Let me begin by thanking Secretary Gates for holding this crucially important conference on suicide prevention and allowing VA to partner in it. I would also like to thank Ellen Embrey for her work in strengthening the military health care system. We overlapped briefly while I was still serving in uniform during the early days of Afghanistan and Iraq. Ellen, we are indebted to you for your devotion to the men and women, who wear our country’s uniforms, and their families. Thank you for your service and your leadership.
I appreciate this opportunity to address this conference. Throughout my years of service in uniform, suicides were one of the most frustrating leadership challenges I faced. As I have often asked—mostly of myself, but others, as well, from time to time, "why do we know so much about suicides, but so little about how to prevent them?" It’s a simple question, but we continue to be challenged. For that reason, I congratulate Secretary Embrey and General Sutton—as well as Dr. Agarwal, Dr. Ira Katz, Jan Kemp, and all of VA’s representatives—for the wisdom of this conference and their efforts to address the serious problems related to the loss of self worth and self esteem and how such fragility can lead to acts of self destruction.
Of the more than 30 thousand suicides in this country each year, fully 20 percent of them are Veteran suicides. That means, on average, eighteen Veterans commit suicide each day. Five of those 18 are under VA care at the time they take their lives. Losing five Veterans, who are in treatment, every month, and never having a shot at helping the 13 others, who aren’t under our care, means that we have a lot of work to do.
Who’s vulnerable? Everyone—young and old, outgoing and reserved, male and female, officer and enlisted—from our Greatest Generation to our latest generation. Warriors suffer emotional wounds just as they suffer physical ones. Combat actions produce both forms of injury. And where you can splint and patch physical wounds, as you are well aware, emotional injuries do not lend themselves to such fixes—but, we must continuously develop equivalent accommodations for the emotionally and mentally injured.
We know a lot about the causes of suicide—from physiological predisposition to receipts of "Dear John" letters—yet, we are still challenged to prevent them. In units I used to command, case-studying each suicide and attempted suicide by re-creating the last 72-96 hours of a soldier’s life was entirely instructive. Where did he or she go, whom did they engage, what was the purpose of the engagement, what did they say, what did they do? The case study usually revealed a multiplicity of signals regarding an individual’s intent. Company mates, friends in other units, spouses and significant others, barkeepers downtown, friends and family back home—all were gifted with a piece of the puzzle. Not until all the pieces were collected was the picture complete and the signaling was usually quite clear.
This audience of health care providers, clinicians, counselors, researchers, and community partners constitutes, in military parlance, our main attack against suicides. You dispense help and hope to those who see themselves as helpless and without hope. Yet, I don’t think any of us can do this alone, and all of us here today may still not be enough. As those case studies informed, there are many other witnesses to the key indicators in pre-suicidal behaviors.
We are in this together, and I consider it a fight to help the most vulnerable of our people. As is true of most organized team activities, it’s usually better to play offense rather than defense. The spirit of the offense means action—act, react, counteract. Take step one when you are prepared to counteract in step three.
We must build and maintain a strong support system—one in which everyone has a role and where we collectively assume ownership of the problem. I think the sense of ownership is a critical aspect of the solution—increasing the level of awareness throughout our communities.
In this regard, the military services probably have an edge in compelling ownership by virtue of their highly-structured reporting and accountability systems. It used to be that almost every suicide and many attempted suicides were case-studied to pinpoint root causes. Three hundred sixty degree interviews would be conducted of reporting chain superiors and subordinates, unit "buddies," family members, and friends. The last hours of someone’s life were recreated as best we could and reviewed. All too often, when the pieces to the question, "why," are collected, it becomes clear that the warning signs were always there—but missed, or not acknowledged for fear of interfering in someone’s privacy. That’s been my experience.
To counteract that tendency, training programs like Operation Saved, urge participants to get involved, and people are empowered to do the right thing if they suspect someone is at risk for attempted suicide.
At VA, we need to raise awareness of suicide indicators and the array of work, economic, and social factors that can trigger them—not just in our patients, but amongst our workforce, as well. How do we foster and sustain the goodness of the buddy system that’s inherent culturally in nearly everything that the military does and apply it in VA amongst a population of 7.5 million that is, at once, diffused, expansive, highly individualized, and spans ages 18-to-80 plus? I believe it can be done for specific Veteran sub-groups—for instance, those pockets of new Veterans now clustering at colleges and universities across the country.
One thing is clear—the old ways of approaching mental health counseling and suicide prevention will not work as effectively for youngsters of the new millennium. They are different from those who came before.
Most were born a decade after the last shots were fired in Vietnam. They’ve never used a dial phone; never watched black-and-white TV; and have never known a world without cell phones, the Internet, and instant messaging. They think fast, talk fast, act fast because they grew up that way.
Engaging them requires a new and different model—no longer across a desk in an imposing government building, but in coffee shops down-the-street, on their cell phones, on the Internet, or through a public service announcement they see on their flat screen TV or read about in a blog.
Transforming our VA culture to such a new, less formal, more open format demands, as well, greater collaboration and transparency in our services and in our service delivery. I’m speaking of an environment where mental health issues, in general, are de-mystified, de-stigmatized, accepted, and more effectively treated—where suicides are prevented because asking for help is a sign of courage; where there is meaningful outreach and ready access to high-quality care; where we identify those at highest risk; where emerging treatments and technologies, coupled with new drugs, advance the success of patient outcomes; where Veterans and active duty personnel don’t feel ashamed or threatened by the idea of mental or emotional problems; and where research encompasses complementary and alternative treatments so we may determine which are the safest and most effective in relieving suffering and restoring health.
How does this all translate from theory into action? Well, at VA, we have taken to heart the Institute of Medicine’s 2003 report calling suicide prevention, a "national imperative." That imperative drives VA’s overall program as well as the actions we have taken so far and the ones we will take in the future.
It has had far-reaching effect. We’ve expanded our mental health workforce enormously, hiring more than 4,000 new employees in the past three years, alone, for a total of 19,000 mental health staff members on our rolls today. Over 400 mental health care employees are dedicated solely to suicide prevention.
Each of our 153 Medical Centers and the largest of our 774 community-based outpatient clinics now has a suicide prevention coordinator who ensures that at-risk Veterans receive the counseling and services they need.
We’ve extended our outreach to Veterans, which, in itself, has significant life-saving potential. Part of that outreach effort can be seen in our Nation-wide advertising campaign on city buses and in commuter stations, raising awareness of our 24/7 suicide prevention lifeline.
Additionally, we’ve opened a mental health center of excellence at our facility in Canandaigua, New York, that focuses on developing and testing clinical and public health intervention standards for suicide prevention. And our new VA research center in Denver is studying the clinical and neurobiological conditions that can lead to increased suicide risk.
Most notably—in 2007, we dramatically improved our prevention program by launching a national suicide prevention hotline in conjunction with HHS. To strengthen our seamless VA-DOD relationship, its opening message welcomes both Veterans and service members to access counselors and services. The demons of suicide do not discriminate between those who wear uniforms and those who do not. Neither do we.
Last year, we further advanced our program by introducing an Internet-based, suicide prevention chat line designed to appeal to today’s Web-savvy Veterans. We must continue to leverage opportunities to access and intervene to save the lives of those in distress—after all, there’s an established protocol for every heart attack victim who comes through the doors of hospital emergency rooms in this country. Why shouldn’t potential suicide victims be afforded similarly systemic and consistent portals of help?
The creator of these two forward-leaning initiatives is VA’s own National Suicide Prevention Coordinator, Dr. Jan Kemp. As many of you may know, the Partnership for Public Service presented Jan with its 2009 Federal Employee of the Year Award for her foresight in anticipating the emotional toll that results from exposure to high-risk, hyper-stress environments like combat. Jan, thank you. We all owe you a tremendous debt of gratitude for your good work.
So how is VA doing? What results do we have to show? Have we made a difference?
There’s no clear cut answer to those questions right now; it’s too soon to tell. Our initiatives are still so new that there is not yet hard evidence for the impact of VA’s suicide prevention activities and enhancements. But we can take heart at some emerging early trends and encouraging indicators.
We know, for example, that since the start of OEF/OIF, suicide rates have decreased in Veterans who use VA health services. And despite public perceptions to the contrary, there is no evidence for increased suicide rates among OEF/OIF Veterans relative to the Veteran population as a whole.
For a more concrete assessment of our efforts, if we look at the two-year plus history of our suicide prevention lifeline, we’ve logged actual rescues of 5,597 active duty and Veteran callers in distress.
Where do we go from here? Well, in large measure, this conference will help point the way. Your deliberations will provide direction for strengthening our current programs and for developing innovative, forward-leaning new ones within a community-based paradigm.
In conjunction with conference faculty and staff, you will give us the benefit of your knowledge and experience in confronting suicide risk and leveraging its prevention. And I know, too, that by sharing your insights and counsel, both the Departments of Defense and Veterans Affairs will be better positioned to aid men and women struggling to regain the courage of life.
I am privileged to join Secretary Ellen Embrey in opening today’s conference. You have an important and ambitious agenda before you. Thank you for participating and for what you do daily on behalf of our men and women in uniform and our Veterans.;