 

brigade I have got soldiers that are 3 hours or more away from the 

unit. 

But these individuals made statements to their first-line leaders. 

Their first-line leaders then utilized the ACE mnemonics and went 

out and asked, took them and escorted them to care. And both of 

them were then enrolled in behavioral counseling services, and I 

truly believe that that program saved those two soldiers’ lives. 

Unfortunately, the completed suicide, although having taken 

place in the same town as where the unit was located, had no previously seen indicators. 
27 

And actually, his first-line leader and he were friends and they 

happened to be out that night together. And then 2 hours later, 

after they departed company, the first-line leader was called and 

told that the person he was just with had successfully committed 

suicide. 

So the issue I bring up about stigma is, as we try to put more 

and more of this responsibility on first-line leaders, especially in 

the Reserves, we are looking at 25-, 26-year-old E–5s, and I can tell 

you that in the successful case, that first-line leader is still beating 

himself up over the fact that not only was he a friend but he was 

his first-line leader, and he feels like he failed in recognizing what 

happened. 

And I can tell you that as we talk—about seeing in the written 

statement the stigma reduction campaign that is being developed, 

I mean, but stigma reduction was identified in 2009. I identified it 

when I returned from my deployment in 2008, because you knew 

that if you checked the box on your post-deployment health risk assessment that you had seen a dead body or anything like that you 

were not going to be released. You were going to spend another 2 

to 3 days going through additional counseling, and obviously everybody is waiting to get home to their families and so they knew not 

to check the box—not because they didn’t want to ask for care but 

they knew it was going to delay their ability to get back to their 

families. 

So why is it taking until—why are we still developing a stigma 

reduction campaign when this had been identified well before 5, 6 

years ago? 

General BROMBERG. Yes, sir. I just think over all—and I understand the frustration and the challenges—think this is a cultural 

change. I think it is not that we are developing a campaign or failing to recognize it. I think as I talk to young men and women, and 

the numbers are getting better as far as people that think stigma 

is improving, but not as fast as we would like. 

This is a huge cultural change for us, whether your background 

or how you were raised all the way through your background in the 

military. And I think it is the engaged leadership and the evasive 

leadership, and then success stories of where you can seek help and 

not be penalized for that help. 

There is just a recent data I looked at this week, we have seen 

very slight improvement this last year, but great improvement over 

4 or 5 years—about 20 percent improvement is in stigma reduction. 

We are just going to have to stay at it and keep leadership engaged. 

Dr. HECK. And I just have a couple seconds remaining. I just 

want to bring up the issue about help to the geographically dispersed. 

It seems like a lot of the concentration has been on getting them 

access to care, but again, if they are remote from their unit, we 

have got to identify them. Who are they going to identify themselves to? 

And have we done anything with, you know, our—you know, 

units within the same compo [component], whether National Guard 

units, sister service units, Active Duty installations, the V.A., so 

that if somebody calls their unit and they are 3 hours away, and 
28 

they say, ‘‘I am having a problem,’’ that we can get them plugged 

in with somebody in a uniform who they are going to be able to 

relate to much easier than somebody showing up in civilian clothes 

on their doorstep. Have we looked at trying to branch out across 

Services and compos? 

General BROMBERG. Yes, sir, we are working at it diligently right 

now, and I will provide you some more additional information on 

the specifics of how we are getting after that. 

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

page 111.] 

Dr. HECK. I appreciate it. 

Thank you, Mr. Chair, for—and the ranking member for holding 

this very important hearing, and I yield back. 

Mr. WILSON. And thank you, Dr. Heck. 

And indeed, this is an important hearing and it is obvious the 

commitment of everyone here. And while we have this opportunity, 

we will proceed with additional questions. 

And, Dr. Reed, in particular, the Center for Disease Control has 

indicated suicide is the third leading cause of death among 15- to 

24-year-olds, and is the second leading cause of death between 25- 

to 34-year-olds. And you have already actually brought up something interesting, and that is there is a differential between college-age—young people who are attending college, not attending 

college, the suicide rate. Are there practices within the civilian 

community that could be adopted to the military? 

Mr. REED. Yes, sir. One of the things that happened in 2005 was 

after the tragic death of Garrett Smith, the son of Senator Gordon 

and Sharon Smith, the Congress passed the Garrett Lee Smith Memorial Act. It has been in place since 2005. It is really the first 

Federal appropriation that has been authorized and funded to fund 

States, tribes, and territories, as well as college campuses, to really 

aggressively look at early intervention and prevention in suicide 

prevention amongst this age group. 

These cohorts have been funded since 2005. It is still active 

today, and we gather the cross-site evaluation that is providing 

SAMHSA some very valuable information in terms of what seems 

to be working. And each grantee has been required to assess their 

own performance, and those performances each year are shared 

with others who are trying to do the same thing. 

So this is a perfect example of where, working with Ms. Garrick, 

we can share some of what we are learning in the civilian community that may have relative value to what is happening in the military community as well, especially for those younger military members who may not have taken their life or thought about taking 

their life as a result of a combat experience, but may be more of 

a developmental issue with regards to their place and age. 

Mr. WILSON. Well, thank you for providing that. 

And, Ms. Garrick, I, too, am—was very appreciative of TAPS. I 

know firsthand the Yellow Ribbon Campaign. I want to thank you. 

We proceed to Mrs. Davis 

Mrs. DAVIS. Thank you, Mr. Chairman. I appreciate just a second 

round quickly to try and mention a few issues that are out there, 

I think, that we talk about. 
29 

One of them is a guilt factor, that, in fact, people came home, 

someone came home and felt that their buddies did not. And I don’t 

know to what extent you find that that is a large factor that is 

being addressed or you think maybe is not getting the attention 

that it deserves. 

I think the other issue is just the loss of hope, which we know 

is probably more than any other thing that people can express or 

that family members can express about a loved one, that they 

didn’t see that coming perhaps, but that was a big factor. People 

have talked about the issue of contagion. 

And I think, Dr. Reed, you mentioned it is how we speak about 

suicide that makes a difference. 

I am recalling, Mr. Chairman, that one of the first hearings that 

we had here where we had a father talk about his son, and of 

course, it was very emotional, and trying to understand, essentially, the question of, how come nobody—how come we didn’t 

know, and what services were out there? 

So I don’t know to what extent you want to address those, but 

those are all issues. 

But the one that I think you can maybe, you know, get your head 

around a little bit is the factor that at least 10 percent, as we 

know, in the service have perhaps access to guns at a greater level 

than in the general population. And the fact that we have the literature indicating that restricting access to means—firearms, of 

course—is an effective strategy for preventing suicides. 

Now, in the military, are we using and thinking about that and 

the preventive strategies that are required, knowing that our service members have access, of course, and perhaps are not getting to 

help because, you know, they—it is just too—in some ways it may 

be too easy. Can anybody like to talk about that? 

Ms. GARRICK. Sure. First of all, the NDAA 13 just gave us some 

really good clarifying language on who can, when can you ask 

about personally owned firearms, ammunition, and other weapons, 

and so we are working on a guidance for that so that we can get 

that information out to the Services and make sure that everybody, 

that the clinicians as well as the commanders, are tracking that on 

what you can do. So, I think, that was an important step for us. 

And I do want to go back and just sort of comment on what you 

said about trauma, hope, and contagion, because this is clearly not 

just a mental health issue. Suicide is a behavior and it is a—and 

I think that is why it is so important that we have chaplains involved in this process as well as commanders and mental health 

providers. This really will take a community response within the 

military community and outside of the military community to address some of those key points. 

And I think the research we need to do—and I just met with 

General Patton the other day, who heads our Sexual Assault Program office [Sexual Assault Prevention and Response Office], I 

think marrying up, so what are the different issues? What are the 

areas of concern? And how can we learn more about trauma and 

the—its implications, and hope and resilience and its implications? 

I think those are all very key factors. 
30 

And then the means restriction is certainly important. I think 

the Services can certainly tell you more about what they are doing 

in that regard. 

Mrs. DAVIS. And if there is anything more that Congress could 

or should be doing to help. In addition, obviously, we talked about 

the—just the resource issue, in terms of assistance. 

I think just one other thing to add—I know my time is running 

out—is just, how do we determine the quality of care that is being 

provided, as well? I mean, I don’t doubt that we have the bulk of 

our caregivers who are providing that quality care, but we also 

sometimes talk to people that don’t go additionally because they 

don’t help them out. 

General BROMBERG. Yes, ma’am, it is to protect the weapons— 

on our installations, of course, that is no issue. Commanders have 

the authority to get in what I call almost that invasive leadership, 

asking those questions to withdraw those weapons. And the NDAA 

did help us significantly by opening up the aperture for those that 

live off-post or off the installation so we can ask the right questions 

to try to retrieve those weapons. 

The commands are going after that very aggressively. So the 

weapons piece, I think, is absolutely essential. 

As far as the quality of care, I think, it is the positive, continuous 

dialogue in reaching out to those individuals to find out what else 

they need, because it may not be just behavioral health. It may be 

some other type of relationship issue or financial issue. Where can 

we provide that additional support? 

General JONES. Ma’am, in the Air Force, we have had—rather 

than going after looking at who carries and has access to weapons 

we look at career fields. Three of our most at-risk career fields are 

security forces, aircraft maintenance, and intelligence. Obviously, 

security forces would have access to weapons. 

We target those career fields with special first-line supervisor 

training, must be done one-on-one, must be done in small groups. 

And we found a lot of success with that. 

The other thing we are trying to do is make our health care providers more accessible without applying the stigma. Eighty-three 

percent of all of our primary care clinics have mental health providers embedded in the clinic, so if you go in to see one physician 

he can take you next door to talk to a mental health care provider 

without having to take you down the hall to the mental health care 

clinic. 

And I think that really gets at some of the stigma. And I think 

the stigma is really the metric that shows us that we are making 

some headway here. Ninety percent of everybody in the 2012 Air 

Force climate assessment survey said they believe leadership was 

interested in suicide prevention and felt that was a great thing. 

And also in the 2012 survey, 84 percent of the people said they 

knew who to talk to. They would talk to their coworkers, they 

would talk to their supervisors and their branch chiefs—not for 

mental health care but for the first contact to tell someone that 

they had trouble—ma’am, much to your question of where they 

would take them. And that leads to the ACE care, where you ask 

the person—do they have an issue, you care for them, you escort 

them over to a real professional. 
31 

And in that same survey, 95 percent of the people in the Air 

Force said—and this was Active Guard and Reserve—said the leadership was genuine. Ninety-five percent said the family, friends, 

and coworkers would support them if they had mental health 

issues and sought help. And 83 percent said that they would feel 

comfortable talking about suicide to their coworkers and to professionals. And we think that is a big plus in our numbers. 

Mrs. DAVIS. Big improvement. Thank you. 

Thank you, Mr. Chairman. 

Mr. WILSON. Thank you, Mrs. Davis. 

And as we conclude, I want to thank all of you for your genuine, 

very thoughtful compassion toward our service members, military 

families, and veterans. 

At this time we shall be adjourned. Thank you. 

[Whereupon, at 12:15 p.m., the subcommittee was adjourned.] 

A P P E N D I X 

MARCH 21, 2013 

PREPARED STATEMENTS SUBMITTED FOR THE RECORD 

MARCH 21, 2013 

(37) 

Statement of Hon. Joe Wilson 

Chairman, House Subcommittee on Military Personnel 

Hearing on 

Update on Military Suicide Prevention Programs 

March 21, 2013 

Today the subcommittee meets to hear testimony on the efforts 

by the Department of Defense and the military services to prevent 

suicide by service members, family members, and civilian 

employees. 

I want to preface my statement by recognizing the tremendous 

work the Department of Defense and the service leadership has 

done to respond to the disturbing trend of suicide in our Armed 

Forces. This has not been an easy task and I thank you for your 

hard work. Suicide by members of our Armed Forces is particularly 

distressing to me because I consider military service an opportunity. I want service members to know they are talented people 

who are important and appreciated by the American people. They 

can overcome challenges. 

Suicide is a difficult topic to discuss. Last year 350 service members took their own lives. Every one of them is a tragedy; every one 

of them has a deeply personal story. We cannot rest until we have 

created every opportunity to change such an awful statistic. 

Suicide is a multifaceted phenomenon that is not unique to the 

military. Unfortunately, in addition to the hardships of military 

service, our service members are subject to the same pressures that 

plague the rest of society today. They are exposed to the same 

stressors that may lead to suicide by their civilian counterparts. I 

am deeply concerned about how the uncertainty of sequestration 

and the coming budget challenges will affect our service members 

and their families. 

Each of the military services and the Department of Defense has 

adopted strategies to reduce suicide by our troops. I would like to 

hear from our witnesses whether those strategies are working. How 

do you determine whether your programs incorporate the latest research and information on suicide prevention? I am also interested 

to know how Congress can further help and support your efforts. 

Lastly, I am interested in learning how our civilian experts are 

tackling this problem across the Nation and how private organizations like Hidden Wounds of Columbia, South Carolina, are 

assisting. 
38 

Statement of Hon. Susan A. Davis 

Ranking Member, House Subcommittee on Military 

Personnel 

Hearing on 

Update on Military Suicide Prevention Programs 

March 21, 2013 

I am pleased that the subcommittee is continuing its attention 

on suicides in the military. It has been nearly a year and a half 

since our last hearing on military suicides, and during this time, 

we have only seen increased numbers of service members taking 

their own lives. While Congress has pushed forward a number of 

initiatives to support the Services and the Department of Defense 

in their efforts to develop policies and programs to reduce and prevent suicides in the force, sadly these numbers continue to grow. 

Yet, military service members are not alone. Over 38,000 individuals die by suicide every year. In 2010, suicide was the 10th leading cause of death in the United States, and the fourth leading 

cause of death for adults between the ages of 18 and 65. While suicide among young individuals, 15–25 years old, continues to be a 

concern, the rate of suicide among older Americans is even higher. 

It is important that we share what we learn in the military and 

what is learned by others if our country is to be successful in addressing this societal issue. 

The establishment of the Department of Defense Task Force on 

the Prevention of Suicide by Members of the Armed Forces in the 

Duncan Hunter National Defense Authorization Act of Fiscal Year 

2009 was a start. The task force made 76 recommendations and I 

am interested in where the Department and the Services are in implementing these recommendations. Have they all been completed, 

and if so, what metrics are being used to track success? What other 

efforts can be undertaken to address suicide in the military? 

I welcome our witnesses, and look forward to hearing from them 

on what has been done, what is being done, and where do we go 

from here in our efforts. 
39 

Statement for the Record 

Rep. Rush Holt 

Hearing on Military Suicide Prevention 

Before the 

Subcommittee on Military Personnel 

House Committee on Armed Services 

March 21, 2013 

Chairman Wilson, Ranking Member Davis, members of the subcommitteethank you for the opportunity to offer my views on a topic of great concern to us all: the 

suicide epidemic among our servicemembers and veterans. 

Once again, our nation is on track this year to suffer more military and veteran 

casualties from suicides than from enemy action. This has happened repeatedly over 

the last few years, and the trend has continued despite a clear recognition of the 

problem by successive Secretaries of Defense and by Secretary of Veterans Affairs Eric 

Shinseki. 

As a House member who has taken a leading role in searching for solutions to 

this ongoing human tragedy, one thing has become clear to me: there are effective 

programs around the country that can help save lives, but the Pentagon and the VA are 

not putting a priority on funding and publicizing those programs-despite explicit 

Congressional direction that they do so. 

Over the last two years and with the bipartisan support for my amendments by 

the House Committee on Appropriations, Congress has increased funding for suicide 

prevention and outreach programs in both departments by $80 million. I've emphasized 

the need for both the Pentagon and the VA to increase their outreach focus via direct 

television ad buys and social media engagement. Instead, both departments continue 

to drag their feet on implementing the kinds of programs that we have pushed them to 

do over the last several years. Ads on city buses-one of the major VA initiatives over 

the last year or so-will only reach a tiny fraction of the audience compared to a TV ad 

buy during the Super Bowl. My frustration is compounded by the knowledge that there 

are truly effective local and state programs that, if properly funded and supported, have 

the capacity to have a national impact. 

Indeed, one of the most successful suicide prevention and counseling programs 

in America, Vets4Warriors, is operated in my home state of New Jersey. It started in 

2005 as Vet2Vet, a New Jersey-only program focused on our state's National Guard 

and Reserve members. Its success was so great-no servicemember who used the 

program took his or her life--that the 2010 DoD Task Force on the Prevention of Suicide 

by Members of the Armed Forces recommended that Vet2Vet should be examined as a 

potential national model. The key reason the program works so well is that every person 

who takes a call from a servicemember or veteran is also a former servicemember. 
40 

This peer-to-peer connection is vital in building the trust necessary to get a soldier or 

veteran with a problem to open up about their experiences, fears, needs and hopes. 

In December 2011, the National Guard Bureau decided that the expanded 

Vet2Vet program, now rechristened Vets4Warriors to denote its national character, 

should be the program of record for Guard personnel nationwide who were seeking 

counseling services. That was the right decision, and it put the Guard Bureau well out 

in front of the rest of 000 in showing a real commitment to working with and funding 

local or state programs with proven track records of success. Unfortunately, you can't 

find a link to Vets4Warriors on the NGB homepage. The NGB also hasn't established a 

Twitter feed for Vets4Warriors, or a Facebook presence, or any other dedicated social 

media presence for the program. That lack of action is in direct contravention of the 

intent that I had when I argued on the House floor for more funds for programs like 

Vets4Warriors. And it certainly isn't for lack of money. 

I'm glad the House Committee on Armed Services is holding an oversight 

hearing on this general topic this week. Why the NGB has failed to take these steps is 

something requiring further oversight by the Armed Services and Appropriations 

committees in both chambers, but so does the entire 000 and VA approach to outreach 

to at-risk veterans. The Iraq War veteran who inspired my efforts to end the military 

suicide epidemic, the late Sgt. Coleman Bean of East Brunswick, New Jersey, took his 

own life while waiting for the VA to schedule his counseling appointment. If they are 

serious about reducing suicides among our nation's warriors, Secretaries Hagel and 

Shinseki will move heaven and earth to make sure that programs like Vets4Warriors 

receive the funding and authority they need to reach-and save-America's finest. 
41 

STATEMENT 

OF 

.JACQUELINE GARRICK, LCSW-C 

ACTING DIRECTOR OF THE DEFENSE SUICIDE PREVENTION OFFICE 

BEFORE THE 

SUBCOMMITTEE ON MILITARY PERSONNEL 

OFTHE 

HOUSE ARMED SERVICES COMMITTEE 

CONCERNING 

UPDATE ON MILITARY SUICIDE PREVENTION 

ON 

MARCH 6, 2013 
42 

Mr. Chaimlan and members of the Commincc, thank you for the opponunilY 10 present 

informmion on the accomplishments of the ikpanment of Defense's (DoD) Suicide Prevention 

Program. 

Suicide ranks as the tenth leading cause of death in the United Stmes (U.s.), according to 

the Centers for Disease Control and Prevention (CDC).' ·2 Ov('r Ihe paSI dcrade. the national 

suicide rate has gmdually increased for Ihe general U.s. population.J For 2010, the U.S. suicide 

rale for males, ages 17-60 was 25.1 per 100.000, which rose from 21.R per 100,000 in 200 1 For 

comparalive purposes, this adjusled mte best mmcrn:s the U.S. Armed Forces population. The 

suicide rate among the U.S. Armed Forces also rose in the past decadc. going from 10.3 suicides 

per 100.000 Service mcmbers in 200 1 ~ to 18 ,3 suicides per 100.000 SeTvice members in 2009.

5 

While essentially level in 20 106 and 2011', the suic ide mte for 2012 is expected to increase once 

death invcstigmions have been completed and a final manner of death determination is issued.' 

The Department has closely monitored and examined suicides since 2008 and suicide 

anempts since 2010 amongst ils Service members. The Do[) collects Ihis data in Ihe DoD 

Suicide Evenl Rcporl (DoDSER), which standardizes suicide surveill ance efforts across Ihe 

Services (Air Force, Army. Marine Corps. and Navy) to suppon the DoD's suicidc prevention 

mis.~ion.Q The OoDSER collects crucial data. s uch as demographic informal ion. cause and 

'This i" bc ranking OS of2011 . Ih< ~I """'nl Y"3r(20 tO) for which CDC has data, Suicide w •• al'" thc 10th 

~.dinl\ c" .. sc of deMh for 20 I O. 2009. and 2008. 

, Hoy.". D. 1.., & Xu, Jioquan. (2012. Oclokr (0), Dealhs: Preliminary 0 ... for 2011. National Vit.1 Slali'lic. 

Repo".,61(6j. )·51. 

, Cenle .. for Oi..,,,,,, Control and ~v<'Tllion (CDC). (1(1 12. May 11). National , uicide SI.,iS!i •• :u a gl.""" Trends 

in ,uicide rale, among person. age. 10 Y"ars and older, by sex. Un;lcd SIOIe., 1991-2009. ~i.ved from 

hup:llwww.cdc.govNiolc"".Pre,'.mionl,uicideJs\ali.liclllrcndiOl,hlml 

, 160 "",fInned , uicides 

' 3toconfirmed suicides 

, 298 confirmed ,uicid • ., I 7,8 per 100,000 

, 30 I confirmed suicide .. I 7,5 per 100.00 

, As ofMar.h 1,2013, th. CY 2012 YTD numb(:.-s . ",:3SOsuici<ies. 291 .'" ,onflrmW and 59 are pending 

• hup,oIlt2hcallh.lITglprogramsldDdscr 

2 
43 

manner of death or attempts, substance abuse and psychological health history, and deployment 

and combat experiences. It incorporates associated factors, such as marital status, rank, and 

educational levels. A comprehensive report summarizing DoDSER data is published annually. 

According to the most recently published DoDSER Calendar Year 20 II Annual Report, 

the Department knows that the majority of military suicides were completed by enlisted 

Caucasian males, age 29 and below. with a high school education. In some cases, legal or 

financial issues were present and many had experienced a failed intimate relationship. Scrvicc 

members primarily used firearms to complete a suicide and died at home. The majority of 

Service members did not communicate their intent for self-hann nor did they have a known 

history of behavioral health problems. Less than half of those who died by suicide had 

deployed, 10 and a small number were involved with direct combat. 

Service members involved in non-fatal suicide attempts were most often high-school 

educated, junior enlisted Caucasian males under the age of 25. Slightly more than half had a 

failed intimate relationship. The majority used drugs in their suicide attempt, which most 

frequently occun-ed in their own residence. The majority did not communicate their intcnt for 

self-harm, but, in contrast to those who died by suicide, most had at least one documented 

behavioral health disorder. Less than half of those who attempted suicide had a history of 

deployment. II and a small number had experienced direct combat. 

With suicide on the rise in the military, the Department established the Task Force on the 

Prevention of Suicide by Members of the Armed Forces in response to Section 733 of the 

National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2009. The Task Force issued 

a report in August 2010 that provided 76 recommendations for how the Department could more 

10 Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OlF), or Operation New Dawn (ON D) 

" OEF, OIF, OND 
44 

efTectively prevent suicide. First among its recommendations was the establishment ofa 

centralized suicide prevention office that would uncover best practices and help identify and 

reduce inefficiencies and gaps across the Services. 

DSPO began operations in November 2011, as a component of the Office ofthc Under 

Secretmy of Defense for Personnel and Readiness. DSPO oversees all strategic development, 

implementation, standardization, and evaluation of DoD suicide and resilience programs, 

policies, and surveillance activities. The Office works very closely with the Army, Navy, Air 

Force. Marine Corps, Coast Guard. and National Guard Bureau through the Suicide Prevention 

General Oftlcer Steering Committee (SPGOSC), which directs the implementation plan for the 

Task Force recommendations, and the Suicide Prevention and Risk Reduction Committee, which 

coordinates on action items and shares best practices to support Service members and their 

families. NDAA FY13 codified this office, which enhances the authority by which DSPO 

operates. 

To fulfill the Task Force recommendations that the Department accepted for action. 

DSPO immediately developed a strategy to work 'with the Services and other key partners that is 

infonned by the DoDSER data. The Department's strategy accounts for other key research 

findings and recommendations-such as President Obama's Executive Order on Mental Health. 

the National Strategy for Suicide Prevention. congressional mandates. the RAND Corporation 

study. 12 and DoD and Veterans Affairs (VA) joint Integrated Mental Health Strategy (IMHS). 

which includes action items for preventing suicide and enhancing resilience among Service 

members and their families. 

12 The RAND Corp. groups behind "The War Within" are the RAND Center for Military Health Policy Research 

and the Forces and Resources Policy Center orthe RAND National Defense Research Institute. 

4 
45 

To execute thesc actions and recommendations, the SPGOSC established nine priority 

groups. These focus on issuing suicide prevention policy, increasing data tidelity, reducing 

stigma, containing access to lethal means, standardizing death investigations, developing a 

research strategy, and evaluating programs, trainings and quality of care. 

DSPO and the Services have made significant strides in the nine priority areas. 

Specifically, the Department is responding to the NDAA FY13 by issuing the first DoD-wide 

comprehensive suicide prevention policy. DSPO developed the DoD Directive 6490.rr, "Defense 

Suicide Prevention Program," which is anticipated to be released in 2013. Once published, the 

policy will detemline applicability, standardize definitions, establish standards, and assign 

responsibilities for the Defense Suicide Prevention Program. For example, it will (I) require 

leaders to foster a command climate that encourages DoD personnel to seek help and build 

resilience; (2) mandate that the Department provides continuity to quality behavioral healthcare 

during times of transition; (3) require a sustainable Service-wide suicide prevention education 

and training program; (4) establish methods for standardized mortality data collection; and (5) 

requires each Service to staff, fund and maintain a Department level Suicide Prevention Program 

Manager. 

To enhance the fidelity of suicide data, DSPO is coordinating and developing a process to 

improve DoDSER and other surveillance data. to analyze data, and translate findings into policy 

updates and program strategy. To create ajoint Suicide Data Repository, DSPO is working with 

our VA partners to jointly purchase Service member and Veteran mortality data from the CDC 

National Death Index (NDI) going back to 1979,13 which will facilitate comparative trending 

over time, improve analytical capabilities. and allow for a richer data set for mining mortality of 

The first year for which NDI data is available. 
46 

all who have served. In addition, DoD will affIrm military service for the CDC, thereby 

enhancing its capabilities to track National Guard and Reserve deaths and Service members who 

die overseas. This mortality data will enhance research projects for longitudinal studies and 

population health surveillance activities. The Department also is reviewing and evaluating the 

non-criminal death investigations currently conducted to determine if the processes can be 

modified and enhanced to include more suicide-related information. 

The 2010 Task Force noted 14 that there were nearly 900 suicide prevention activities 

across the Department and fonnd that while the Department had attempted to evaluate its 

programs, there were inconsistencies. redundancies. and gaps in its approach. Rccognizing that 

there are challenges with measuring prevention since outcomes of the counterfactual-that 

which did not happen-arc difficult to capture and connecting programs to reduced mortality or 

morbidity are not easy conclusions to draw, DSPO responded by developing a comprehensive 

capacity analysis of suicide prevention programs and resources through an automated resource 

management tool that tracks requirements and funding across the Future Year Defense Plan. 

DSPO plans to unite these efficiency measures with effectiveness and engage in continuous 

process improvements reporting that will have pecuniary implications for decision makers. The 

objective of this approach is to be able to identify suicide prevention and resilience programs that 

align to strategic goals and areas where there are shortfalls or duplication of effort. This will 

result in potential savings by eliminating duplicative programs and generate fiscal effIcacy by 

using those savings to cover identified gaps, or fund new evidence-based initiatives that 

leverages efforts to translate research. Eventually, the plan is to be able to case manage Service 

members at risk and track the changes in their well ness to the referral resources utilized. 

14 DoD Task Force on the Prevention of Suicide by Members of the Armed Forces, "The Challenge and the Promise: 

Strengthening the Force. Preventing Suicide and Saving Lives," August 20 1 O. 

6 
47 

To meet a similar goal, DSPO is conducting a comprehensive training evaluation to 

develop an overarching training strategy by the end of fiscal year 2013 that provides a 

framework of core competencies for the Services to implement training in a way that meets their 

individual and sub-population needs, such as at the peer. command, clinical, or pastoral level. 

A significant achievement for the Department has been its annual suicide prevention 

conference partnership with V A, which is an Integrated Mental Health Strategy requirement. Tn 

June 2012, the conference was attended by over 1, I 00 participants; primarily mental health 

providers and peer counselors who were able to receive the latest research intonnation and 

emerging best practices. The importance of this conference was underscored by the appearance 

of not only the Secretary of Defense, but the Secretaries of V A and Health and Hwnan Services 

(HBS); together addressing the public health response needed to curtail suicide in the U.S. 

The Department is tackling one of the most critical aspects of preventing suicide: 

eliminating the stigma that prevents some Service members or their families from seeking help 

when they have behavioral health and other problems. The Department is working to implement 

the Executive Order on Improving Access to iviental Health Services for Veterans, Service 

lvfembers, and Military Families issued by President Obama on August 31, 2012. To accomplish 

these requirements, the DoD and V A are leading a 12-month, help-seeking campaign to 

encourage Service members, Veterans, and their families to contact responders at the 

Veterans/Military Crisis Line by phone l5 or online J6 when they are in crisis. The DoD and VA 

created "It's Your Call" messaging for Service members and "Stand By Them" materials to 

involve family and friends. DoD and V A are also collaborating to develop several Public Service 

Announcements (PSAs) that encourage Service members and their friends and families to 

" 1-800-273-8255, press 1 

16 www.militarycrisisline.com 

7 
48 

contact the Veterans/Military Crisis Line. For instance, in December 2012, a Military Crisis Line 

PSA aired on the White House's Joining Forces Website, 17 encouraging help-seeking over the 

holidays. V A and DoD are also launching a PSA nationwide in March 2013 that urges families 

and friends to stand by Service members and Veterans and to get them help in their time of need. 

In cooperation with the Services and V A, DSPO has worked to ensure that the Military 

Crisis Line is available in Europe, and we are in the process of extending that capability in Japan 

and Korea. The Military Crisis Line is available at larger bases in Afghanistan, but where it is 

not available, such as on many forward operating bases, DSPO worked with Task Force 14 

Medical to establish a confidential peer support crisis hotline that utilizes local cell phone 

services. General Allen signed off on this hotline just before the holidays, and we trained a 

Combat Operational Stress Control team of medics to answer the lines using a similar protocol 

that the National Guard uses with the successful Vets4Warriors peer support call center. 

In addition, the Department is focused on training and educating a wide variety of 

Service members and DoD civilian employees on how to cultivate a ready and resilient force. To 

foster this "Total Force Fitness," DSPO works closely with the office of the Joint Chiefs of Staff 

and the Services to present this model. To ensure that best practices in suicide prevention are 

widely instilled, DSPO hosted numerous educational sessions geared to a vast range of audiences 

including. senior military leaders, wounded warrior Recovery Care Coordinators, public affairs 

officers, and civilian supervisors. 

Through these trainings, DSPO is increasing awareness among Service members and 

health providers about mental health exclusions related to their security clearances and the 

Standard Form 86 (SF-86), "Questionnaire for National Security Positions." Service members 

describe seeking behavioral healthcare as the "last resort" due to fear of negative career impacts, 

17 http://www.whitehollse.gov/blogi2012/12/11/taking-care.our.military-families-holiday-season 

8 
49 

which include adverse determinations of personal security clearances. Although the vast majority 

of behavioral problems would not disqualify Service members from obtaining or maintaining 

their security clearances, they often believe that seeking care is career-ending. In reality, the 

percentage of all security clearance denials and revocations for cases involving mental health 

issues is very small-less than 1 percent. 18 To this end, we are working to ensure Service members 

understand that seeking help is a sign of strength and, when they proactively reach out for 

assistance, it does not jeopardize their security clearances. 

Postvention, the response in the wake of a suicide, also has implications for prevention 

and reducing suicide contagion. A DoD Reserve Component stakeholder group identified the 

need for a Postvention Guide, 19 so one was created and published for Reserve Component 

Commanders. It gives them guidance on survivor support, memorial services, and community 

involvement in the wake of a unit member's suicide. The survivor perspective is informative in 

understanding the impacts of policies and practices. To further its surveillance efforts. DSpO 

engages in a monthly postvention debrief with the Tragedy Assistance Program for Survivors 

(TAPS) Suicide Program Director to review factors leading up to a Service member's death as 

reported by the families referred to TAPS by the Services for peer support. This dialogue builds 

a frame of reference that the DoDSER data alone does not provide. 

In light of the fact that fireanns are the main means for completed suicides, the 

Department established a working group to define policies that will contain at-risk Service 

members' access to both military and privately-owned weapons. As part ofthis effort, the 

Department is also providing clarifying guidance on Section 1057 of the NDAA FY13, which 

authorizes mental health professionals and commanding officers to inquire ahout plans to acquire 

18 Defense Personnel Security Research Center. June 2011. 

i9 Department of Defense. "Reserve Component Suicide Postvention Plan: A Toolkit for Commanders." May 2012. 

9 
50 

or possess privately-owned fireanns, ammunition, and other weapons. Further efforts to promote 

safety involve a partnership with the Yellow Ribbon Reintegration Program and the Unifonned 

Services University ofthe Health Sciences to develop curriculum for a family home safety 

planning class that incorporates the use of gun locks. The Department has distributed over 

70,000 gun locks across the Services and National Guard as a part of this effOJi. 

Since suicides and suicide attempts were also associated with prescription drugs 

according to DoDSER data, the Department contracted a feasibility study to detennine how to 

best implement a drug take-back program aiming to reduce drug-induced suicides and attempts 

by allowing recipients of phannaceuticals to return unused medications to the phannaey in 

compliance with Drug Enforcement Agency rules. 

The Department continues to increase Service members' access to and quality of 

behavioral health care by expanding the practice of embedding behavioral health providers in 

operational units. These providers have a positive impact on mission readiness and safety. 

Behavioral teams are made up of several mental health providers who train, deploy and reside 

with their units. As integral members of the unit, the providers build a bridge between Service 

member and mental health professional, leading to early identification and intervention for those 

unit members who need their help. 

Through its program evaluation approach, DSPO will be able to monitor appropriate 

access to care. Furthennore, DSPO is examining ways to more effectively identify and track risk 

and protective factors within the force to identify Service members whose wcllness is at risk. 

DSPO is building a capability to identify active and Reserve components experiencing stressors 

that could impact their individual resilience, and then help to ensure that they receive outreach 

and/or care from an effective resource. 

10 
51 

Thc Department is developing a unified, strategic, and comprehensive DoD plan for 

research in military suicide prevention and consults with the Military Suicide Research 

Consortium. This also includes working with the RAND Corporation to examine whether current 

research efforts map to the Department's strategic needs and congressional mandates for suicide 

prevention. This study will be completed by June 2013, and a plan that incorporates research 

goals for the National Suicide Prevention Strategy will be drafted by July 2013. DSPO 

established a team dedicated to translating knowledge accrued from evaluations, research and 

studies into clinical and non-clinical practices or policies that benefits leaders and support 

personneL Moreover, the Department conducted the first systematic assessment of the Reserve 

Components' use of and satisfaction with suicide prevention and resiliency resources, which 

allowed it to obtain information about program oversight practices and command climate 

elements that influence planning and implementation of initiatives. 

The Department is responding to Section 533 of the NDAA FY12, which accents the 

importance of collaborating with both public and private partners in several ways. First, DSPO 

created a Community Action Team approach, as described by the Office of the Joint Chiefs of 

Stan: that links Department experts with non-profit organizations, universities, and other entities 

in order to assess best practices in suicide prevention and share lessons learned in areas such as 

family and peer support education. Secondly, working with the Substance Abuse and Mental 

Health Services Administration, DSPO expanded Partners in Care, a chaplain program in which 

faith-based organizations provide services and support to members of the National Guard and 

their families. Next, through the DoD Joint Service Committee on Military Justice, DSPO is 

exploring the feasibility of developing policies that would recommend using therapeutic 

sentencing techniques developed by Veterans Treatment Courts in military justice proceedings 

11 
52 

for Service members diagnosed with behavioral health problems. Finally, the Department has 

worked closely with the National Action Alliance, a group created by HHS Secretary Kathleen 

Sebelius and former Defense Secretary Robert Gates. The Honorable John McHugh, Secretary 

of the Army. is the public sector executive committee co-chair of the National Action Alliance, 

and the Department had several other key players who reviewed and provided recommendations 

for the National Strategy on Suicide Prevention (NSSP), which was issued in September 2012. 

The NSSP focuses on reducing suicide over the next 10 years, and DSPO has incorporated these 

strategic goals into its program evaluation approach. 

Also in response to Section 533 of the NDAA FY12, the Department is taking steps to 

ensure the availability of suicide prevention resources or Veterans Crisis Line materials to 

Service members and their dependents during pre-separation counseling from the armed forces 

and at the V A benefits briefing during the Transition Assistance Program. 

In closing. everyone in the Department fervently believes that even one life lost to suicide 

is one too many and prevention is everyone's responsibility. The Department has launched a vast 

array of initiatives in collaboration with the Services, and other Depatiments and agencies to 

most effectively prevent suicide in the military. The Department will continue to address the 

urgent need to standardize and enhance suicide prevention and resiliency activities and to 

disseminate all lessons learned and best practices across the arnlcd forces. This issue is complex, 

and the challenges are great. However, while this fight will take enormous collective actionand the implementation of proven and effective initiatives-the Department remains optimistic 

that it will find better solutions that will save morc lives. 

Again thank you for allowing my testimony. 

12 
53 

Jacqueline Garric k, LCSW·C, BCETS 

Acting Director, 

Defense Suicide Prevention Office 

Department of Defense 

Jacqueline Garrick has been named the Acting Director for the Defense Suicide 

Prevention Office (DSPO) under Readiness. Since November 2011 , she has lead 

the charge to create a Defense Suicide Prevention Program that includes drafting 

policies, standardizing data collection and reporting, evaluating programs, 

reducing stigma, building resilience, and increasing help seeking behavior 

through partnerships and outreach efforts to Service members and their families. 

In 2009, she was appointed to the Department of Defense first as the Principal 

Director and was briefly the Acting Deputy Under Secretary of Defense for the 

Wounded Warrior Care and Transition Policy 0f'N'JCTP) Office and then 

assigned to be the Special Assistant in Reserve Affairs to oversee Resiliency, 

Readiness and Suicide Prevention. She has had responsibility for Recovery 

Care, Transition Assistance, Disability Evaluation and Suicide Prevention 

activities across the Department. 

Prior to that, she served the House Committee on Veterans' Affairs as a 

Professional Staff Member to assist the Disability Assistance and Memorial 

Affairs Subcommittee hold hearings and draft legislation on such issues as 

stressor evaluations, benefits outreach. and information technology. She was a 

Senior Policy Analyst for the Veterans' Disability Benefits Commission from 2005 

to 2007 and supported the Commission in its efforts to evaluate all benefits 

programs available for disabled veterans, supervised research and legal 

assistants, and contributed to its Final Report. 

Ms. Garrick was the Deputy Director for Health Care at The American legion for 

six years. She developed and implemented its policies on veterans' healthcare 

issues, gave congressional testimony, ran outreach initiatives, and was a media 

spokesperson. She supervised the Gulf War Task Force and the National Field 

Service, which visited all VA facilities. She led task force visits to over 50 VA 

facilities exploring issues, such as patient care, budget, and research 

compliance. 

In 1992, she accepted a commission as a United States Army captain, and 

served as a social work officer at Walter Reed Army Medical Center. During that 

time, she managed programs for soldiers who had served in the Gulf War, 

Somalia, Bosnia, and Haiti and counseled soldiers, retirees, and their families on 

a myriad of issues and assisted with transition. 

Upon completion of her BSW and MSW from Temple University in Philadelphia 

PA, she returned to her native New York to become the Program Director for the 

Vietnam Veterans Resource Center. During her tenure, Ms. Garrick provided 

Jacqueline Garrick 
54 

individual, group, and family therapy to Vietnam veterans and their dependents. 

In addition, she ran a program for incarcerated veterans. Ms. Garrick consulted 

for Vietnam Seminars and Consulting in 1991, and developed a program for 

former Soviet Union military members who served in Afghanistan. She created a 

self-help guide for Russian veterans, and traveled extensively throughout the 

Soviet Union marketing these techniques and educating veterans about 

Posttraumatic Stress Disorder (PTSD). 

Ms. Garrick is involved with many professional and civic organizations, and was 

the editor of Trauma Lines for six years. After September 11, she was a disaster 

mental health counselor at the Pentagon Family Assistance Center. She also ran 

her own consulting practice for four years, the FARgroup, and provided policy 

analysis, strategic planning, fundraising, program development and evaluation 

support to nonprofit, private and government entities. She has presented on 

PTSD throughout the United States, Germany, Great Britain, Turkey, Russia, the 

Ukraine, Israel, and the Netherlands. Her books; You Can Too: A Mind, Body, 

Spirit Connection for Weight Loss and Trauma Treatment Techniques: Innovative 

Trends were both published in 2005. 

2 

Jacqueline Garrick 
55 

RECORD VERSION 

STATEMENT BY 

LIEUTENANT GENERAL HOWARD B. BROMBERG 

DEPUTY CHIEF OF STAFF, G-1 

UNITED STATES ARMY 

BEFORE THE HOUSE ARMED SERVICES COMMITTEE 

SUBCOMMITTEE ON MILITARY PERSONNEL 

FIRST SESSION, 113TH CONGRESS 

ON MILITARY SUICIDE PREVENTION 

MARCH 6, 2013 

NOT FOR PUBLICATION UNTIL RELEASED BY THE 

COMMITTEE ON ARMED SERVICES 
56 

Introduction 

STATEMENT BY 

LTG HOWARD B. BROMBERG 

DEPUTY CHIEF OF STAFF, G1 

UNITED STATES ARMY 

Chairman Wilson, Ranking Member Davis, and Distinguished Members of this 

Committee - Thank you for the opportunity to appear before you on behalf of America's 

Army. 

The United States Army remains engaged in the longest period of combat operations in 

our Nation's history. Our Soldiers, Army Civilians and Families remain the strength of 

our Nation and have demonstrated unprecedented strength, performance and resilience 

over the past 12 years. While physical injuries may be easier to see, "invisible wounds" 

such as depression, anxiety and post traumatic stress take a significant toil on our 

service members. Army leaders at all levels are committed to eliminating the negative 

stigma associated with seeking help; building physical, emotional and psychological 

resilience in our Soldiers, Army Civilians and Families; and ensuring that anyone who 

may be struggling gets the help he or she needs. 

Strategic Overview 

The Army had 324 potential suicides during 2012 - the highest annual total on record. 

Of those, 183 deaths occurred within the Active Component and Reserve Component 

on Active Duty. This total exceeds the previous high of 148 in 2009. The Reserve 

Component (ARNG/USAR) not on Active Duty total of 141 is the second highest on 

record, exceeded only by the 2010 total of 166. While most Army suicides continue to 

be among junior enlisted Soldiers, the number of suicides by Non-Commissioned 

Officers has increased over each of the last three years. Of note, during this same 

three-year period, 2010-2012, we have seen a decrease among Asian/Pacific Islanders 

and Native Americans. By far, most Army suicides were in the 21-30 age range, a trend 

that held each year from 2010 to 2012. 
57 

The observed attributes of the Army's suicide profile describe Soldiers across all 

components; however, it is important to remember that while Soldiers in all components 

share some common challenges, Army National Guard (ARNG) and United States Army 

Reserve (USAR) Soldiers may face unique and disparate stressors. Army Leadership 

recognizes that suicide prevention is even more challenging with these individuals who 

may not be "full-time" Soldiers. Soldiers in the ARNG and USAR may be more acutely 

affected by unemployment issues and other negative effects of current economic 

conditions than their Active Component counterparts. Financial stress borne by many 

ARNG and USAR Soldiers is the same as those in the civilian community 

As requirements in Afghanistan and Iraq began to decrease, starting with troop 

withdrawal from Iraq in 2009 (completed in 2011), we have seen an aggregated 

increase in the number of suicides in Service Members who have not deployed. 

However, we have also seen an increase in suicide numbers of Soldiers who have 

deployed one or more times from year to year from CY 2009 through CY 2012. 

Suicide is not solely a military problem - it is a rising National issue. Comparison 

between the National suicide rate and Army suicide rate should be done with caution. 

There are differences between the two populations, which make direct correlations 

problematic (e.g. gender ratio, age range, etc.). The demographically-adjusted 2010 

U.S. national suicide rate for males between 17- 60 is 25.1 per 100,000, based on the 

latest crude rate published by the Centers for Disease Control (CDC). Thisl rate is 

slightly higher than the Army Active Duty rate for 2010 and 2011, which was 22.2 per 

100,000 and 22.1 per 100,000, respectively. These very general comparisons strongly 

support the notion that suicidal behavior is an urgent national problem that affects all 

Americans across all dimensions of society, including those who have chosen to serve 

in an Army uniform. 

With all things considered, and with what we know about the U.S. national suicide rate, 

the approach towards the suicide challenge should continue to be coordinated and 

multifaceted. The Army is confident that through our continued emphasis in the 

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services, programs, policies, and training that support our Army Family, we will 

overcome this threat to our Force. 

The Army continues to institute a multi-disciplinary, holistic approach to health 

promotion, risk reduction, and suicide prevention. This approach is reflected in the 

various senior leader forums that are conducted throughout the Army: the Army Vice 

Chief of Staff-led Suicide Senior Review Group; the Health Promotion Risk Reduction 

Council; and the Community Health Promotion Councils at posts, camps, and stations. 

Key elements of the Army's approach are: 

• Prompt access by Soldiers to quality behavioral health care; 

• Multi-points screening and documentation of mild Traumatic Brain Injuries/Post 

Traumatic Stress Disorders; 

• Improved leader and Soldier awareness of high-risk behavior and intervention 

programs; and 

• Increased emphasis on programs that support Total Force (Soldiers, Army 

Civilians and Family members) readiness and resilience. 

Changing Culture 

The Army had traditionally perpetuated a culture in which asking for help was seen as 

weakness. This culture is now changing and must continue to change. 

Although the Army is overcoming most of the stigma related barriers, stigma remains a 

challenge within the Force. A comprehensive Stigma Reduction Campaign Plan is 

being developed to identify and eliminate institutional and cultural barriers and promote 

seeking help for invisible wounds. The campaign will highlight Army, 000, VA and 

national stigma reduction initiatives and target: Education and Outreach; Policies and 

Procedures; and Evaluation and Measurement. At the core of this initiative will be a 

robust communications campaign with effective messaging to promote help seeking for 

a myriad of invisible wounds. 

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We have experienced a degree of reduction in Soldiers' negative perception toward 

seeking help for behavioral health issues. Results from the Sample Survey of Military 

Personnel (SSMP) from 1999 to fall 2012, revealed that the percentage of officers and 

enlisted Soldiers who felt seeking behavioral health counseling I care would harm their 

career dropped significantly, from 81% to 54% for officers and from 69% to 52% for 

enlisted Soldiers. While many factors may influence this occurrence, we believe that 

two key efforts contributed to this change: co-locating behavioral health care with 

primary care and expanded use and promotion of confidential services (Military Crisis 

Line; on-line self-assessment programs for substance abuse; and confidential treatment 

programs). The Army has also increased access to, and availability of, Behavioral 

Health Care services. This has contributed to an overall increase in the number of 

Behavioral Health encounters from 991,655 in FY07 to 1,961,850 in FY12, a 97.8% 

increase. 

We continue to employ a multi-tiered approach to increase awareness regarding suicide 

prevention and behavioral health services. Included are public service announcements 

using celebrities and Amy leaders; advocacy and outreach messages and programs 

through numerous non-governmental organizations; and educational videos such as our 

"Soldier to Shoulder" series. Additionally, the Army continues to promote the use of 

confidential support programs such as Military OneSource and the Army's Confidential 

Alcohol Treatment and Education Pilot (CATEP) which bolster our efforts to ultimately 

mitigate stigma associated with seeking behavioral health care from among our ranks. 

Suicide Prevention Awareness Training 

Suicide Prevention Awareness Training continues to be updated based on trends and 

lessons learned from the Vice Chief of Staff of the Army-led Suicide Senior Review 

Group meetings each month and assessments conducted during installation visits. 

During the 2012 Suicide Prevention Stand Down, commanders across the Army led 

their personnel in team-building activities and conducted suicide prevention and 

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resilience training to promote the buddy system and sharpen intervention skills and 

knowledge. 

Programs such as Embedded Behavioral Health, a multidisciplinary, community based 

program that provides behavioral health care to Soldiers in close proximity to their units 

and in coordination with their unit leaders is a leading example in how the Army is 

redesigning behavioral health services. Embedded Behavioral Health is being 

established for all operational units in the active Army. Program evaluation determined 

that Embedded Behavioral Health resulted in statistically significant reductions in: 1) 

inpatient psych admissions 2) off-post referrals, 3) high risk behaviors and 4) number of 

non-deployables. 

Additionally, Embedded Behavioral Health has higher acceptability and satisfaction 

rates by both Soldiers and supported leaders than conventional systems. These results 

directly contributed to the decision to expand the program in support of all operational 

active Army units and an example in how the Army is aligning behind evidenced based 

programs in establishing a network of complementary behavioral health services in 

support of Soldiers and Families. 

Among other efforts, the Army is enhancing behavioral health care through: TeleBehavioral Health, Patient Centered Medical Home and School Behavioral Health 

focused on reaching Soldiers and beneficiaries wherever they are located in order to 

improve access and reduce stigma. 

Ready and Resilient Campaign 

For us to continue to improve, and increase capability and performance, we must 

continue to build resilience in our total force. We have a historic opportunity to 

understand the lessons of the last 12 years and make our strong force stronger. Thus 

on February 4, 2013, the Secretary of the Army issued a Directive requiring the Army to 

move forward with its Ready and Resilient Campaign (R2C) plan. The R2C will address 

the challenges that stress the Force, and integrate and synchronize the multiple efforts 

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and programs designed to improve the readiness and resilience of Soldiers (Active, 

Reserve and National Guard), Army Civilians and their Families. 

The R2C is focused on making resilience a part of our culture, using the 

Comprehensive Soldier and Family Fitness (CSF2) program and other supporting 

programs to accomplish that objective. The campaign also recognizes the value of the 

Army Profession Campaign. R2C, like many of our suicide prevention programs, 

targets Soldiers; however, every opportunity is taken to expand available programs and 

services to our Army Civilians and Family Members, as appropriate to their needs. 

Some programs don't elicit immediate change in behavior, but are based on the 

premise that investment now will help achieve desired results in the future. 

Comprehensive Soldier and Family Fitness Program 

Another holistic approach is the Army's Comprehensive Soldier and Family Fitness 

(CSF2) Program which addresses the precursors to suicide. CSF2's mission is to 

increase the physical and psychological health, resilience and enhanced performance of 

Soldiers, Families and Army Civilians. Key elements of the CSF2 Program include: 

• Training for Soldiers, Family members and Army Civilians by a cadre of NCOs 

(along with some spouses and Army Community Service personnel) who 

serve as Master Resilience Trainers (MRT) at their home stations. The 

Army's goal is to embed MRTs down to the company level. 

• A Global Assessment Tool (GAT) which measures an individual's 

psychological health and level of resilience. The designed to be taken 

annually and after deployments; it is designed to identify additional training 

needs to improve resiliency. Taking of the GAT is mandatory for all Soldiers 

on at least an annual basis; it is available to Family members and Army 

Civilians on a voluntary basis. 

• Comprehensive Resilience Modules - short videos that provide selfdevelopment in specific areas identified by individual GAT assessments. 

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A key element of resilience training is teaching individuals to avoid the catastrophic 

thinking that leads to an emotional downward spiral, and providing them with skills to 

identify the positive things in their lives. The Army is focused on Institutional Training --

ensuring that elements of resilience training are taught at all levels -- from basic training 

to the War College. 

The effectiveness of CSF2's holistic approach has been verified by four independent, 

peer-reviewed technical studies performed between February 2011 and February 2013. 

The results include the following findings: 

• Soldiers who committed suicide were significantly less resilient (as measured by 

the GAT) than other Soldiers 

• Soldiers who received training conducted by a MRT improved their GAT scores 

(a measure of their psychological health and resilience) more than Soldiers who 

did not 

• MRT training shows the greatest results for Soldiers 18 to 24 years old 

• Developing MRT skills leads to improved Soldier adaptability and optimism, 

which, in turn, leads to decreased anxiety, depression and PTSD 

CSF2 provides tools and skills that stay with Soldiers, Army Civilians and their Families 

long after leaving the Army. Some future plans include: expanding the number of 

CSF2 Training Centers at installations throughout CONUS and OCONUS; making 

resilience training part of Soldier in-processing; and developing a social media-oriented 

Health and Fitness Platform to provide an interactive online environment. 

Army Strong Bonds Program 

One program that has been tremendously beneficial is Army Strong Bonds. The Strong 

Bonds program has been highly effective in helping Soldiers and Family members 

develop resilience and readiness by giving them the skills necessary to cope with stress 

within relationships. Data shows that suicide rates are closely related to relationship 

issues; therefore, programs that support healthy relationships also potentially reduce 

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suicides. Strong Bonds training helps reduce relationship-related stress, thereby 

reducing the number of failed relationships and, potentially, the number of suicides. In 

support of Army-wide suicide prevention efforts and in response to the Army Vice Chief 

of Staff's Health of the Force assessment, the Chaplaincy conducted a Strong Bonds 

"surge" that trained 50,000 Soldiers and their Family members in FY12. 

Learning More Through Research - Army STARRS 

In June 2013, the Army will enter its fifth year of the Army Study to Assess Risk and 

Resilience in Servicemembers (Army STARRS) partnership with the National Institute of 

Mental Health (NIMH). This study represents the largest study of mental health, 

psychological resilience, suicide risk, suicide-related behaviors, and suicide deaths in 

military personnel ever conducted. The goal is to identify factors that put a Soldier at 

risk for suicide, and factors that provide resilience, at specific points of Army service and 

over time. This information will then be used to develop evidence-based, targeted 

intervention strategies to decrease the frequency of suicides in the Army. 

During the initial years of Army ST ARRS, researchers analyzed information from nearly 

40 Army and Department of Defense datasets, spanning more than a billion data 

records, on all 1.6 million Soldiers who served on active duty from 2004-2009. In 

addition, the team is collecting data from willing Soldiers in every component of the 

Force (Active Army and those Army National Guard and Army Reserve Soldiers on 

active duty) who are in all phases of Army Service (Soldiers in initial entry training, 

Soldiers before and after deployment, Soldiers in theater, and Soldiers assigned to 

installations worldwide). Extensive information is collected through surveys and 

psychological evaluations, blood samples, and through Army and Department of 

Defense administrative records. 

To date approximately 112,000 Soldiers have voluntarily participated in Army STARRS 

and approximately 52,000 have given blood samples. Researchers will analyze these 

samples to look at biological risk associated with a history of mental illness and these 

samples could be used as a baseline for future studies. 

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The size of these cohorts is unprecedented in military research; this grand scale will 

help our understanding of suicide risk and protective factors and the development of 

mental health disorders. The data will compliment other survey and neurocognitive data 

to give researchers a more complete understanding of risk and resilience. 

Preliminary findings include analyses in the areas of deployments, enlistment waivers, 

unit combat deaths, unit suicides, marriage, private housing, age and education, rank, 

years of service, military occupational specialties, exposure to traumatic events, 

head/neck/blast injury, prescription drug abuse, mental health disorders and treatment, 

and suicide attempts. Researchers are using these findings to develop tools to help 

identify subsets of Soldiers who may be at elevated risk for suicidal behaviors. Army 

ST ARRS is currently working with the Army on analogous approaches to targeting 

prevention and treatment interventions for Soldiers with particularly elevated suicide 

risk. 

Conclusion 

Any time a Soldier, Army Civilian or Family member chooses to end his or her life, the 

loss is devastating to Family and friends, fellow Soldiers, and the Army. It is our shared 

responsibility - the responsibility of our nation's military leaders and CongreSSional 

leaders - to ensure the readiness of our military and the well being of our Soldiers. As 

we continue our mission to reduce the occurrence of suicide, I ask for your support as 

we continue to build and sustain the resiliency and readiness of our Soldiers, civilians 

and Families. 

We have invested a tremendous amount of resources and deliberate planning to 

preserve the All-Volunteer force. Simply put, People are the Army. We have a 

continued responsibility to the courageous men and women who defend our country to 

take care of them and their Families. We must not break faith with those who dedicate 

their lives to serving our nation. 

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I assure the esteemed Members of the committee that there is no greater priority for me 

and the other senior leaders of the United States Army than the safety and well-being of 

our Soldiers, I wish to thank all of you for your continued support, which has been vital 

in sustaining our all-volunteer Army through an unprecedented period of continuous 

combat operations and will continue to be vital to ensure the future of our Army. 

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Lieutenant General Howard B. Bromberg 

u.s. Army Deputy Chief of Staff, G-1 

Lieutenant General Howard B. Bromberg became the U.S. 

Army's 46th Deputy Chief of Staff, G-1 on July 21,2012. He 

is responsible for developing, managing, and executing 

manpower and personnel plans, programs, and pOlicies for 

the total Army. Prior to this assignment, he served as the 

Deputy Commanding General/Chief of Staff, U.S. Army 

Forces Command. 

Lieutenant General Bromberg hails from California and was 

commissioned as an Air Defense Artillery officer in the U.S. 

Army upon graduation from the University of California at 

Davis in 1977. He holds a bachelor's degree in Agricultural 

Economics and Management. Throughout his career, 

Lieutenant General Bromberg has served in Army units in 

the United States, Germany, Korea and Southwest Asia. He 

has commanded at every level in the air defense community 

from platoon to installation. 

Lieutenant General Bromberg's command assignments include Commanding General, Fort 

Bliss, Texas; Commanding General, 32d Army Air Missile Defense Command, Fort Bliss, 

Texas, while serving in Operation ENDURING FREEDOM, Operation IRAQI FREEDOM, Saudi 

Arabia, Kuwait and Iraq; Commander 11th Air Defense Artillery Brigade, Third Army; 

Commander 1st Battalion, 43d Air Defense Artillery, Eighth Army, Republic of Korea; 

Commander, A Battery, 6th Battalion, 52d Air Defense Artillery, Germany. 

Lieutenant General Bromberg's principal staff assignments include Chief of Staff, U.S. Strategic 

Command, Offutt Air Force Base, Nebraska; Deputy Director, Force Protection/Director, Joint 

Theater Air and Missile Defense Organization, J-8, The Joint Staff, Washington, DC; Director of 

Enlisted Personnel Management Directorate, U.S. Army Human Resources Command, 

Alexandria, VA.; Operations Officer (S-3)/Executive Officer (XO), 2d Battalion, 43d Air Defense 

Artillery, Germany and Operation DESERT SHIELD/STORM, Saudi Arabia; Operations Officer, 

Defense Branch, J-3, The Joint Staff, Washington DC; Chief, HAWK Operational Readiness 

Evaluation Team, 32d Army Air Missile Defense Command, Germany; and Platoon Leader, D 

Battery, 6th Battalion, 52d Air Defense Artillery, Germany. 

Lieutenant General Bromberg's decorations and awards include the Distinguished Service 

Medal (with two Oak Leaf Clusters), Defense Superior Service Medal (with Oak Leaf Cluster), 

the Legion of Merit (with three Oak Leaf Clusters), Bronze Star, Purple Heart, Defense 

Meritorious Service Medal, Meritorious Service Medal (with three Oak Leaf Clusters), Army 

Commendation Medal (with two Oak Leaf Clusters), Joint Service Achievement Medal, Army 

Achievement Medal (with Oak Leaf Cluster), Parachutist Badge, Joint Chiefs of Staff 

Identification Badge and the Army Staff Identification Badge. 

Lieutenant General Bromberg is married. He and his wife have two daughters. 
67 

NOT FOR PUBLICATION 

UNTIL RELEASED BY THE 

HOUSE ARMED SERVICES 

COMMITTEE 

STATEMENT OF 

VICE ADMIRAL SCOTT R. V AN BUSKIRK, V.S. NAVY 

CHIEF OF NA VAL PERSONNEL 

AND 

DEPUTY CHIEF OF NAVAL OPERATIONS 

(MANPOWER, PERSONNEL, TRAINING AND EDUCATION) 

BEFORE THE 

SUBCOMMITTEE ON MILITARY PERSONNEL 

OF THE 

HOUSE ARMED SERVICES COMMITTEE 

ON 

UPDATE ON SUICIDE PREVENTION 

NOT FOR PUBLICATION 

UNTIL RELEASED BY THE 

HOUSE ARMED SERVICES 

COMMITTEE 

MARCH 6, 2013 
68 

Chainnan Wilson, Ranking Member Davis, and distinguished members of the 

Committee, thank you for holding this important hearing and for affording me the opportunity to 

offer an update on Navy's Snicide Prevention and Resiliency Programs. 

The loss of a single shipmate to suicide is a tragedy that affects many; it takes away a 

life, shatters a family, and hurts unit cohesion and morale. We have been working closely with 

the Office of the Secretary of Defense and the other Services in their broader efforts of 

implementing the President's Military Mental Health Executive Order. As part of these efforts 

all of our programs are being internally reviewed and vetted to ensure we provide access to 

serviccmembers and their families to best quality services and care. Only when we work 

together will we be able to make a difference. We remain resolute in our efforts as we focus on 

the root causes and contributing factors that lead to suicide-related behaviors and suicides, and 

creating an environment in which Sailors arc comfortable coming forward when they feel they 

may harm themselves, or when they know of a shipmate contemplating harm or showing 

symptoms of excessive stress that may lead to suicidal thoughts or acts. 

We continue to vigilantly monitor the health of the force and investigate every suicide 

and suicide related behavior. The suicide prevention team examines each case for pertinent 

infornlation about the circumstances leading to the behavior and action that might infOlID our 

prevention program. Lessons learned from these case examinations are applied towards training 

improvement. Our observations continue to support that: 

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• Demographic distribution of suicides largely mirrors the demographics of the Navy as 

a whole. (Typically a male in pay grades E4 to E6 who completes the act of suicide 

with a firearm.) 

• Suicides typically occur at a time in which Sailors are experiencing increased work 

responsibilities and family demands. 

• Recent deployment experiences may contribute to suicide in some instances, 

although, overall, deployment history alone does not appear to increase suicide risk. 

• Sailors who complete suicide tend to have experienced stress factors across multiple 

aspects of their lives, including relationship, legaL financial problems, or mental 

health issues. 

While stressors may contribute to suicide risk, resiliency is strengthened through 

leadership and peer support, strong family bonds, support services, and a sense of purpose. 

Suicide prevention training requires leader-focused action and responsibilities to promote 

resilience and well being in Sailors, which is where Navy's efforts remain focused. 

Suicide Prevention - All Hands, All of the Time 

Suicide prevention is an "all-hands - all of the time" effort, involving Sailors, family 

members, peers, and leadership. We have adopted a comprehensive, tailored approach to 

resilience-building, suicide prevention training, intervention, research, and analysis. This 

includes a solid foundation of unit-level suicide prevention coordinators, mental health 

providers, installation first responders skilled in handling behavioral emergencies, and increased 

family awareness of suicide risk, waming signs, and support resources. 

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Command awareness and intervention remain a critical component of our suicide 

prevention strategy. Leadership provides Sailors with a clear sense of mission and purpose while 

creating an environment of trust and unit cohesion in which Sailors and families can thrive in the 

face of multiple demands and stressors. We remain vigilant about known risk factors such as: 

the effects of work related stress, tlnancial concerns, legal problems. relationship issues and their 

impact on the physical health and psychological well-being of Sailors. Identifying such issues, 

we must intervene and offer assistance. Current efforts are focused on: 

• Education and Awareness 

• Prevention and Intervention 

• Sailor Care and Crisis Response 

Education and Awareness 

One of the keys to successful suicide prevention in the Navy is robust edncation and 

awareness aimed at improving knowledge and understanding throughout the Navy. Our 

Operational Stress Control (OSC) training program provides an integrated structure of health 

promotion, family support. and prevention information, and focuses on building resilience, 

addressing problems early, and promoting a healthy and supportive command climate. 

OSC offers Sailors a lexicon by which to self~identify stress reactions, and encourages 

them to seek help before the situation escalates to an unmanageable state. Engaged leadership 

promotes awareness of the stress continuum and underlines the importance of mind and body 

fitness to support Navy's tenets of Walfzghting First, Operate Forward and Be Ready. Every 

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uniformed member, from our newest recruit to the Chief of Naval Operations, receives basic 

OSC and Suicide Prevention training. Institutionalized across the fleet and embedded in various 

career milestone courses, more than 32 advanced OSC modules are tailored to the career 

milestones of the Sailor and incorporate tangible skills to strengthen resilience and mitigate 

stress. 

Recognizing the importance ofa leadership-driven effort in de-stigmatizing help-seeking 

behaviors, leaders receive additional specialized training in five core areas of responsibility: 

(l) Strengthen Sailors, families, and units; 

(2) Identify signs of stress response; 

(3) Mitigate the effects of stress; 

(4) Treat (and support treatment of) stress injuries, and 

(5) Reintegrate the Sailor into the unit and/or society following suicide-related behaviors 

or other interventions. 

Confronted with increased tempo of operations (OPTEMPO) and stress placed on Sailors, 

we launched four Mobile Training Teams (MTTs) in support ofOSC training, based in our two 

largest fleet concentration areas, Norfolk and San Diego. These MTTs provide world-wide, ondemand interactive training to Navy commands, both afloat and ashore, which offers a more 

personal and relevant method of delivery that meets the needs of our Sailors in varied operational 

envirolm1cnts. There is a significant demand for these services and we will continue to evaluate 

the location and number of teams available, providing additional teams when and where 

necessary. 

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Prevention and Intervention 

We appreciate Congress including in the National Defense Authorization Act for Fiscal 

Year 2013, language that authorizes health care professionals and for commanding officers to 

inquire about personal firearms when there are reasonable grounds to believe a Sailor may be at 

risk for suicide or causing harm to others. Engaging with Sailors on a personal level is the 

foundation of effective prevention and intervention. Empowering shipmates, leaders, family, 

and community members to recognize early signs of risk and to take actions that address such 

concerns at the earliest possible point is a fundamental tenet of suicide prevention. We are 

acutely cognizant that recognition of stress-related behaviors must be followed by effective 

action. Mobilizing the network of shipmates to help fellow shipmates in distress is a critical 

protective factor against suicide. 

Our prevention and intervention strategy promotes training Sailors to Ask, Care and Treat 

(ACT). This brings a command-level focus to the issue of suicide and the impOIiance of 

breaking down barriers and reducing stigma, thereby promoting a more resilient force. 

Behavioral Quick Polls reflect that over 90 percent of our force knows to ASK a shipmate what is 

bothering him/her and then to CARE about the Sailor, engage in conversation and then to escort 

the Sailor to TREATMENT. All hands receive stress first-aid intervention training to ensure they 

are able to recognize a shipmate in trouble, break the code of silence and intervene, and connect 

the shipmate to the right leader or caregiver for support. When integrated with our OSC 

curriculum, Sailors are taught to look beyond stereotypical warning signs, recognize changes in 

behavior and initiate helpful actions to save lives, reduce further injury, and promote personal 

growth. 

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This deck plate level focus is reinforced by providing every commanding officer with a 

Suicide Prevention and Response Toolkit containing a wealth of resources, checklists and tools 

including intervention strategies and information to address known suicide risk factors, and 

assessments for key command Sailor readiness programs (e.g., Physical Fitness, Navy Alcohol 

and Drug Abuse Prevention, Sexual Assault Prevention, Operational Stress Control). Each 

toolkit includes post-intervention guidance for leaders and addresses required actions when a 

command experiences suicide-related behavior or a suicide, 

Sailors increasingly recognize the importance and courage needed to seek help when 

distress becomes overwhelming. A 2010 Behavioral Health Quick Poll reflects that the majority 

of Sailors are confident in their ability to effectively respond to a Sailor who talks about suicide 

and the ability of their commands to support Sailors seeking help for suicidal thoughts or actions, 

Our Navy web sites include the message, "Life is Worth Living" and a link to the Military Crisis 

Line, reinforcing a coordinated and systematic year-round communications strategy that 

includes leadership messaging, internal media, and educational materials to raise awareness 

about suicide risk and provides ready access to resources. In 2012, over 1,900 Sailors requested 

and received command assistance for reported suicidal ideations, Others have sought help from 

chaplains, family services or medical professionals. It is clear leadership plays a critical role in 

creating an environment that promotes resilience, encourages use of resources to address 

potential problems before thoughts of self-harm occur, and actively supports reintegration into 

the unit following intervention or treatment. 

Navy's suicide prevention program focuses on Sailors as well as the families who support 

them. We provide resiliency support for Navy families struggling to cope with the challenges of 

long separations, disruption to family routine, anxiety over the safety of the deployed parent, and 

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the well-being of the parent caring for the family at home. Fleet and Family Support Centers 

(FFSCs) provide comprehensive family and deployment support, life skills training, counseling, 

and transition support. 

Project FOCUS (Families Overcoming Under Stress), initiated by the Navy Bureau of 

Medicine and Surgery (BUMED) in 2008. provides state-of-the-art family resiliency services to 

military children and families at over 20 Navy installations and online for those in remote 

locations. FOCUS promotes a culture of prevention and reduction of stigma through a familycentered array of programs, such as community briefings, educations workshops. individual and 

family consultations, and resiliency training. This approach teaches Sailors and their families to 

understand their emotional reactions, communicate morc clearly, solve problems more 

effectively, and set and achieve goals throughout the deployment cycle. FOCUS has been 

recognized by the Executive Office of the President and the Office of the First Lady as a model 

for prevention/intervention of psychological health services for military families. More than 

300,000 Service members, families. providers and community members have participated in 

FOCUS. 

Our efforts are not limited to our Active component, in addition to leveraging all of the 

mental health programs, Reserve component (RC) Sailors and their families receive specific 

support through the Navy Reserve Psychological Health Outreach program. Psychological health 

outreach team coordinators and members, located at the five regional reserve commands. provide 

RC Sailors psychological health assessments. education, and refcrrals to mental health 

specialists. This program has facilitated successful reintegration of countless citizen/warriors 

mobilized in support of national defense requirements. 

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The increased attention on suicide prevention and behavioral challenges faced by today's 

force has motivated Sailors to step up and care for each other. The Coalition of Sailors Against 

Destructive Decisions (CSADD), a grassroots peer-mentoring program led by, and for, young 

Sailors, continues to grow with over 200 chapters Navy-",;jde. CSADD focuses on empowering 

junior Sailors with the tools and resources to promote good decision-making processes, 

bystander intervention and leadership development, while reinforcing a culture of shipmateshelping-shipmates. CSADD promotes awareness and discussion among peers across a range of 

areas, including suicide prevention, financial management, and responsible use of alcohol, 

personal safety, and domestic violence. CSADD initiatives include the "Stop and Think 

Campaign," which highlights the potential consequences of poor decisions, an active Facebook 

page on which Sailors can ask questions, access information and training materials, share lessons 

learned, and access a semi-annual newsletter which highlights best practices across the Navy. 

Sailor Care and Crisis Response 

While most Navy suicide prevention activities focus on resilience-building and early 

intervention, we must also be prepared to intervene at any stage of a crisis. It is not enough to 

know what to do. We must also know how to do it. Every Navy command is required to 

maintain a crisis response plan to ensure individuals understand how to quickly and effectively 

get help to someone in distress, and to ensure the safety of someone at acute risk, until they can 

receive professional care. 

To better support deployed Sailors, we created the Navy Mobile Care Team (MCT). This 

team, which consists of mental health clinicians, research psychologists, and enlisted psychiatry 

technicians, has been continuously deployed to Afghanistan since its inception in 2009. The 

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team routinely travels across all regions of Afghanistan providing behavioral health surveillance 

using the Navy Behavioral Health Needs Assessment Survey (BHNAS), individual, unit, and 

command consultations, and combat and operational stress control training (including 

psychological first aid) to Sailors serving in the combat zone. The MCT mission is to provide 

preventative mental health services and immediate unit level feedback and consultation to Sailors 

and unit leaders, frequently engaging Sailors in close proximity to their units after critical 

stressful events with the expectation of returning them to duty. It routinely links Sailors in the 

combat zone with mental health providers as a means of reducing stigma associated with seeking 

care. 

In addition to the Mobile Care Team, the Medical Home Port Program is a team-based 

model focused on optimizing the relationship between patients, providers and the broader 

healthcare team. Mental health providers are embedded within Medical Home Ports to facilitate 

regular assessment and early mental health intervention. This model enables Sailors to be treated 

in settings in which they feel most comfortable and reduces the stigma associated with the care 

they receive. Additionally, improving early detection and intervention in the primary care 

setting reduces the demand for time-intensive intervention in mental health specialty clinics. 

When a suicide occurs, timely and compassionate resources and assistance are the first 

step to mitigating the effects on those impacted by the tragedy. Navy formalized a memorandum 

ofundcrstanding with the renowned Tragedy Assistance Program for Survivors (TAPS), 

enabling them to offer their unique support services directly to Navy families during the long 

grief and recovery process following a suicide loss. Additionally, Navy Special Psychiatric 

Rapid Intervention Teams (SPRINT) are on call 24 hours-a-day, seven days-a-week, for 

circumstances requiring a higher level of support, and local chaplains and Fleet and Family 

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Support Centers regularly provide command consultation, assistance in arranging memorial and 

funeral services, and grief counseling. 

Investigations into completed Navy suicides indicate that when contemplating suicide a 

Sailor may come in contact with key personnel. such as legal professionals, first responders, and 

chaplains, who have the opportunity to intervene. We implemented targeted training to ensure 

these individuals are prepared to identify risk factors and respond appropriately. Specialized 

training for officers of the .Jndge Advocate General Corps (.JAGC) and agents of the Naval 

Criminal Investigative Service (NCIS) has proven critical in recognizing and intervening when 

suicide ideations and gestures are made. We are creating new training products specifically for 

installation emergency first responders, such as Emergency Medical Services (EMS), dispatch, 

and security personnel, which covers safety, de-escalation, and response coordination for 

behavioral health emergencies and suicide risk situations. 

Conclusion 

We ask an incredible amount of our Sailors and their families. In return, we are 

inherently responsible for providing them with the level of support and care commensurate with 

their personal sacrifices. On behalf of all the men and women of the United States Navy and 

their families, thank you for your commitment to this critical issue and for your continued 

support of our Sailors and their families. 

11 
78 

United States Navy 

" I 

1011 1120 11 - Present 

Vice Admiral Scott R. Van Buskirk 

Vice Adm. Van Buskirk, a native of Petaluma, Calif., 

graduated from the United States Naval Academy in ! 

He assumed duties as the Navy's 56th Chief of Naval 

Personnel on Oct. 11, 2011. Serving concurrently as the 

Deputy Chief of Naval Operations (Manpower, Personnel, 

Training and Education) (N!), he is responsible for the 

planning and programming of all manpower, personnel, 

training and education resources for the U.S. Navy. He 

manages an annual operating budget of $29 billion and 

leads over 20,000 employees engaged in the recruiting, 

personnel management, training and development ofN 

personnel. His responsibilities include overseeing Navy 

Recruiting Command, Navy Personnel Command, and 

Naval Education and Training Command. 

Ashore, he received his master's degree at the Naval Postgraduate School and served 

tours in the Navy Office of Legislative Affairs; Submarine Force U.S. Pacific Fleet; 

Bureau of Naval Personnel; and, Submarine Force U.S. Atlantic Fleet. 

At sea, he served on board USS Seawolf(SSN 575), USS Salt Lake City (SSN 716), USS 

Tunny (SSN 682), and USS Georgia (SSBN 729) GOLD, and commanded the USS 

Pasadena (SSN 752) and Submarine Development Squadron 12. 

As a flag officer, he has served as commander, Task Force Total Force; deputy to the 

Deputy ChiefofStaft~ Strategic Effects (MNF-Iraq); commander, Carrier Strike Group 

Nine; assistant deputy, Chief of Naval Operations for Operations, Plans and Strategy 

(N31N5B); deputy commander and chief of staff, U.S. Pacific Fleet; and, most recently, 

as the 47th commander of the United States 7th Fleet, forward deployed in Yokosuka, 

Japan. 

He is entitled to wear the Distinguished Service Medal, Defense Superior Service Medal, 

Legion of Merit (seven awards), and other various personal, unit and service awards. 

Updated: 18 November 2011 
79 

DEPARTMENT OF THE AIR FORCE 

PRESENTATION TO THE SUBCOMMITTEE ON MILITARY PERSONNEL 

COMMITTEE ON ARMED SERVICES 

UNITED STATES HOUSE OF REPRESENTATIVES 

SUBJECT: SUICIDE PREVENTION 

STATEMENT OF: LIEUTENANT GENERAL DARRELL D. JONES 

DEPUTY CHIEF OF STAFF MANPOWER, PERSONNEL 

AND SERVICES UNITED STATES AIR FORCE 

NOT FOR PUBLICATION UNTIL RELEASED 

BY THE COMMITTEE ON ARMED SERVICES 

UNITED STATES HOUSE OF REPRESENTATlVES 

MARCH 6. 2013 
80 

Air Force Suicide Prevention 

Suicide prevention remains a top priority of Air Force leadership, and we remain committed to 

doing everything possible to save lives. The Air Force Suicide Prevention Program (AFSPP), launched in 

1996 and fully implemented by 1997, emphasizes leadership involvement and a community approach to 

reducing deaths from suicide. The program is an integrated network of policy and education that focuses 

on reducing suicide through the early identification and treatment of those at risk. It uses leaders as role 

models and agcnts of change, establishes expectations for Airman behavior regarding awareness of 

suicide risk, develops population skills and knowledge, and analyzes every suicide. The program 

represents the Air Force's fundamental shift from viewing suicide and mental illness solely as medical 

problems and instead seeing them as larger service-wide community problems. The program was 

designed with 11 overlapping clements that resulted in enhancing the capacity of the Air Force to 

recognize and respond to Airmen in distress on multiple levels. These 11 elements can be grouped into 

the three broad categories of Leadership and Community, Education and Protections for Those Under 

Investigation. 

Lessons Learned 

In 2004 and 2010 the Air Force joined with researchers from the University of Rochesterto 

evaluate the effectiveness of the Air Force program in reducing suicides. The results of these efforts 

concluded that the program works best with a sustained focus on measured execution of all 11 Elements. 

Also in 20 I 0, the Air Force program managers conducted a comprehensive gap analysis and identified 

areas for enhancement. Some of these improvements included publishing guidance and communication 

to leaders, chaplains, and public affairs on the topics of suicide prevention and post suicide response. The 

Air Force began updating its guidance by rewriting and publishing our Suicide Prevention Instruction, 

establishing tiered training requirements, and codifying DoD Suicide Event Report (or DoDSER) 

requirements. We identified our career fields at highest risk for suicide and tailored training specifically 

for them, to include requiring a frontline supervisor training course. We developed the Airman's Guide to 

Assisting Personnel in Distress, and the Community Action Information Board (CAm) directed all units 
81 

to complete an annual end-of-year selt~assessment checklist to ensure full implementation of the II 

Elements of our program. 

Recent Initiatives 

The Air Force is committed to strengthening and improving its program. Some recent suicide 

prevention initiatives include conducting live training for all installation suicide prevention program 

managers and hosting an Air Force-wide suicidc prevention focus group to gather feedback on the 

perceptions of the program from our Airmen in the field. We queried their knowledge of the program and 

asked them to recommend improvements. A summary of these suggcstions was briefed to senior 

leadership at the Air Force CAlB and those recommendations are currently being evaluated for 

implementation. Our required annual training was revised to increase emphasis on early help-seeking and 

leadership involvement with an interactive training module that cmphasizes the Ask, Care, Escort model, 

which focuses Airmen on how to serve as good Wingmen, and specifically how to identifY distress 

signals from fellow Airmen who may be at risk for suicide, and how to take appropriate action. Units 

have the option of completing this training on-line or via small group discussions. A 20-minute annual 

key skills frontline supervisor refresher training module is in development to sustain leadership skills in 

the prevention of suicides in our highest risk career fields. The Air Force Guide to Managing Suicidal 

Behavior, a clinical guide for mental health providers for assessing, managing, and treating suicidal 

ideation, is currently under revision. 

Recent Research Efforts 

The Air Force is fortunate to have a long history of research partnerships with 000 and non-DoD 

experts to expand our knowledge of suicide and suicide prevention. Current research with RAND Project 

Air Force is seeking to understand how Airmen use social media, to include the impact of social media 

use on relationships, help seeking, and emotional well-being. Research with the University of Rochester 

is examining the role of life events and social stressors factors in the suicides of specific clusters of 

personnel. The Air Force Research Lab and the University of Rochester are studying the relationships 

between personal well-being and suicide risk. 

2 
82 

Active Duty, Guard, aud Reserve Trend 

Last year 51 active duty Airmen took their lives, a rate of 15.3 per 100.000, Although this is 

consistent with the upward trend in Air Force suicide rates since 2007 and is reflective of similar 

increases found in U,S, civilian rates during this same time period, we tind this trend extremely disturbing 

as each member of our Air Force Total Force team is highly valued, Deployment does not seem to be a 

risk factor for suicide in the Air Force, The stressors most tl'equently experienced by Airmen prior to a 

suicide include relationship problems, legal/administrative issues, work-related issues or a combination of 

these factors, The Air Reserve Component had a total of 25 suicides in 2012, consistent with the rate of 

incidence in 2011 and 2010, Unfortunately, the Air National Guard trended slightly upward in 2012, 

while the Reserve was down, The Guard and Reserve also report similar risk factors for suicide as the 

Active Component. 

National Perspective on Suicide 

The AFSPP is actively engaged with the Defense Suicide Prevention Office (DSPO) in helping shape 

suicide prevention efforts across the Department of Defense through the Suicide Prevention and Risk 

Reduction Committee, the General Officer Steering Committee on Suicide Prevention, and other working 

groups and committees, The Air Force significantly contributes to 5 DSPO working groups, with significant 

impact on strategic messaging and stigma reduction, The Air Force also partners with DSPO and other 

services in promoting the "Military Crisis Line" component of the Veterans Crisis Line to assure 

Airmen have access to immediate confidential services as close as their phone, 

The AFSPP continues to contribute to the hody of scientific literature and to the study of suicide 

and suicide prevention. The 2012 National Strategy on Suicide Prevention states: " "the experience of 

the U,S, Air Force Suicide Prevention Program has shown that leadership, policy practices, and 

accountability can combine to produce very impressive successes, These findings should be shared and 

adapted for use in different settings," The Air Force is very committed to our ground-breaking program 

to prevent suicides and will continue to apply all the best practices science has to offer. 

Post-Traumatic Stress Disorder 

3 
83 

Although Post-Traumatic Stress Disorder (PTSD), has not proven to be contributing factor for recent 

suicide incidents or trends in the Air Force, newly diagnosed cases are rising on a yearly basis, However, we 

are encouraged that our overall rate of PTSD remains below 0,5 percent, and our retention rate for Airmen 

diagnosed with PTSD remains at 74 percent We believe the best way to reduce mental health stigma is to 

treat and retain Airmen who seek care, Retaining the majority of Airmen with a PTSD diagnosis is concrete 

evidence that we are meeting that goal, 

Our Airmen continue to be screened for PTSD symptoms via Pre- and Post-Deployment Health 

Assessments at various points throughout the deployment cycle, All Airmen receive education and 

training on how to recognize symptoms ofPTSD and how to access the right resources, Because of the 

nature of their work, we know that our Explosive Ordnance Disposal (EOD), Security Forces, Medical, 

and Transportation career fields are at highest risk for developing PTSD. In 20 I 0, the Air Force 

established the Deployment Transition Center at Ramstein AB, Germany_ to provide an effective 

reintegration program for members of these occupational fields as they return home from a high risk 

deployment. To date, more than 5,000 Airmen have passed through the Center and research has shown 

solid evidence that the program helps Airmen by decreasing symptoms of Post-Traumatic Stress Disorder 

along with problematic alcohol use and relationship difliculties. 

Another way the Air Force supports the growing needs of our Airmen in uniquely stressed career 

fields is by dedicating Mental Health and Primary Care staff to select EOD units and assigning Mental 

Health providers to support several Remotely Piloted Aircraft and Intelligence units. In addition, mental 

health clinicians known as Behavioral Health Optimization providers have been placed in 82 percent of 

our Primary Care clinics, with a goal of staffing 100 percent of clinies by the end of2013. This allows 

the delivery of less formal and less stigmatizing care within Primary Care clinics, helping provide "the 

right care at the right time in the right place." 

We are also dedicated to providing adequate mental health provider stafling and training. In 

response to the 20 10 National Defense Authorization Act, Section 714, mental health active duty 

4 
84 

authorizations will increase 25 percent by 2016 to support the psychological needs of all Airmen. We 

thank the Committee for your efforts to help us meet our critical staffing needs. Our mental health 

providcrs are trained in evidence-based treatments. to include Prolonged Exposure and Cognitive 

Processing Therapy. This training is delivered in internships and residency programs for trainces and to 

all providers following completion of training. Finally, the Air Force continues to collaborate with the 

Depaliments of Defensc and Veterans Affairs in advancing research on prevention and treatment of 

combat related injuries, including PTSD. 

Conclusion 

On behalf of Air Force leadership, I pledge to you that we will continue to seek the answers to 

why suicides occur and how we can intervene to prevent them. We need every Airman on the team as we 

face the difficult challenges of the future. We will continue to work closely with our Army, Navy, DoD 

and VA collcagues to find the best practices and to share them effectively. Thank you for your 

tremendous support in this endeavor. 

5 
85 

UNI 'fED S 'fA 'fESA I R FO ROE 

LIEUTENANT GENERAL DARRELL D. ,JONES 

Lt. Gen. Darrell D. Jones is the Deputy Chief 

of Staff for Manpower, Personnel and 

Services, Headquarters U.S. Air Force, 

Washington, D.C. General Jones serves as the 

senior Air Force officer responsible for 

comprehensive plans and policies covering all 

life cycles of military and civilian personnel 

management, which includes military and 

civilian end strength management, education 

and training, compensation, resource 

allocation, and the worldwide USAF services 

program. 

General Jones entered the Air Force in 1979 

as a graduate of Mississippi State University's 

ROTC Program. He has served in a wide 

variety of assignments at base level, major 

command, secretariat, combatant commands 

and Headquarters U.S. Air Force. He has 

commanded a squadron, group, two wings and 

a direct reporting unit. The general also led the Headquarters U.S. Air Force Deputy Chief of Staff 

for Personnel's Issues Team, served as Director of Personnel for Pacific Air Forces, and was 

Director of Manpower and Personnel, Headquarters U.S. Central Command. 

Prior to his current assignment, the general was the Commander, Air Force District of Washington, 

and Commander of the Air Force For~es for Joint Forces Headquarters-National Capital Region, 

Andrews Air Force Base, Md., which provides the single Air Force voice and component to the 

Joint Forces Headquarters-National Capital Region, as well as organizes, trains and equips combat 

forces for the aerospace expeditionary forces, homeland operations, civil support, national special 

security events and ceremonial events. 

EDUCATION 

1979 Bachelor of Science degree, Mississippi State University 

1984 Master of Arts degree in business administration, Webster University, St. Louis, Mo. 

1984 Squadron Officer School, Maxwell AFB, Ala. 

1991 Air Command and Staff College, Maxwell AFB, Ala. 
86 

1994 Air War College, Maxwell AFB, Ala. 

ASSIGNMENTS 

I. October 1979 - April 1982, assistant Chief, Quality Force Section; Chief, Customer Assistance 

Section; Chief, Quality Force Section; and Chief, Personnel Utilization Section, Consolidated Base 

Personnel Office, Williams AFB, Ariz. 

2. April 1982 - August 1984, assistant for Resource Distribution, later, Chief, Assignment Analysis 

Branch, Deputy Chief of Staff for Personnel, Headquarters Air Training Command, Randolph AFB. 

Texas 

3. August 1984 - August 1985, executive officer to the Deputy Chief of Staff for Personnel, 

Headquarters Air Training Command, Randolph AFB, Texas 

4. August 1985 - August 1986, personnel adviser and board member, Secretary of the Air Force 

Personnel Council, Air Staff Training Program, Washington. D.C. 

5. August 1986 - August 1987, Chief, Consolidated Base Personnel Office, 384th Combat Support 

Group, McConnell AFB, Kan. 

6. August 1987 - September 1988, Director of PersonneL 384th Combat Support Group, McConnell 

AFB, Kan. 

7. September 1988 - June 1990, Commander, 384th Mission Support Squadron, and Chief, Mission 

Support, 384th Combat Support Group, McConnell AFB, Kan. 

8. June 1990 - June 1991, student, Air Command and Staff College, Maxwell ArB, Ala. 

9. June 1991 - May 1992, Chief, Entitlements, Compensation and Education, Directorate of 

Manpower Personnel and Security, Headquarters U.S. European Command, Stuttgart, Germany 

10. June 1992 - June 1994, Chid; World War II Commemoration Branch, later, Deputy Chief, 

World War II Commemoration Division, Directorate of Manpower Personnel and Security, 

Headquarters U.S. European Command, Stuttgart, Germany 

11. July 1994 - June 1995, student, Air War College, Maxwell ArB. Ala. 

12. June 1995 - June 1997, Chief, Force Structure Plans and Policies, Directorate of Military 

Personnel Policy, Deputy Chief of Stafffor Personnel, Headquarters U.S. Air Force, Washington, 

D.C. 

13. June 1997 - June 1999, Chief, Personnel Issues Team, Deputy Chief of Staff for Personnel, 

Headquarters U.S. Air Force, Washington, D.C. 

14. June 1999 - May 2001, Commander, 62nd Support Group, McChord AFB, Wash. 

15. May 2001 - July 2002, Director of Personnel, Headquarters Pacific Air Forces, Hickam AFB, 

Hawaii 

16. July 2002 - Junc 2004, Commander, 66th Air Base Wing, Hanscom AFB, Mass. 

17. June 2004 - June 2006, Director of Manpower and Personnel, Headquarters U.S. Central 

Command. MacDill AFB, Fla. 

18. June 2006 - January 2008, Commander, 37th Training Wing, Lackland AFB, Texas 

19. February 2008 - November 2009, Director of Force Management Policy, Deputy Chief of Staff 

for Manpower and Personnel, Headquarters U.S. Air Force, Washington, D.C. 

20. November 2009 - December 2010, Commander, Air Force District of Washington, Andrews 

AFB, Md. 

21. December 20 I 0 - present, Deputy Chief of Staff, Manpower, Personnel and Services, 

Headquarters U.S. Air Force, Washington DC 
87 

SUMMARY OF .JOINT ASSIGNMENTS 

1. June 1991 - May 1992, Chief, Entitlements, Compensation and Education. Directorate of 

Manpower Personnel and Security, Headquarters U.S. European Command, Stuttgart, Germany, as 

a major 

2. June 1992 - June 1994, Chief, World War II Commemoration Branch, later, Deputy Chief, World 

War II Commemoration Division, Directorate of Manpower Personnel and Security, Headquarters 

U.S. European Command, Stuttgart, Germany, as a major and lieutenant colonel 

3. June 2004 - June 2006, Director of Manpower Personnel, Headquarters U.S. Central Command, 

MacDill AFB, Fla., as a colonel and brigadier general 

MAJOR A WARDS AND DECORATIONS 

Distinguished Service Medal 

Defense Superior Service Medal 

Legion of Merit with two oak leaf clusters 

Defense Meritorious Service Medal 

Meritorious Service Medal with two oak leaf clusters 

Air Force Commendation Medal 

Air Force Recognition Ribbon 

National Defense Service Medal with bronze star 

Global War on Terrorism Expeditionary Medal 

Global War on Terrorism Service Medal 

OTHER ACHIEVEMENTS 

1988 Outstanding Personnel Manager of the Year Award (Base-level Senior Personnel Manager), 

Strategic Air Command 

1989 Outstanding Personnel Manager of the Year Award (Base-level Senior Personnel Manager). 

SAC 

1989 Outstanding Personnel Manager of the Year Award (Base-level Senior Personnel Manager), 

USAF 

2008 General and Mrs. Jerome O'Malley Award 

EFFECTIVE DATES OF PROMOTION 

Second Lieutenant Oct. 28, 1979 

First Lieutenant Oct. 28, 1981 

Captain Oct. 28, 1983 

Major March 1, 1988 

Lieutenant Colonel May 1, 1993 

Colonel March 1, 1999 

Brigadier General March 1,2006 

Major General July 3, 2009 

Lieutenant General Dec. 14,2010 

(Current as of January 2011) 
88 

NOT PUBLIC UNTIL RELEASED BY THE 

HOUSE ARMED SERVICES COMMITTEE 

STATEMENT 

OF 

BRIGADIER GENERAL ROBERT F. HEDELUND 

DIRECTOR, MARINE AND FAMIL Y PROGRAMS DIVISION 

UNITED STATES MARINE CORPS 

BEFORE THE 

SUBCOMMITTEE ON MILITARY PERSONNEL 

OF THE 

HOUSE ARMED SERVICES COMMITTEE 

CONCERNING 

MILITARY SUICIDE PREVENTION 

ON 

MARCH 21, 2013 

NOT PUBLIC UNTIL RELEASED BY THE 

HOUSE ARMED SERVICES COMMITTEE 
89 

Introduction 

Chairman Wilson, Ranking Member Davis, and distinguished Members of the 

Subcommittee, on behalf of your Marine Corps, I would like to thank you for inviting me here 

today to discuss the issue of military suicide prevention. We are grateful for your continued. 

active engagement in making lasting improvements to the overall health. well-being, and quality 

oflife for Marines and their families. 

One suicide is too many. Each tragic loss to suicide has a far-reaching impact on 

families. friends and our entire Marine Corps community. Suicide prevention is not a single act 

but rather a series of actions that support the Marine Corps community health approach to 

addressing the issues facing Marines and providing support to Marines and family members. 

Preventing suicide requires vigilance and our concerted effoli to harness the strength of engaged 

leaders. Engaged leaders are alert to those at risk for suicide and take action to help Marines 

address the stressors in their lives. They help individual Marines optimize their physical, 

psychological, social, and spiritual needs. Totally fit Marines are fortified and strengthened and 

better able to withstand the tensions and stressors oflife in and out of the Marine Corps. 

Affirming and restoring the indomitable spirit of Marines is an enduring mission and how we 

"keep faith with Marines and families." 

Individual suicide cases are uniquely complex and the effects ripple through the family 

and Marines left behind. Prevention takes a multilevel (unit, family, peer, individual, 

community, society), multifaceted public health approach (individual/peer suicide prevention, 

family training, responsible reporting of suicide, stigma reduction of receiving behavioral 

healthcare treatment, case management). The Marine Corps is committed to consistently and 

aggressively identifying sources of suicide risk and ways to approach and increase effectiveness 
90 

of our training and support efforts. We are working with the Department of Defense in their 

broader efforts of implementing the President's Military Mental Health Executive Order. As part 

of thcsc efforts all of our programs are being intemally reviewed and vetted to ensure we provide 

access to servicemembcrs and their familics to best quality services and care .. 

At this point, all Marines are taught to recognize the waming signs of suicide, ask if a 

Marinc is thinking of suicide, express genuine care and concem for the Marine. and immediately 

escort the Marine to help. Further, Marine Corps leaders are taught and make it a priority to 

know their Marines on a personal level and show genuine compassion and concem for them. 

Leaders are also taught that they serve as models to show Marines that it takes a strong, 

committed person to ask lor and receive help. 

Understanding the Statistics and Risk Factors 

Between 200 I and 2007, the number of suicides in the Marine Corps fluctuated between 

23 and 34, but bctween 2007 and 2009 we saw a disturbing increase. From a recent low point of 

25 suicides in 2006, the number increased to 52 in 2009. During Calendar Year 2010 and 201 L 

37 and 32 Marines, respectively, died by suicide. For Calendar Year 2012, the number of 

suicides increased to 48. The Marine Corps is concerned with the increased number of suicides 

in 2012 and the primary challenge remains teaching Marines to engage help-seeking services 

early, before problems worsen to the point of suicide. Attempted suicides have increased from 

164 attempts in 2009. to 172 in 2010, to 163 in 2011 and to 179 in 2012. 

Understanding the risk factors is very complicated. Therefore, identifying one reason for 

trends in the number of suicides is difficult. However, we consistently track suicides through the 

Department of Defense Suicide Event Reporting surveillance system and have partnered with 

2 
91 

several research agencies to further explore the underlying reasons of suicide. We believe that 

the increase in suicide attempts may be due to au increase in surveillance and reporting 

requirements and command interventions where a Marine noticed another Marine in distress and 

helped them receive support and care. 

Marine suicides and attempts resemble our institutional demographics: Caucasian male, 

17-25 years old, and between the ranks of Private and Sergeant (E I-E5). Based on our analysis, 

we know that the primary stressors Marines experience prior to suicides and attempts are 

relationship problems, legal or disciplinary problems, behavioral health diagnoses, financial 

problems, and substance abuse. 

Suicide Prevention Efforts 

We will not rest in our efforts to prevent suicide. To efficiently manage behavioral health 

risk, protective factors, and ultimately prevent suicide, the Marine Corps combined all related 

programs under a new Behavioral Health Branch. The reorganization synchronized program 

functions such as research, policy, training, prevention, and treatment. The Marine Corps is 

developing prevention activities to mitigate the risk across behavioral health. 

Currently, we are developing a behavioral health integrated training which addresses 

common risks and protective factors across all behavioral health domains. The training, built on 

the Institutc of Medicinc Prevention Continuum, suppOlis universal awareness and selected and 

indicated training for certain high risk Marincs populations. We believe that our universal 

awareness of suicide within the Corps is effective. Supporting research is ongoing and will 

inform our continued action to cover all areas of need. 
92 

Our Never Leave a A1arine Behind suicide prevention training series focuses on key 

leaming objectives including seeking help early, before a situation becomes a crisis, and how to 

help your fellow Marine. Marines are taught to recognize the waming signs for suicide during 

the Never Leave a Marine Behind suicide prevention training. The training requirement 

reinforces that Marines are alert to those at risk for suicide at all times and take immediate action 

to help Marines address the hard times or pain in their lives. All Marines are taught the acronym, 

R.A.C.E. (Recognize; Ask; Care; Escort), method as a simple tool to recognize suicide waming 

signs, ask one another about suicide, care for each other through listening and support, and escort 

fellow Marines to help. It is important for all Marines and family members to take an active role 

in suicide prevention. 

Marines are also taught that distress in some individuals can lead to the development of 

unhealthy behaviors including withdrawal from social suppOli and ineffective problem solving. 

These behaviors may intensify the risk of suicide. The people who a Marine sees every day 

(fellow Marines, co-workers, family, friends) are in the best position to recognize changes 

stemming from distress and to provide support. Marines are taught to know each other at a 

personal level - to know their behavior pattems and their likes and dislikes so that they can 

identify even subtle changes. Any substantial or obscrvable change in behavior warrants further 

discussion with the individual. 

The Marine Corps is implementing a Case Management System (CMS). The CMS 

reaches across multiple programs to provide the most suitable information and analysis. greatly 

enhancing appropriate treatment planning and assisting with addressing the Marine's needs. The 

system assists in the identification of at-risk Marines and improves appropriate service delivery 

as well as aftercare efforts. The eMS better equips the Marine Corps to closely monitor Marines 

4 
93 

at risk for suicide to ensure they receive appropriate care. Plans are underway to streamline 

access to care to highlight community counseling capabilities of improved screening, preventive 

and treatment services. Community counseling will improve tracking of refenals to specialty 

care. 

The Marine Corps is expanding the Military Family Life Consultant (MFLC) Program. 

The addition of embedded MFLCs as part of the behavioral health services provided to Marines 

and their families will be seamlessly woven into the larger support network of command 

structures, and will enhance unit cohesiveness and health and human services across the Corps. 

The embedded MFLC Program will provide confidential counseling by licensed clinical 

providers. 

The Marine Corps DSTRESS line, which expanded worldwide in early 2012, provides 

anonymous, 2417 counseling services to any Marine, attached Sailor, or family member. The 

line is staffed by veteran Marines and Fleet Marine Force corpsmen, Marine family members, 

and civilian counselors specifically trained in Marine culture. The counseling provided gives 

any Marine, attached Sailor, or family member 'one of their 0".11' to speak with about everyday 

stress or their heaviest burdens in life. 

Operational Stress Control and Readiness (OSCAR) team training builds teams of 

Mentors (selected unit Marines and leaders), Extenders (unit medical and religious personnel), 

and Mental Health Professionals who work together to provide a network of support. This model 

empowers Marines with leadership skills to break associated stigmas and act as sensors for the 

commander by noticing small changes in behavior and taking action early. This supports the 

commander in building unit strength, resilience, and readiness as well as keeping Marines in the 
94 

fight. Further combat and operational stress control training and education is expanding across 

the Marine Corps to provide targeted knowledge, skills, and tools to Marines and families. 

Additional on-going or new prevention dforts include: the appointment and training of 

Suicide Prevention Program Officers for each battalion and squadron to essentially serve as the 

"eyes and ears" orthe suicide prevention program for the commanding officer; implementation 

orthe Columbia Suicide Severity Rating Scale to assess and evaluate for suicide; continuing 

dialogue with Marine Corps Defense Counsel to address an important stressor for Marines -

legal issues; force-wide dissemination of reintegration and postvention plans aimed at 

reintegrating Marines following a suicide-related event and for command postvention plans 

following a death; and partnering with weapons and field training battalion to gain insights into 

reducing access to lethal means. 

Research and Partnerships 

The complex nature of suicide prevention requires an important balance between 

immediate action and long-term planning. Research, partnerships, and effective collaboration 

are necessary to stay abreast of the latest available information within the suicide prevention 

arena and to explore future program needs. To fmiher our understanding of suicide prevention 

and to evaluate program effectiveness, the Marine Corps is partnering with federal agencies, 

academia and private industry. 

In October 2011, the American Association of Suicidology (AAS) began a two-year 

focused study of suicides to better understand suicide risk and protective factors and better 

infonTI prevention and surveillance efforts. The AAS study involves investigating a person's 

death by attempting to reconstruct what the person thought, felt, and did in the days preceding 

6 
95 

his or her death. This approach is a gold standard in researching suicides, and involves 

collecting all available infonnation on the deceased via stmctured interviews of family members, 

relatives. friends, and attending health care personnel. 

In an effort to improve upon our mandatory Never Leave a Marine Behind suicide 

prevention training series. the Defense Centers of Excellence for Psychological I !ealth and 

Traumatic Brain injury is conducting a study to assess the effectiveness of our prevention 

training. Additionally, we are collaborating with the National Institute of Mental Health and the 

Army Study to Assess Risk and Resilience in Service members, the Department of Veterans 

Affairs/University of Califomia San Diego Marine Resilience Study to continue research of the 

biological, psychological, and social factors affecting Marine resilience. 

Other ongoing or future research efforts focus on: examination of suicide behavior in the 

Marine Corps and early career variables to better identify those in need of targeted prevention 

services; development of a new high impact clinical suicide prevention tool utilizing text 

messages based on the "Caring Letters Project;" and studying the effects of suicide on Marine 

family members and evaluation of postvention and casualty response. 

The Marine Corps is partnering with Navy Medicine to identify and reduce gaps in 

prevention and treatment. Areas of focus include: (1) Enhanced screening for suicide risk; (2) 

Management of at-risk personnel, including those with a history of mental health issues and 

suicide attempt; and (3) Strieter policies for the monitoring of at-risk personnel, including 

follow-on care. We are also attentive to the mental health of our warriors and are dedicated to 

ensuring that all Marines and family members who bear the invisible wounds caused by stress 

receive the best help possible. Our partnership with the Navy will continue to address the needs 

of Marines and their families in the face of the nationwide shortage of qualified mental health 
96 

care providers, and are committed as a Corps to making sure every Marine struggling with a 

stress issue gets the support and treatment they need. Finally, we actively participate as a 

member of the DoD Suicide Prevention and Risk Reduction Committee (SP ARRC), meeting 

monthly with our DoD and Department of Veterans Affairs partners to join efforts in reducing 

suicides. 

Conclusion 

Suicides are a loss that we simply cannot accept. The Corps is connected to each of our 

Marines and the loss is felt throughout the Corps from the individual Marine in the unit to the 

Commandant. The Mariue Corps is concerned with our number of suicides. Taking care of 

Marines is fundamental to our ethos and serves as the foundation of our resolve to do whatever it 

takes to help those in need. We will not rest in our efforts to prevent suicide. Suicide is a 

complex problem that requires an 'all-hands' comprehensive strategy. Our leaders at all levels 

are personally involved in efforts to address and prevent future tragedies and will remain actively 

engaged in this fight. We don't leave a Marine behind on the battlefield and we don't leave a 

Marine behind at home. 

Thank you again for your concern on this very imp0l1ant issue. 

8 
97 

A native of Pompano Beach, Florida, BGen Hedelund 

received his bachelor's degree from Florida Atlantic 

University and was commissioned a Second Lieutenant in 

April 1983. He was designated an unrestricted Naval 

Aviator in May 1985. 

As a CH46E pilot, BGen Hedelund has deployed overseas 

with HMM-264 (1985-1988), HMM-365 (1991-1994) and 

HMM-162 (2001-2003). He was a Basic and Advanced 

Helicopter Flight Instructor at Helicopter Training 

Squadron 18 at NAS Whiting Field from 1989-1991. 

BGen Hedelund served as a CH46E Instructor and Assanlt 

Support Department Head at Marine Aviation Weapons 

and Tactics Squadron One (MA WTS-l) in Yuma, AZ. 

Command assignments include Commanding Officer, Headquarters Squadron, Marine 

Aircraft Group 29, MCAS New River in 2000. In 2001, he assumed command ofHMM162. The Golden Eagles deployed with Marine Aircraft Group 29 in support of major 

offensive combat operations during Operation IRAQI FREEDOM from January to May 

2003. BGen Hedelund also served as the Commanding Officer, MA WTS-l from July 

2006 to June 2008. From August 2009 to February 2011 BGen Hedelund was 

Commanding General, Marine Corps Warfighting Laboratory; serving concurrently as 

the Vice Chief of Naval Research at the Office of Naval Research (ONR). 

BGen Hedelund is a distinguished graduate of The Basic School and Marine Corps 

Command and Staff College. He attended the Air War College, Montgomery, AL during 

the 2004 academic year and has also attended the Joint Forces Staff College, Norfolk, 

VA. 

Staff assignments include selection as a member of the Marine Corps Strategic Studies 

Group serving the Commanding General, Marine Corps Combat Development 

Command. BGen Hedelund has also served at US Joint Forces Command where he was 

assigned to the Joint Warfighting Center/n, responsible for Joint Force Training and 

Exercise support for US Northern Command. He reported to the Pentagon in July 2008 to 

serve as Military Assistant and Marine Aide to the Secretary of the Navy and finished his 

tour there as the Secretary's Senior Military Assistant. 

In February 2011, BGen Hedelund assumed duties as Director, Marine and Family 

Programs Division (MF), M&RA, HQMC in Quantico, VA. 
98 

Introduction 

Testimony of Jerry Reed, Ph.D., MSW 

House Armed Services Committee 

Military Personnel Subcommittee 

"Update on Military Suicide Prevention" 

March 6, 2013 Hearing 

Good afternoon Chairman Wilson, Ranking Member Davis, members of the subcommittee. I appreciate 

this opportunity to testify before you on the topic of suicide prevention. My task today is to present the 

information on suicide in the general population with an emphasis on the age and demographic groups 

equivalent to that of junior enlisted personnel who represent the majority of military suicides. I also 

hope to help the subcommittee better understand if the patterns of suicidal behavior occurring in the 

military are unique to the service setting or representative of suicide in the general population. I will 

also share a few recommendations on lessons learned from our work with suicide prevention efforts in 

the general population. 

Since 2008 I have served as the Director of the national Suicide Prevention Resource Center operated by 

the Education Development Center and funded by the Substance Abuse and Mental Health Services 

Administration. Our center is the only federally-funded suicide prevention resource center promoting 

the advancement of the National Strategy for Suicide Prevention, building national capacity, capturing 

best practices, providing training and technical assistance, and serving as a clearinghouse for suicide 

prevention. Prior to this position, I directed the Suicide Prevention Action Network USA, worked for a 

few years on Capitol Hill, served 15 years as a career civil servant managing quality of life programs with 

the Department of the Army and served four years on active duty in the U.S. Navy. I hold a doctorate in 

health related sciences from the Virginia Commonwealth University where my dissertation focused on 

variation among state suicide rates in older adult males. I have worked in the field of suicide prevention 

for the past sixteen years. 

Understanding the Challenge 

In recent years much attention has been paid to the burden of suicide among Service Members and 

Veterans. We frequently hear the statistics on the number of Service Members who die by suicide in a 

given month. These numbers capture our attention and rightfully, mobilize our concern. Rarely a week 

goes by when there is not an article in a newspaper or a feature story in a major magazine that brings 

this problem to the attention of the American people. These reports are certainly a call to arms. But the 

fact is that suicides by Service Members represent less than one percent of suicides in the nation. It is 

important to note that suicide is not just a defense or veteran problem; it is an American problem that 

must be addressed by a collective national effort. It is also important to remember that suicide is not 

just a problem affecting younger people. Just a few weeks ago, the Veterans Administration released the 

2012 Suicide Data Report that revealed that a majority of Veteran suicides are among males aged 50 and 

older and that males between 50-59 years of age are the most frequent callers to the Veteran Crisis line. 
99 

The fact that suicide occurs in such numbers among older Veterans reflects a similar reality in the 

general population. 

Suicide claims a tremendous toll on the people of the United States. In 2010, the last year for which 

national data are available, 38,364 Americans died by suicide. This represents a rate of 12.4 per 

100,000. Suicide was the 10th leading cause of death in the nation. By comparison, homicide was the 

16'h leading cause of death claiming 16,259 lives in 2010 or 60 percent fewer deaths than suicide. In 

addition to death by suicide, there are other forms of suicidal behavior which we must acknowledge as 

we seek to find effective solutions. The 2011 National Survey on Drug Use and Health administered by 

the Substance Abuse and Mental Health Services Administration reported that 8.5 million adults over 

the age of 18 had serious thoughts of suicide; 2.4 million made a suicide plan; and 1.1 million made nonfatal suicide attempts. More than 600,000 of these attempts required medical treatment. In short, 

suicide and suicidal behavior is a national problem, warranting a national solution. The good news is 

that many suicide deaths are preventable and we can, through our collective action, save lives. 

While suicide affects all age groups, suicide among our youngest citizens is a particular concern as these 

lives are cut far too short before they have had the opportunity to lead long, productive and meaningful 

lives. In 2010, suicide was the 3'd leading cause of death for young people ages 15-24. For those 

between the ages of 25-34, suicide was the 2"' leading cause of death. 

Is the suicide problem in the military different than it is for the general population? The recently 

released National Strategy for Suicide Prevention reported that "The suiCide rate for active duty military 

personnel has historically been significantly lower than the rate for a comparable population of 

Americans. However, both the numbers and rates of suicide have been increasing over the past 

decade." Some of the patterns of suicidal behavior in the military and the general population are 

similar. In both civilian life and the military, men die by suicide at higher rates than women. In 2010, 79 

percent of suicides in the United States were males and 95 percent of those who died by suicide in the 

military were males. Men more often use guns, which generally inflict a fatal wound in an instant. In 

spite of these similarities, the fact that the military population is screened for mental illnesses and drug 

abuse on accession, is healthier than the general population, is fully employed and fully insured, is 

routinely screened for drug use while serving, and has virtually unlimited availability of health and 

mental health care, we would expect them to have lower suicide rates than the general population. And 

this was true until the last few years. So clearly something is happening that warrants both study and 

action. 

Young adulthood is a time of transition. Young people are leaving the family environment and entering 

other settings with different rules, roles, and risks. Young people who choose to enter the military are 

entering a unique environment, one that offers both challenges and opportunities for suicide 

prevention. The military offers structure, well-defined roles, a community, housing, and health care. But 

as the data show, even the military environment does not protect young people from the tragic 

experience of suicide. While offering important opportunities for connection and support, the military 

presents unique pressures and demands that might elevate the risk for suicide. These include separation 

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100 

from family, long work hours, deployments, and exposure to potentially traumatizing events to name a 

few. But we must not let media reports lead us to the conclusion that suicide in the military results 

directly from the stresses of combat. The National Strategy for Suicide Prevention also pointed out that 

"the overwhelming majority of suicides occurred in a nondeployed setting, and more than half of those 

who died by suicide did not have a history of deployment." The Department of Defense Suicide Event 

Report (DoDSER) found that less than 16 percent of those in the military who died by suicide in 2011 had 

direct combat experience. However, the Army STARRS study showed that combat experienced 

members had higher rates of sUicide than their non-combat experienced peers. Therefore, we need to 

examine opportunities for prevention, both pre and post deployment that will inform our knowledge of 

the impact of combat service on suicide in our military. While it may not explain all suicides, it may 

provide insight to some suicides. Implicit in the social contract we make with the young people who 

volunteer to protect our nation is that we, the nation, will provide them with the resources to do this 

job as safely and efficiently as possible. We provide them with the training, arms, and technologies to 

engage in combat. We provide them with medical care to maintain their readiness and to help them 

heal when wounded. We should do no less to protect them from the behavioral health dangers they 

face - regardless of whether these dangers are inherent to their age or particular to the stresses of 

serving in the armed forces. 

The Need for a Comprehensive Approach 

The real question is whether there are steps we can take to effectively reduce the levels of suicidal 

behavior in our military. Both research and experience show that the answer to this question is "yes." 

We may be able to learn from the experience of suicide prevention on the campuses of colleges and 

universities. While there are obvious differences between service in the military and attendance at 

university, the age group (18-24) of those participating in each is roughly the same. The suicide rate 

among college age students is approximately 7.5 deaths per 100,000. This is roughly half the rate of 

their same-aged peers that do not attend college. College students have access to resources that their 

non-collegiate peers do not. These resources include access to campus counseling services, prohibitions 

concerning firearms on campus, reduced access to alcohol and other drugs on campus, a support 

structure including resident aSSistants, and the availability of campus support and engagement 

opportunities such as sororities, fraternities and clubs that encourage student engagement with their 

peers. College students are also actively in pursuit of a career goal or ambition. These resources may 

function as protective factors for those attending college. Through the federally-funded Garrett lee 

Smith Memorial Act which provides grants to campuses to advance suicide prevention efforts, we hope 

to learn much about suicide prevention with this age group that could be helpful to inform actions 

which could be used to prevent suicide in the military. 

I also want to acknowledge the military's own successes in implementing comprehensive and effective 

suicide prevention efforts. There is no doubt in my mind that much is being done to prevent suicide in 

the military. The Department of Defense Suicide Event Report (DoDSER) is an excellent capture of 

important data to use for planning interventions. The U.s. Air Force created a program that resulted in a 

33 percent reduction in Airmen suicides along with corresponding reductions to other threats to the 

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well-being of military personnel. Their approach implemented 11 initiatives aimed at strengthening 

social support, promoting development of social skills, and changing policies and norms to encourage 

effective help-seeking behaviors. Another initiative is occurring at Fort Bliss, Texas, where the command 

leadership created a comprehensive approach that focused on suicide prevention, risk reduction and 

resilience that resulted in a reduction of suicide deaths in one year. This approach called the "No 

Preventable Soldier Deaths" campaign warrants a close look. Let's hope these results are sustained over 

time. 

The successes of the Air Force and Fort Bliss programs provide testimony to the importance of creating a 

comprehensive response. Approaches where leadership support from the top, education and training 

for all who provide support to service members and their families, strengthening connections, 

promoting resilience and ensuring access to care are the approaches we should take moving forward. 

Every suicide is a tragedy. Suicide does not have one simple cause. It is not the result of a virus or a 

bacterium. Suicide is a complex outcome that is influenced by many factors. While individual factors are 

important, so too are relationships with family, peers, and others as well as influences from the broader 

social, cultural, economic, and physical environments. Just as there is no single path that will lead to 

suicide, there is no single solution or program that will solve the issue of suicide. We must create 

programs and support approaches that respond to the range of risks that impel individuals toward 

harming themselves and at the same time promote the range of protections that support those who are 

experiencing a difficult time. At the same time, we need to tailor these comprehensive efforts to the 

specific environment and culture in which we are trying to prevent suicide. We need to look at both the 

data on suicide in the military to understand what groups are at risk, and what role if any their military 

service plays in their suicide risk. I would suggest there is much that the suicide prevention community 

supporting efforts in the general population can add to this conversation in support of our colleagues in 

both DoD and VA as they engage in this important work. From my perspective, we must approach this 

issue with the attitude of "One Team ... One Fight" and work side by side to learn from each other on 

behalf of all those who struggle with suicide. We all want to save lives and prevent suicide. Every life 

matters and while cultures and environments may differ, solutions may have much more in common 

than we realize. We should remember that those who serve in our military come from the general 

population and will return to the general population when their service is complete. The more we can 

provide seamless and consistent support, informed by practice and research, the more stability we can 

provide for those at potential risk. 

Applying the Evidence 

We don't need to start an exploration for a comprehensive approach to suicide prevention from scratch. 

We know a great deal about what works to prevent suicide. In 2005, Mann and two dozen colleagues 

conducted a systematic review of the evidence for suicide prevention. Their findings emphasized the 

importance of two strategies that the research has shown will reduce rates of suicide. One is training 

physicians to recognize and treat depression. The other is restricting access of people at high risk for 

suicide to lethal methods. While other strategies they reviewed had promise, these two had robust data 

on outcomes. Our knowledge of effective strategies to prevent suicide does not end with these two 

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approaches, or the Air Force and Fort Bliss experiences. The National Registry of Evidence-based 

Programs and Practices includes 13 approaches specific to suicide prevention. The SPRC/ AFSP Best 

Practices Registry includes over 100 programs, materials, and practices that science and experience 

show can prevent suicidal behaviors and reduce risk. Some of these programs and materials were 

designed specifically for use with the military and with veterans. We need to make sure that effective 

programs are implemented where they can do the most good. And we need to continue to study how 

suicide prevention programs among Service Members and Veterans can be delivered and evaluated to 

expand the options available in all the settings that can have an impact upon our military, veterans, and 

their families. 

Responding to mental health needs of our young people in the military is an essential part of our 

collective focus. This focus should include training physicians, behavioral health providers, and 

counselors on detecting and responding to the warning signs of suicide. We also need to promote a 

culture in which members of the military are not afraid to seek help because it may subject them to 

ridicule or interfere with career advancement. Preserving confidentiality would go a long way to 

changing help-seeking behavior in the military. If service members do not think that their problems will 

remain confidential, or perceive that their seeking help will have career consequences, they will not seek 

help. If they are concerned they will be humiliated or singled out in front of their peers in a very public 

way, many will not seek treatment. And if they do not seek help, their problems will remain untreated. 

Some may argue that members of the military have a great advantage over civilians in their access to 

health care, including behavioral health care. Our challenge is to ensure that they seek this access when 

they are experiencing behavioral health issues associated with suicide. We must also make sure that the 

health care professionals serving members of the military are trained to effectively treat the behavioral 

health problems associated with suicidal behaviors. I am pleased to report that a one-day training 

program offered by the Suicide Prevention Resource Center in training mental health providers the core 

competencies in suicide risk assessment entitled "Assessing and Management of Suicide Risk," has been 

utilized by the Navy, Air Force and Marine Corps. To date over 2700 providers have been trained. 

Nationally, more than 20,000 mental health providers have received the training. Other important 

partners for suicide prevention found on our military installations are family services centers, financial 

counseling, legal offices, drug and alcohol services, chaplains, and other social and healthcare services. 

Programs and services like Military One Source, the 1-800-273-TALK network of crisis centers, and 

behavioral health providers in the community puts help within reach of Service Members and Veterans 

and encourages them to seek this help. All those on military installation have a role to play in suicide 

prevention. We must fully engage them in these efforts just as we are trying to do in the general 

population. We need to help them learn how to look for signs of stress in those they lead, serve and 

support, and we must engage commanders, peers, families, support staff, and others in the chain of 

command to know the signs of distress and ensure those in need are referred for care. 

Restricting the access of individuals experiencing an emotional crisis to lethal means is a proven method 

of preventing suicide. This is especially true of firearms, which often prove fatal when used by an 

individual to harm him or herself. Reducing access to lethal means may be especially challenging in the 

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military environment. But it can be done without impairing the ability of the military and individuals in 

the military to have ready access to the weapons necessary to protect themselves and our country. If we 

can take steps to minimize access to a lethal mean at the time of crisis, we may introduce enough time 

for the crisis to subside and help those at risk connect with the support that will put them on a path to 

recovery. 

Planning and Working Together 

Addressing suicide in any sector whether military or civilian, public or private, requires a team effort and 

a carefully thought out and carefully implemented plan. When we go into war, we have a battle plan. 

And we have a national plan for preventing suicide. I had the privilege of working with our Surgeon 

General of the United States, Dr. Regina Benjamin, as a co-lead for the revision of the National Strategy 

for Suicide Prevention, our nation's battle plan for combating suicide. I also serve on the team that is 

coordinating implementation ofthis plan, the Action Alliance for Suicide Prevention, which was 

launched in 2010 by Secretaries Sebelius and Gates. The Action Alliance is a public-private partnership 

whose mission is to advance the National Strategy and to catalyze, champion and cultivate action on 

behalf of suicide prevention in our nation. This partnership is led by our private sector co-chair, Senator 

Gordon Smith, and our public sector co-chair, Secretary of the Army John McHugh. They are working 

side-by-side with approximately 45 representatives from the public and private sectors in an effort to 

save 20,000 lives over five years. This is an unprecedented effort to bring all the players to the table to 

ensure that we each do our part and mobilize the resources of our respective sectors to reduce suicide 

in the nation. The Action Alliance includes representatives from public agencies such as the Centers for 

Disease Control and Prevention, National Institute of Mental Health, Departments of Justice, Defense 

and Veterans Affairs and the Substance Abuse and Mental Health Service Administration, to name a few. 

It includes representatives from the private sector, including the media, health care, and the faith 

community. And it includes representatives from the armed services and agencies that serve Veterans. 

To fully protect our nation's military personnel and Veterans, it is necessary to bring together the 

agencies in which they serve, the agencies which serve them, and the communities in which they live, 

and with everyone at the table, create and implement a comprehensive plan to address the unique 

factors that put Service Members at risk. We have much to share and much to learn by working more 

closely together. We are making progress. 

Sustaining Our Efforts 

Another important lesson we've learned about suicide prevention is the importance of sustainability. 

Activities to prevent suicide are only effective insomuch as they are sustained. Again and again we have 

seen that when effective programs are implemented, suicide rates go down. But when attentiveness to 

those programs diminishes, rates once again rise. We see this in other public health problems, too. 

Sustainability is especially important in the military environment as personnel rotate through commands 

and new people enter the service as older members retire or leave the service and re-enter civilian life. 

Fortunately, the military has a framework for sustaining programs. It is a culture informed by regulations 

and compliance standards, enforced with inspections and a commitment to continuous improvement. 

6 
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We need to ensure that suicide prevention efforts are knitted together by a cohesive strategy and 

sustained over time with vigor. It is also important that we require ongoing evaluation to find out what 

is working, what is not, and to keep evaluating so we sustain improvements over time. It must be 

maintained as a permanent component of the military's health infrastructure, as well as the Veteran's 

Administration health services and the other health and behavioral health providers that serve Veterans 

and their families. 

Changing the Conversation 

Finally, we have to change the way we talk about suicide in the military. Changing the conversation does 

not mean ignoring the problem or pretending it does not exist. But much of the current conversation 

about suicide in the military tends to ignore the larger context of suicide as a problem in our country. It 

also tends to ignore the fact that we know a lot about preventing suicide. Our conversation about 

suicide in the military and in the nation needs to stress how much we do to prevent suicide. We need to 

highlight success stories, like that of Fort Bliss. While not concealing the very real problem of suicide in 

the military, and the toll it entails, we need to be careful not to present suicide as more common than it 

actually is. We don't want to create the impression that suicide is a normal - or even acceptableresponse to stress, even the most traumatic stress from combat. We don't want to stereotype our 

Service Members and Veterans as being damaged permanently from the psychological wounds of war. 

The truth is that the men and women wearing this nation's military uniforms have shown outstanding 

resilience in the face of over a decade of war. They have responded to their nation's call, have born the 

burden, and are returning to their communities as upstanding citizens. In many cases, they have 

weathered punishing adversity and kept going. Some have struggled with thoughts of suicide for a time, 

even for a long time, and most, have survived and are surviving. This in my opinion is a part of the story 

we must be sharing. They are truly heroes and we need to hear more of their stories. Their stories can 

be lifesaving for them and for others. They can provide hope and guidance to the soldier, sailor, airman 

or marine who may feel that a self-inflicted death is the only solution to their problems. 

Conclusion/Summary 

I want to thank the Committee for this opportunity to speak on behalf of suicide prevention, as well as 

on behalf of Service Members and Veterans of the United States Armed Forces, of which I am one. I 

want to encourage members of the Committee to work with us in suicide prevention, as well as those 

who serve the military and our Veterans, to continue our collective and collaborative efforts to prevent 

suicide, in the military, among our Veterans and in the general population as well. I hope I have shown 

that we have the knowledge and ability to take steps to reduce the toll of this needless tragedy. We 

have a national strategy that should guide our future efforts. What we need now is the will, the 

collaboration, and the resources to implement and sustain these efforts, and help protect those who 

have so generously volunteered to serve and to all the citizens they so graciously defend. 

7 
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Jerry Reed, Ph.D., M.S.W. 

Vice President and Director 

Education Development Center 

Center for the Study and Prevention ofInjury, Violence and Suicide 

Suicide Prevention Resource Center 

Jerry Reed began serving as the Director of the national Suicide Prevention Resource Center in 

the United States in July 2008. In this role he oversees the federally funded Suicide Prevention 

Resource Center (SPRC). Through this work he provides state and local officials, grantees, 

policymakers, interested stakeholders and the general public with assistance in developing, 

implementing and evaluating programs and strategies to prevent suicide. Additionally, Dr. Reed 

serves as the Director of the Center for the Study and Prevention ofInjury. Violence and Suicide 

overseeing a staff of 45 and directs the work on multiple projects. 

Prior to this appointment, Dr. Reed served for five years as Executive Director of the Suicide 

Prevention Action Network USA (SPAN USA) a national non-profit created to raise awareness, 

build political will. and call for action with regard to advancing, implementing and evaluating a 

national strategy to address suicide. He spent 15 years as a career civil servant working in both 

Europe and the United States as a civilian with the Department of the Army developing, 

implementing and managing a variety of quality of life programs including substance abuse 

prevention and treatment, family advocacy, child and youth development programs, social 

services and the range of morale, welfare and recreation programs. Selected as a Congressional 

Fellow in 1996, Dr. Reed worked in the Office of U.S. Senator Harry Reid (NV) serving as 

senior advisor on health care, mental health. suicide prevention and aging issues. 

Dr. Reed speaks nationally and internationally on the topic of suicide prevention. His interests 

include geriatrics, mental health, suicide prevention, violence prevention and public policy. He 

serves on the Board of the International Association for Suicide Prevention as Chair of the 

Council of Organizational Representatives and is a member of the Violence Prevention Alliance 

Steering Committee operated with the World Health Organization in partnership with 

international partners. 

Dr. Reed received a Ph.D. in Health Related Sciences with an emphasis in Gerontology from the 

Virginia Commonwealth University in Richmond in 2007. His research topic addressed 

variation among states in crude rates of older adult male suicide. He also received a Masters of 

Social Work degree with an emphasis in Aging Administration [rom the University of Maryland 

at Baltimore in 1982. 
106 

DISCLOSURE FORM FOR WITNESSES 

CONCERNING FEDERAL CONTRACT AND GRANT INFORMATION 

INSTRUCTION TO WITNESSES: Rule 11, clause 2(g)(5), of the Rules of the U.S. 

House of Representatives for the 113'h Congress requires nongovernmental witnesses 

appearing before House committees to include in their written statements a curricnlum 

vitae and a disclosure of the amount and source of any federal contracts or grants 

(including subcontracts and subgrants) received during the current and two previous 

fiscal years either by the witness or by an entity represented by the witness. This form is 

intended to assist witnesses appearing before the House Committee on Armed Services in 

complying with the House rule. Please note that a copy of these statements, with 

appropriate redactions to protect the witness's personal privacy (including home address 

and phone nnmber) will be made publicly available in electronic form not later than one 

day after the witness's appearance before the committee. 

Witness name: Jerry Reed, Ph.D., MSW 

Capacity in which appearing: (check one) 

X,Jndividual 

Representative 

If appearing in a representative capacity, name of the company, association or other 

entity being represented: 

FISCAL YEAR 2013 

federal grant(s) / federal agency dollar value subject(s) of contract or 

contracts grant 

Suicide Prevention SAMHSA $5,271,000 (prime) Suicide prevention 

Resource Center 

Grant for Injury Control CDC! University of $203,343 (sub) Suicide prevention. injury 

Research Centers Rochester i prevention 

Reducing Barriers to US. Army $294,819 (prime) Stigma reduction, discrimination, 

Help Seeking for Mental I help seeking behavior 

~"'-th Problems 

FISCAL YEAR 2012 

federal grant(s) / federal agency dollar value subject(s) of contract or 

contracts grant 

Suicide Prevention SAMHSA $5,471,000 Suicide prevention 

Resource Center 

Reducing Barriers to U.S. Army $498,790 Stigma reduction. discrimination, 

Help Seeking for Mental help seeking behavior 

Health Problems 

FISCAL YEAR 2011 
107 

r-=--

Federal grant(s)j federal agency dollar value subject(s) of contract or 

contracts grant 

Suicide Prevention SAMHSA $4,471,000 Suicide prevention 

Resource Center 

Reducing Barriers to U.S. Army $383,973 Stigma reduction, discrimination, 

Help Seeking for Mental help seeking behavior 

Health Problems 

Federal Contract Information: If you or the entity you represent before the Committee 

on Anned Services bas contracts (including subcontracts) witb the federal government, 

please provide the following information: 

Number of contracts (including subcontracts) with the federal government: 

Current fiscal year (2013): __ . ___ _ 

Fiscal year 2012: ____ . ___ . _______________ . 

Fiscal year 2011 . 

Federal agencies with which federal contracts are held: 

Cun'ent fiscal year (2013):___ __ , 

Fiscal year 2012: __ .. _______ . ____ . ______ ; 

Fiscal year 2011.' _______________ . __ ._. _______ . 

List of subjects offederal contract(s) (for example, ship construction, aircraft parts 

manufacturing, software design, force structure consultant. architecture & engineering 

services, etc.): 

Current fiscal 

Fiscal year 

(2013): __ .. 

Fiscal year 2011·. _________ .. ____ .... ____ .. _________ . 

Aggregate dollar value of federal contracts held: 

Current fiscal year (2013):_. 

Fiscal year 2012: 

Fiscal year 2011' . ____ __ 

2 
108 

Federal Grant Information: If you or the entity you represent before the Committee on 

Armed Serviees has grants (including subgrants) with the federal government, please 

provide the following information: 

Number of grants (including subgrants) with the federal government: 

CUlTent fiscal year (2013): "-_______________ , 

Fiscal year2012: "'-_________________ , 

Fiscal year 2011: =-_________________ . 

Federal agencies with which federal grants are held: 

Current fiscal year (20l3): SAMHSA. CDC. US Army; 

Fiscal year 2012: SAMHSA, US Army; 

Fiscal year 2011: SAMHSA, US Anny. 

List of subjects offederal grants(s) (for example, materials research, sociological study, 

software design, etc.): 

CUlTent fiscal year (2013): suicide prevention, injury prevention, Stigma 

reduction, discrimination, help seeking behavior; 

Fiscal year 2012: suicide prevention. Stigma reduction, discrimination, help 

seeking behavior; 

Fiscal year 2011: suicide prevention, Stigma reduction, discrimination, help 

seeking behavior. 

Aggregate dollar value of federal grants held: 

Current fiscal year (2013): $5,769,162 

Fiscal year 2012: $5.969,790; 

Fiscal year 2011: $4.854,973. 

3 
WITNESS RESPONSES TO QUESTIONS ASKED DURING 

THE HEARING 

MARCH 21, 2013 

(111) 

RESPONSE TO QUESTION SUBMITTED BY MRS. DAVIS 

General HEDELUND. Yes, I am aware of the pilot program in mindfulness training. 

The goal of the program is to provide Marines with another tool to combat stress 

through the use of meditative techniques. We’re expecting the results from the 

study in the fall of 2013. [See page 15.] 

RESPONSE TO QUESTION SUBMITTED BY MR. SCOTT 

Ms. GARRICK. Since the VA claims backlog issue falls under the VA, we would 

have to defer to them for the percentage of those who were waiting for their VA 

claims. 

However, we do know that from the initiation of the Disability Evaluation System 

(DES) Pilot (November 2007) through November 2012 (the most recent update from 

Military Departments, there were 156 deaths reported of Service members enrolled 

in the DES. Of these, 32 determined to be suicide. During the same time period 

(2007–2012), there were approximately 1700 Service members who died by suicide. 

Therefore, approximately 1.9 percent (32/1700) of the total Active Duty and Reserve 

suicides were in the DES process at the time of their death. [See page 16.] 

RESPONSE TO QUESTION SUBMITTED BY MRS. NOEM 

General BROMBERG. The investigating officer (IO) did not interview the Soldier’s 

Family because he did not feel it was pertinent to addressing the lines of inquiry 

in Army Directive (AD) 2010–01. He initiated his investigation by looking at the 

County Sheriff’s Department report, which included depositions from the two individuals who had found the Soldier after the incident. He then developed a list of 

acquaintances and members of the chain of command who knew the Soldier, and 

after these interviews the IO believed he was able to answer each question of each 

line of inquiry in AD 2010–01. 

The policy states that during an investigation, ‘‘any contact or communications 

with a Family member of the Soldier should be pursued only when absolutely essential to the conduct of the investigation.’’ AD 2010–01 directs the IO to answer a series of questions which largely are focused on the Soldier’s interactions with his/her 

peers, superiors, and subordinates. [See page 21.] 

RESPONSE TO QUESTION SUBMITTED BY DR. HECK 

General BROMBERG. The unit chain of command represents the center of gravity 

for the health and care of our Soldiers and Families. The uniqueness of our geographically dispersed population mandates sustained partnerships with local community leaders and resources. Our leadership is committed to health, safety and 

welfare of all Soldiers and Family members; providing the appropriate linkage to 

available resources and assistance closet to where they live is a key component of 

that commitment. Venues such as the Yellow Ribbon Reintegration Program and 

Strong Bonds facilitate this connection with education and awareness of local networks of community support most appropriate and available to our Soldiers. Other 

resources like our Fort Family Outreach Center and Army Strong Community Centers assist in virtually bridging the gap with commensurate services inherent to an 

active duty installation. These resources provide geographically relevant information. We continue to work collaboratively with our sister components in order to capitalize on both inherent capability and capacity to connect our Soldiers and Families 

with the resources and assistance needed. [See page 28.] 

QUESTIONS SUBMITTED BY MEMBERS POST HEARING 

MARCH 21, 2013 

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QUESTIONS SUBMITTED BY MS. SHEA-PORTER 

Ms. SHEA-PORTER. 1) What steps are the Defense Suicide Prevention Office and 

the Services taking in terms of support and treatment, to meet the mental health 

challenges facing spouses and children? There are some innovative National Guard 

Yellow Ribbon Programs, like that of our own New Hampshire National Guard, that 

follow and support families as well as Guard members before, during, and after deployment. Are you talking to the States and incorporating the best practices of such 

programs? 

Ms. GARRICK. Yes. The Department of Defense (DOD), through the Defense Suicide Prevention Office, has formed a Community Action Team process comprised of 

representatives from non-profit organizations, universities and others to discuss suicide prevention best practices. In addition, it has recommended policy changes for 

military justice and civilian court processing adjudicating Service members who appear in civilian courts under state jurisdiction diagnosed with psychological conditions. DOD has expanded the National Guard Chaplain Partners In Care program, 

which leverages state community faith-based organizations responding to Service 

members, Reserve members and their families. 

Family members may be able to recognize warning signs and see changes in their 

Service member’s behaviors before anyone else since they interact with them in a 

less-guarded state. DOD is drafting an Info Guide ‘‘Supporting Military Families In 

Crisis: A Guide to help You Prevent Suicide.’’ It is designed to empower military 

families by introducing them to the warning signs of suicide, reduce the stigma and 

uncertainty associated with seeking behavioral health, and provide ways to avail resources, get help, and build family resilience. 

Ms. SHEA-PORTER. 2) Do DSPO and the Services have a strategy and the capacity, 

to provide adequate mental health screening and care for families? If not, how are 

they partnering with civilian social services and non-profit organizations to fill the 

support gaps? New Hampshire’s National Guard Yellow Ribbon Program, for example, partners with Easter Seals to provide needed support. 

Ms. GARRICK. Yellow Ribbon Reintegration Programs (YRRP) and Returning Warrior Workshops are retreats that facilitate family member involvement in the reintegration process. YRRP offers specific pre, during, and 30, 60 and 90 day post 

deployment sessions that focus on managing the stressors related to deployment and 

the resources for reintegration. 

Military Treatment Facilities and the TRICARE network offer behavioral health 

care and support to all beneficiaries. The Patient Centered Medical Home—Behavioral Health Team (PCMH–BHT) model is leveraging a primary care behavioral 

health case management approach and the Psychological Health Council has incorporated suicide prevention and family issues into its scope. 

The Services have dedicated military family support centers (MFSC) that help 

Service members successfully balance and integrate their military and civilian lives. 

MFSCs provide relocation assistance, financial training, and family education/advocacy services. For National Guard/Reserve members, military and family life counselors (MFLC) are available to provide short-term, non-medical counseling during 

drill weekends and other events or locations where Service members and their families gather. Family members can also benefit from Military OneSource’s 12 (nonmedical brief intervention) sessions to resolve marital or family challenges. Section 

706 of the 2013 NDAA authorizes the Department to conduct a pilot study on enhancement of mental health in the National Guard by partnering with community 

agencies. The National Guard Bureau has developed a draft pilot program. 

Ms. SHEA-PORTER. 3) Are family member (spouses and children) suicides being 

tracked by DSPO and/or the Services? If not, why not? 

Ms. GARRICK. DOD does not track at the Department level suicide deaths for families of Service members, because DOD has no reliable means to do so. Suicide 

deaths among spouses or dependents are determined by a civilian authority and not 

a medical examiner from the Armed Forces Medical Examiner System (AFMES). As 

a result, DOD must rely on civilian authorities and Service members to report 

spouse/dependent deaths. DOD has no authority to require civilian health and mortality authorities to forward autopsy findings to DOD. Service members do report 
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dependents’ death for beneficiary purposes, but there are often lags in that information, and manner of death is not always included. 

Ms. SHEA-PORTER. 4) What authority will DSPO have to ensure the suicide prevention policies they develop will be implemented by the Services? 

Ms. GARRICK. DSPO activities are under the authority of the Secretary of Defense, 

who exercises authority, direction, and control over the Military Department and 

Services. 

Ms. SHEA-PORTER. 5) What steps are the Defense Suicide Prevention Office and 

the Services taking in terms of support and treatment, to meet the mental health 

challenges facing spouses and children? There are some innovative National Guard 

Yellow Ribbon Programs, like that of our own New Hampshire National Guard, that 

follow and support families as well as Guard members before, during, and after deployment. Are you talking to the States and incorporating the best practices of such 

programs? 

General BROMBERG. Yes, we are talking to the states to ensure the best practices 

are being incorporated. Two major barriers in obtaining Behavioral Health (BH) 

care for Military Children and Families are limited Access to Care and Stigma. 

The Army, in an effort to reduce these barriers, established School Behavioral 

Health Programs (SBH) and Child and Family Assistance Centers (CAFAC), specifically designed using the Public Health and Communities of Practice Models. SBH 

Programs and CAFACs are currently in varying stages of development and provide 

services at a limited number of Army Installations. These programs are at risk of 

being reduced for numerous reasons to include: a critical national shortage of BH 

Child and Family providers; lack of sustained funding in the current fiscal environment; sustainment of programs and proliferation of new programs supporting the 

BH needs of Children and Families. 

SBH programs currently operate in 46 schools on eight installations (Tripler, 

Joint Base Lewis-McChord, and Forts Carson, Campbell, Meade, Bliss, Bavaria and 

Landstuhl, Germany). SBH programs, by design, support resiliency, promote access 

and reduces stigma. SBH is currently limited to providing services to on-post 

schools; however, a pilot program to provide the services to Military Children in offpost schools is underway in the communities surrounding Schofield Barracks, Hawaii. 

Child and Family Assistance Centers (CAFAC), are being developed on 10 installations (Schofield Barracks, Joint Base Lewis-McChord, and Forts Carson, Wainwright, Bliss, Hood, Polk, Bragg, Campbell and Drum); the majority not being fully 

operational due to limited BH provider resources and difficulties in hiring, particularly at more ‘‘rural’’ installations. 

Ms. SHEA-PORTER. 6) Do DSPO and the Services have a strategy and the capacity, 

to provide adequate mental health screening and care for families? If not, how are 

they partnering with civilian social services and non-profit organizations to fill the 

support gaps? New Hampshire’s National Guard Yellow Ribbon Program, for example, partners with Easter Seals to provide needed support. 

General BROMBERG. The Child, Adolescent, and Family Behavioral Health Office 

(CAFBHO), U.S. Army Medical Command, has established collaborative working relationships with national and state organizations and professional entities in order 

to identify and share best practices in terms of prevention and interventions for behavioral health problems for Army children and Families. CAFBHO has also developed, and is implementing, a comprehensive training curriculum for Army Pediatric 

Primary Care Providers by using evidence-based practices for preventing, screening, 

identifying and treating common behavioral health disorders in children within the 

primary care setting. 

Partnerships have been established with the following national organizations and 

universities in order to collaborate on best practices and disseminate knowledge: 

• American Psychological Association 

• Academy of Child and Adolescent Psychiatry 

• American Academy of Pediatrics 

• Center for School Mental Health, University of Maryland 

• IDEA Partnership and the National Community of Practice, Office of Special 

Education, United States Department of Education 

• Military Child Education Coalition 

• National Association of State Directors of Special Education 

• Center for Deployment Psychology 

• The Beach Center on Disability, University of Kansas 

• University of South Carolina 

• University of Washington 

• Mayo Clinic/REACH 
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• U.S. Department of Agriculture, Operation Military Kids 

Ms. SHEA-PORTER. 7) Are family member (spouses and children) suicides being 

tracked by DSPO and/or the Services? If not, why not? 

General BROMBERG. The Army tracks Family member suicides of Active Duty Soldiers; regardless of whether or not the death occurred on a military installation. 

Suicides of non-Active Duty Soldiers’ Family members are not currently tracked due 

to challenges related to the collection of reliable and substantiated data, identification of data sources, and legal issues related to obtaining and maintaining civilian 

personal information. 

Ms. SHEA-PORTER. 8) What steps are the Defense Suicide Prevention Office and 

the Services taking in terms of support and treatment, to meet the mental health 

challenges facing spouses and children? There are some innovative National Guard 

Yellow Ribbon Programs, like that of our own New Hampshire National Guard, that 

follow and support families as well as Guard members before, during, and after deployment. Are you talking to the States and incorporating the best practices of such 

programs? 

Admiral VAN BUSKIRK. Navy offers a full complement of programs designed to address the needs of Navy families. Working within the Department of Defense, with 

other federal agencies, and with state and local partners, Navy identifies best practices and incorporates them into our programs. Navy leadership recognizes the 

unique challenges our families face and is fully committed to providing them the 

best possible support as they support our Sailors and our mission. 

Navy’s version of the Yellow Ribbon Program is the Returning Warrior Workshop 

(RWW). RWW participants have the opportunity to address personal, family, or professional situations experienced during deployment and receive readjustment and 

reintegration support from a broad array of resources, including: Navy Reserve Psychological Health Outreach Teams (PHOT), TRICARE Joint Family Support Assistance (JFSAP), Military and Family Life Consultants (MFLC), Personal Financial 

Council (PFC), Military OneSource (MOS), Chaplains, Fleet and Family Support 

Centers (FFSC) and Veterans Affairs (VA). 

Other Navy and DOD programs to help families cope with the challenges they 

face before, during and after deployment include: 

— Ombudsman and Family Readiness Groups (FRG) are the primary method of 

family support, outreach and communication with families of deployed Sailors. 

The ombudsman program supports a volunteer associated with the command— 

typically a spouse, appointed by the commanding officer, to serve as a confidential liaison between command leadership and the families. Ombudsmen 

are trained and certified to disseminate information both up and down the 

chain of command, including official Department of the Navy and command information, command climate issues, local quality of life (QOL) improvement 

opportunities, and community support opportunities. Ombudsmen also provide 

resource referrals and are instrumental in resolving family issues. 

— An FRG is a private organization, closely-affiliated with the command, comprised of family members, Sailors, and civilians associated with the command 

and its personnel, who support the flow of information, provide practical tools 

for adjusting to Navy deployments and separations, and serve as a link between the command and Sailors’ families. FRGs help plan, coordinate and conduct informational, care-taking, morale-building and social activities to enhance preparedness, command mission readiness and increase the resiliency 

and well-being of Sailors and their families. 

— Commander Navy Installations Command (CNIC) Deployment Readiness Program. CNIC supports unit level family support and deployment readiness programs with a wide variety of complimentary training and support activities, 

including: unit level deployment cycle training, online information and individualized one-on-one counseling. 

— Navy Project FOCUS (Families Over Coming Under Stress). FOCUS provides 

resiliency training to military families, including practical skills to meet the 

challenges of deployment and reintegration, communication techniques, effective problem-solving and family goal-setting. 

— The Navy Center for Combat & Operational Stress Control (NCCOSC). Dedicated to the mental health and well-being of Navy and Marine Corps service 

members and their families, NCCOSC promotes resilience, and investigates 

and implements best practices in the diagnoses and treatment of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). 

— The Defense Centers of Excellence are responsible for leading a national collaborative network of military, federal, family and community leaders; clinical 
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experts; and academic institutions to best serve the urgent and enduring needs 

of warriors and their families with psychological health and/or traumatic brain 

injury concerns. 

— The Real Warriors Campaign promotes the processes of building resilience, facilitating recovery and supporting reintegration for returning service members 

and their families. 

The Navy supports a comprehensive mental health strategy to provide high quality, evidence-based care for Active Duty Service members, reservists, and their families. Navy Medicine continues to improve and enhance access to care for Active Duty 

members and their families by increasing the size of the mental health work force 

and opportunities to interact with behavioral health providers. The Behavioral 

Health Integration Program in the Medical Home Port has being implemented 

across 67 Navy sites, as well as 6 Marine Corps sites. This program embeds behavioral health providers in the primary care setting to increase access and reduce 

stigma. 

Navy Medicine continues to focus on the mental health needs of reservists. In 

FY12, the Navy and Marine Corps Reserve Psychological Health Outreach Program 

(PHOP) provided over 11,000 outreach contacts to returning Service members and 

provided behavioral health screenings for approximately 1,000 reservists. Similarly, 

as of December 2012 over 12,000 military family members participated in our Returning Warrior Workshops (RWWs) for reservists. RWWs are funded through Defense Health Program and Navy appropriations. 

Ms. SHEA-PORTER. 9) Do DSPO and the Services have a strategy and the capacity, 

to provide adequate mental health screening and care for families? If not, how are 

they partnering with civilian social services and non-profit organizations to fill the 

support gaps? New Hampshire’s National Guard Yellow Ribbon Program, for example, partners with Easter Seals to provide needed support. 

Admiral VAN BUSKIRK. Yes; Navy Medicine continues to support a comprehensive 

mental health strategy to provide ready access to high quality, evidence-based, mental health care for military members and their families. This includes prevention 

and resilience-building services, as well as more traditional treatment. For instance, 

Navy’s FOCUS program (Families Over Coming Under Stress), which is widely recognized as a model for prevention/intervention psychological health services for military families, provided services to over 91,000 military family members in Fiscal 

Year 2012. Outcomes have shown statistically significant improvements in anxiety 

and depression among both children and parents. 

Family members can also access mental health care through our Behavioral 

Health Integration Program, part of Medical Home Port, which embeds behavioral 

health providers in the primary care setting to increase access and reduce stigma. 

This program has been implemented across 67 Navy and six Marine Corps sites. 

Navy Medicine also continues to place the highest priority on the mental health 

needs of reservists and their families. In Fiscal Year 2012, the Navy and Marine 

Corps Reserve Psychological Health Outreach Program (PHOP) provided over 

11,000 outreach contacts to returning service members and behavioral health 

screenings for approximately 1,000 reservists. PHOP staff made over 500 visits to 

reserve units providing over 800 presentations to approximately 19,000 reservists, 

family members and commands. As of December 2012, over 12,000 service members 

and their loved ones have participated in 100 Returning Warrior Workshops 

(RWWs), which assist demobilized service members and their families in identifying 

immediate and potential issues that often arise during post-deployment reintegration. 

Ms. SHEA-PORTER. 10) Are family member (spouses and children) suicides being 

tracked by DSPO and/or the Services? If not, why not? 

Admiral VAN BUSKIRK. Navy does not track family member suicides. There is no 

statutory or policy requirement to do so, and no reporting mechanism in place by 

which to track family member suicides. 

Ms. SHEA-PORTER. 11) What steps are the Defense Suicide Prevention Office and 

the Services taking in terms of support and treatment, to meet the mental health 

challenges facing spouses and children? There are some innovative National Guard 

Yellow Ribbon Programs, like that of our own New Hampshire National Guard, that 

follow and support families as well as Guard members before, during, and after deployment. Are you talking to the States and incorporating the best practices of such 

programs? 

General JONES. A variety of programs provide support for the mental health needs 

of spouses and dependent children. Each installation has a Family Advocacy Program, which provides outreach and prevention services to families. One novel Family Advocacy Program approach is the New Parent Support Program, which provides 
119 

support and guidance in the home to parents screened as high risk for family maltreatment. Educational and Development Intervention Services are provided by a 

child psychologist for special education children in Department of Defense schools. 

Other programs provide education on common family issues like good parenting, 

couples communication, or redeployment integration. Counseling for families is also 

available. Military OneSource is a Department of Defense program using a civilian 

network that provides face-to-face, telephonic, or online counseling/consultation to 

service members and families for up to 12 sessions. Also, Office of the Secretary of 

Defense-funded Military and Family Life consultants and Child and Youth Behavioral consultants offer confidential, non-medical, short-term counseling services, 

which address issues common in military families such as deployment stresses and 

relocation. Family members not able to be seen at military medical treatment facilities have access to services through community TRICARE providers. TRICARE network providers offer an array of services from individual counseling and group therapy, to inpatient behavioral health care. However, these services vary significantly 

from location to location. This is due to a nationwide shortage of doctoral level child 

and adolescent psychiatrists and psychologists. 

The Yellow Ribbon Program offers resources on behavioral health issues and suicide mitigation and is offered to Reserve and Air National Guard (ANG) Airmen and 

their families pre-deployment, during deployment, and post deployment. Funded by 

Yellow Ribbon, the Psychological Health Advocacy Program (PHAP) is designed to 

assist Reserve Airmen and their family members with a variety of needs, including 

mental health issues, financial assistance, relationship and family counseling, and 

substance abuse through referrals. The ANG Psychological Health Program (PHP) 

was developed to address psychological health needs of ANG Airmen and their families. The PHP places a licensed behavioral health provider at each of the ANG’s 89 

wings throughout the 54 states, territories and the District of Columbia. The program provides three categories of service: leadership advisement and consultation; 

community capacity building; and direct services—to include assessment, referral, 

crisis intervention, and case management—that are available daily. The Wing Directors of Psychological Health are available 24/7 to operational leadership and provide 

services to ANG Airmen and their family members regardless of whether they are 

at home or on duty status. Both ANG Wing Directors of Psychological Health and 

AFRC Psychological Health Advocates work with their local communities to develop 

resources, referrals, and partnerships to maximize services for Airmen. Additionally, 

mental health and personnel leaders from ANG, Reserve and each of the services 

participate in the Department of Defense and the Department of Veterans Affairs 

level committees on suicide prevention and psychological health where they share 

best practices and ideas. 

TRICARE Reserve Select is available for Reserve Component Airmen and their 

family members and provides coverage for both outpatient and inpatient treatment. 

Access to military medical care is available to service members with duty-related 

conditions through TRICARE and the Department of Veterans Affairs. 

Since Air Reserve Component wingmen (e.g. family, friends) are often non-military personnel, the ANG’s Wingman Project provides information and resources for 

suicide prevention on publicly-accessible websites. The ANG tailors marketing and 

resource materials for each state. The primary goal of the Wingman Project, located 

at http://wingmanproject.org, is to reduce warfighter, Department of Defense civilian, and family member suicides through human outreach, education, and media. 

The Air Force Reserve Wingman Toolkit is a broad-based Air Force Reserve initiative designed to empower Airmen and their families to achieve and sustain health, 

wellness, and balanced lifestyles by using the four domains of Comprehensive Fitness. The toolkit is located at: http://AFRC.WingmanToolkit.org. The Wingman Toolkit provides Commanders, Airmen, families, and friends (i.e., Air Force Reserve 

Wingmen), access to a wide variety of resources, training opportunities, a dedicated 

Wingman Day page, promotion of the Ask, Care, Escort (A.C.E.) suicide intervention 

model, educational outreach materials, social media (Facebook, Twitter, Etc.), a mobile phone application, Short Message Service (SMS) texting capability (‘‘WMTK’’ to 

24587), inspirational and training videos, a YouTube page, and partnerships with 

other organizations. 

Finally, the Military (or Veterans) Crisis Line, 1–800–273–8255 (TALK), Press #1, 

www.militarycrisisline.net, or text to 838255 is available 24/7 to all service members 

and their families. It is a joint venture between the Department of Defense and the 

Department of Veterans Affairs’ call center, which is associated with Substance 

Abuse and Mental Health Service Administration’s National Suicide Prevention 

Lifeline. Resources include an online ‘‘Veteran’s Chat’’ capability and the call center’s trained personnel provide crisis intervention for those struggling with suicidal 

thoughts or family members seeking support for a Veteran. 
120 

Ms. SHEA-PORTER. 12) Do DSPO and the Services have a strategy and the capacity, to provide adequate mental health screening and care for families? If not, how 

are they partnering with civilian social services and non-profit organizations to fill 

the support gaps? New Hampshire’s National Guard Yellow Ribbon Program, for example, partners with Easter Seals to provide needed support. 

General JONES. Through the TRICARE network and community organizations, 

the Air Force Medical Service (AFMS) has a strategy and the capacity to provide 

mental health screening and care for families. Air Force family members’ care typically is provided by TRICARE providers in the community. There are several options to purchase long-term healthcare insurance for Air Reserve Component family 

members, to include TRICARE Reserve Select, if eligible. TRICARE provides coverage for both outpatient and inpatient treatment. 

The Air Force Reserve Wingman Toolkit and Air National Guard Wingman 

Project Websites provide 24/7/365 support and information. These websites provide 

links to local, city, state, and national organizations that provide behavioral health 

services to service members and their families. Organizations include, but are not 

limited to, the Substance Abuse and Mental Health Services Administration, Military Pathways, and The Center for Deployment Psychology. 

Air Force Reserve Psychological Health Advocacy Program (PHAP) staff are 

present and conduct break-out sessions for the members returning from deployment. 

During these sessions, the members are given instructions on accomplishment of 

mental health screening, as well as recommendations for follow-up. This information 

is also available on the PHAP website, as well as through each regional office. 

The Air National Guard Psychological Health Program (PHP) was developed to 

address psychological health needs of Air National Guard (ANG) Airmen and their 

families. The PHP places a licensed behavioral health provider at each of the ANG’s 

89 wings throughout the 54 states, territories and the District of Columbia. The program provides three categories of service: leadership advisement and consultation; 

community capacity building; and direct services—to include assessment, referral, 

crisis intervention, and case management—that are available daily. The Wing Directors of Psychological Health are available 24/7 to operational leadership and provide 

services to ANG Airmen and their family members regardless of whether they are 

at home or on duty status. 

Finally, Military OneSource is a nonmedical counseling option available to active 

duty, reserve component members and their adult family members. 

Ms. SHEA-PORTER. 13) Are family member (spouses and children) suicides being 

tracked by DSPO and/or the Services? If not, why not? 

General JONES. The Air Force does track family member (spouses and children) 

deaths to disburse monetary benefits and funeral entitlements; however, the Air 

Force does not track the cause of each family member death (specifically, suicides). 

We do not have access to specific information about family member deaths other 

than that in the public domain; the Centers for Disease Control and the American 

Association of Suicidality. The Air Force is collaborating with the Defense Suicide 

Prevention Office to study this issue and determine if a reliable process or database 

can be developed to track this information in the future. 

Ms. SHEA-PORTER. 14) What steps are the Defense Suicide Prevention Office and 

the Services taking in terms of support and treatment, to meet the mental health 

challenges facing spouses and children? There are some innovative National Guard 

Yellow Ribbon Programs, like that of our own New Hampshire National Guard, that 

follow and support families as well as Guard members before, during, and after deployment. Are you talking to the States and incorporating the best practices of such 

programs? 

General HEDELUND. The Yellow Ribbon Reintegration Program supports reintegration efforts by providing access to programs, resources, and services geared 

to minimizing stressors before, during, and after deployments of 90 days or more. 

It is not used as a mental health screening vessel. Counselors are on-site for each 

event to address stress and finances as well as address the common challenges our 

Service members and their families face. These events are structured to follow a Reserve Marine and family (family is defined as mom, dad, spouse, children, significant other) or their designated representative, throughout their entire cycle of deployment from the call to mobilization and then their re-assimilation to civilian life. 

The more prominent focus of these events is addressing those areas most likely to 

trigger stress responses such as employment, finances, and education. By targeting 

these areas, and making counselors available at every opportunity, we hope to address issues prior to them building and causing a significant stress response by the 

individual. In FY12 MARFORRES executed 209 Yellow Ribbon events nation-wide, 

supporting 3,766 family members and designated representatives, and 5,984 Service 
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members. Supporting programs at each of these events are the Psychological Health 

Outreach Team for the Unit/Region (PHOP), Unit Personal and Family Readiness 

Program, as well as local Unit Leadership. Additional assistance remains available 

on an on-going basis for every Marine and family through the DSTRESS Program, 

Unit Chaplains, and the Unit Personal and Family Readiness Program. 

Ms. SHEA-PORTER. 15) Do DSPO and the Services have a strategy and the capacity, to provide adequate mental health screening and care for families? If not, how 

are they partnering with civilian social services and non-profit organizations to fill 

the support gaps? New Hampshire’s National Guard Yellow Ribbon Program, for example, partners with Easter Seals to provide needed support. 

General HEDELUND. Medical treatment for diagnosable mental health conditions 

is available to family members through the TRICARE system (either military treatment facility or network providers). Should specialty care not be available within 

the system, patients may be referred to non-network providers. Marine Corps Community Services (MCCS) offers non-medical, short term counseling programs to Marines and their family members for problems such as anger management, coping 

with loss or separation, parenting, etc. Family members also have access to counseling from Military OneSource, where they can deal with a credentialed counselor 

telephonically or in person with a geographically local counselor. Both MCCS and 

OneSource ensure a warm handoff to the medical system should the family member’s condition warrant a medical referral. 

Project FOCUS (Families Overcoming Under Stress), initiated by the Navy Bureau of Medicine and Surgery (BUMED) in 2008, provides state-of-the-art family resiliency and psychological health services to military children and families at over 

20 Navy and Marine Corps sites and online for those in remote locations. FOCUS 

is a family-centered resiliency training program developed from evidenced-based 

interventions that enhance understanding, psychological health, and developmental 

outcomes for highly stressed children and families facing challenges related to multiple deployments, combat operational stress, and physical injuries in a family 

member. 

Ms. SHEA-PORTER. 16) Are family member (spouses and children) suicides being 

tracked by DSPO and/or the Services? If not, why not? 

General HEDELUND. The Marine Corps tracks suicides by dependents of active 

duty Marines. The reporting of the information is not required by DOD. 

Æ